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Assessing response, remission, and treatment resistance in patients with obsessive–compulsive disorder with and without tic disorders: results from a multicenter study

Published online by Cambridge University Press:  16 September 2021

Beatrice Benatti*
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
Nicolaja Girone
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
Dario Conti
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
Rita Cafaro
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
Caterina Viganò
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy
Matteo Briguglio
Affiliation:
IRCCS Orthopedic Institute Galeazzi Department of Functional Neurosurgery, Tourette Center, Milan, Italy
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Federico Mucci
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Orsola Gambini
Affiliation:
“Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
Benedetta Demartini
Affiliation:
“Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
Antonio Tundo
Affiliation:
Institute of Psychopathology, Rome, Italy
Roberta Necci
Affiliation:
Institute of Psychopathology, Rome, Italy
Domenico De Berardis
Affiliation:
Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, NHS, Teramo, Italy Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
Roberta Galentino
Affiliation:
IRCCS Orthopedic Institute Galeazzi Department of Functional Neurosurgery, Tourette Center, Milan, Italy
Sara De Michele
Affiliation:
IRCCS Orthopedic Institute Galeazzi Department of Functional Neurosurgery, Tourette Center, Milan, Italy
Roberta Balestrino
Affiliation:
Università Vita-Salute San Raffaele, Milano, Italy
Umberto Albert
Affiliation:
Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy SC Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
Sylvia Rigardetto
Affiliation:
San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
Giuseppe Maina
Affiliation:
San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
Giacomo Grassi
Affiliation:
Brain Center Firenze, Florence, Italy
Stefano Pallanti
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
Andrea Amerio
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Andrea Aguglia
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Davide Prestia
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Mario Amore
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Alberto Priori
Affiliation:
“Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
Domenico Servello
Affiliation:
IRCCS Orthopedic Institute Galeazzi Department of Functional Neurosurgery, Tourette Center, Milan, Italy
Mauro Porta
Affiliation:
IRCCS Orthopedic Institute Galeazzi Department of Functional Neurosurgery, Tourette Center, Milan, Italy
Bernardo Dell’Osso
Affiliation:
Luigi Sacco University Hospital, Psychiatry 2 Unit, University of Milan, Milan, Italy “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche”, University of Milan, Milan, Italy
*
*Author for correspondence: B. Benatti Email: beatrice.benatti@unimi.it

Abstract

Background

Highlighting the relationship between obsessive–compulsive disorder (OCD) and tic disorder (TD), two highly disabling, comorbid, and difficult-to-treat conditions, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) acknowledged a new “tic-related” specifier for OCD, ie, obsessive–compulsive tic-related disorder (OCTD). As patients with OCTD may frequently show poor treatment response, the aim of this multicenter study was to investigate rates and clinical correlates of response, remission, and treatment resistance in a large multicenter sample of OCD patients with versus without tics.

Methods

A sample of 398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from 10 different psychiatric departments across Italy. For the purpose of the study, treatment response profiles in the whole sample were analyzed comparing the rates of response, remission, and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to identify possible factors associated with treatment response.

Results

The remission group was associated with later ages of onset of TD and OCD. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts emerged in the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement.

Conclusions

Although remission was associated with later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response with a significant impairment in quality of life for both patients and their caregivers, suggesting a worse profile of treatment response for patients with OCTD.

Type
Original Research
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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