Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-20T03:21:41.461Z Has data issue: false hasContentIssue false
  • English
  • Français

Differences in duration of untreated illness, duration, and severity of illness among clinical phenotypes of obsessive-compulsive disorder

Published online by Cambridge University Press:  26 June 2014

Bernardo Dell’Osso ,
Beatrice Benatti ,
Lucio Oldani ,
Gregorio Spagnolin  and
A.Carlo Altamura
Bernardo Dell’Osso*
Affiliation:
Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Beatrice Benatti
Affiliation:
Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Lucio Oldani
Affiliation:
Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Gregorio Spagnolin
Affiliation:
Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
A.Carlo Altamura
Affiliation:
Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
*
*Address for correspondence: Bernardo Dell’Osso, MD, Assistant Professor of Psychiatry, Department of Psychiatry, University of Milan, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Via Francesco Sforza 35, 20122 Milano, Italy. (Email: bernardo.dellosso@unimi.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Obsessive-compulsive disorder (OCD) is a prevalent, disabling, and comorbid condition that is frequently under-recognized and poorly treated. OCD phenotypes may differ in terms of clinical presentation and severity. However, few studies have investigated whether clinical phenotypes differ in terms of latency to treatment (ie, duration of untreated illness[DUI]), duration, and severity of illness. The present study was aimed to quantify the aforementioned variables in a sample of OCD patients.

Methods

One hundred fourteen outpatients with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnosis of OCD were recruited, and their main clinical features were collected. Severity of illness was assessed through the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), and the main phenotypes were identified through the Y-BOCS Symptom Checklist. A one-way analysis of variance (ANOVA) test, followed by a Bonferroni post-hoc test, were performed to compare DUI, duration, and severity of illness across subgroups.

Results

In the whole sample, the mean DUI exceeded 7 years (87.35±11.75 months), accounting for approximately half of the mean duration of illness (172.2±13.36 months). When subjects were categorized into 4 main clinical phenotypes, respectively, aggressive/checking (n=31), contamination/cleaning (n=37), symmetry/ordering (n=32), and multiple phenotypes (n=14), DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup, compared to other subgroups (F=3.58, p<0.01; F=3.07, p<0.01; F=4.390, p<0.01).

Discussion

In a sample of OCD patients, along with a mean latency to treatment of approximately 7 years, regardless of the phenotype, patients had spent half of their duration of illness (DI) without being treated. DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup.

