Long