Keywords

Obsessive compulsive disorderduration of untreated illnessobsessive compulsive disorder clinical phenotypes
Type
Original Research
Information
CNS Spectrums , Volume 20 , Issue 5 , October 2015 , pp. 474 - 478
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Grabe, HJ, Ruhrmann, S, Ettelt, S, et al. Familiality of obsessive-compulsive disorder in nonclinical and clinical subjects. Am J Psychiatry. 2006; 163(11): 1986–1992.CrossRefGoogle ScholarPubMed
2.Fontenelle, LF, Mendlowicz, MV, Versiani, M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(3): 327–337.CrossRefGoogle ScholarPubMed
3.Dell'Osso, B, Camuri, G, Benatti, B, Buoli, M, Altamura, AC. Differences in latency to first pharmacological treatment (duration of untreated illness) in anxiety disorders: a study on patients with panic disorder, generalized anxiety disorder and obsessive-compulsive disorder. Early Interv Psychiatry. 2013; 7(4): 374–380.CrossRefGoogle Scholar
4.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
5.Mataix-Cols, D, Rauch, SL, Manzo, PA, Jenike, MA, Baer, L. Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 1999; 156(9): 1409–1416.CrossRefGoogle ScholarPubMed
6.Dell'Osso, B, Benatti, B, Buoli, M, et al; ICOCS group. The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). Eur Neuropsychopharmacol. 2013; 23(8): 865–871.CrossRefGoogle ScholarPubMed
7.Narayanaswamy, JC, Viswanath, B, Veshnal Cherian, A, Bada Math, S, Kandavel, T, Janardhan Reddy, YC. Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry Res. 2012; 200(2–3): 554–559.CrossRefGoogle ScholarPubMed
8.Erzegovesi, S, Cavallini, MC, Cavedini, P, Diaferia, G, Locatelli, M, Bellodi, L. Clinical predictors of drug response in obsessive-compulsive disorder. J Clin Psychopharmacol. 2001; 21(5): 488–492.CrossRefGoogle ScholarPubMed
9.Rosario-Campos, MC, Leckman, JF, Mercadante, MT, et al. Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry. 2001; 158(11): 1899–1903.CrossRefGoogle ScholarPubMed
10.Storch, EA, Larson, MJ, Shapira, NA, et al. Clinical predictors of early fluoxetine treatment response in obsessive-compulsive disorder. Depress Anxiety. 2006; 23(7): 429–433.CrossRefGoogle ScholarPubMed
11.Catapano, F, Perris, F, Masella, M, et al. Obsessive-compulsive disorder: a 3-year prospective follow-up study of patients treated with serotonin reuptake inhibitors OCD follow-up study. J Psychiatr Res. 2006; 40(6): 502–510.CrossRefGoogle ScholarPubMed
12.Dell'Osso, B, Buoli, M, Hollander, E, Altamura, AC. Duration of untreated illness as a predictor of treatment response and remission in obsessive-compulsive disorder. World J Biol Psychiatry. 2010; 11(1): 59–65.CrossRefGoogle ScholarPubMed
13.Altamura, AC, Dell'Osso, B, D'Urso, N, Russo, M, Fumagalli, S, Mundo, E. Duration of untreated illness as a predictor of treatment response and clinical course in generalized anxiety disorder. CNS Spectr. 2008; 13(5): 415–422.CrossRefGoogle ScholarPubMed
14.Goodwin, R, Koenen, KC, Hellman, F, Guardino, M, Struening, E. Helpseeking and access to mental health treatment for obsessive-compulsive disorder. Acta Psychiatr Scand. 2002; 106(2): 143–149.CrossRefGoogle ScholarPubMed
15.Fullana, MA, Mataix-Cols, D, Caspi, A, et al. Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. Am J Psychiatry.. 2009; 166(3): 329–336.CrossRefGoogle ScholarPubMed
16.Altamura, AC, Buoli, M, Albano, A, Dell'Osso, B. Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study. Int Clin Psychopharmacol. 2010; 25(3): 172–179.CrossRefGoogle ScholarPubMed
17Dell’Osso, B, Altamura, AC. Duration of untreated psychosis and duration of untreated illness: new vistas. CNS Spectr. 2010; 15(4): 238–246.CrossRefGoogle ScholarPubMed
18.Rasmussen, SA, Eisen, JL. The epidemiology and clinical features of obsessive compulsive disorder. Psychiatr Clin North Am. 1992; 15(4): 743–758.CrossRefGoogle ScholarPubMed
19.Alonso, P, Menchon, JM, Pifarre, J, et al. Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. J Clin Psychiatry. 2001; 62: 535–554.CrossRefGoogle ScholarPubMed
20.Fontenelle, LF, Mendlowicz, MV, Soares, ID, Versiani, M. Patients with obsessive-compulsive disorder and hoarding symptoms: a distinctive clinical subtype? Compr Psychiatry. 2004; 45(5): 375–383.CrossRefGoogle ScholarPubMed
21.Khanna, S, Mukherjee, D. Checkers and washers: valid subtypes of obsessive compulsive disorder. Psychopathology. 1992; 25(5): 283–288.CrossRefGoogle ScholarPubMed
22.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed text rev Washington, DC: American Psychiatric Association; 2000.Google Scholar
23.First, MB, Spitzer, RL, Gibbon, L, Williams, JBV. Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Research Version, Non-Patient Edition (SCID-I/NP). New York: New York State Psychiatric Institute, Biometric Research; 2002.Google Scholar
24.Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989; 46(11): 1006–1011.CrossRefGoogle ScholarPubMed
25.Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale–Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry. 1989; 46(11): 1012–1016.CrossRefGoogle ScholarPubMed
26.Denys, D, de Geus, F, van Megen, HJ, Westenberg, HG. Symptom dimensions in obsessive-compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure. Psychopathology. 2004; 37(4): 181–189.CrossRefGoogle ScholarPubMed
27.Hasler, G, LaSalle-Ricci, VH, Ronquillo, JG, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005; 135(2): 121–132.CrossRefGoogle ScholarPubMed
28.Fontenelle, JM, Harrison, L, Santana, M, Conceição do Rosário, M, Versiani, M, Fontenelle, LF. Correlates of insight into different symptom dimensions in obsessive-compulsive disorder. Ann Clin Psychiatry. 2013; 25(1): 11–16.Google ScholarPubMed
29.Prabhu, L, Cherian, AV, Viswanath, B, Kandavel, T, Bada Math, S, Janardhan Reddy, YC. Symptom dimensions in OCD and their association with clinical characteristics and comorbid disorders. Journal of Obsessive-Compulsive and Related Disorders. 2013; 2(1): 14–21.CrossRefGoogle Scholar
30.Matsunaga, H, Hayashida, K, Kiriike, N, Maebayashi, K, Stein, DJ. The clinical utility of symptom dimensions in obsessive-compulsive disorder. Psychiatry Res. 2010; 180(1): 25–29.CrossRefGoogle ScholarPubMed
31.Williams, MT, Elstein, J, Buckner, E, Abelson, J, Himle, J. Symptom dimensions in two samples of Africans Americans with obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders. 2012; 1(3): 145–152.CrossRefGoogle ScholarPubMed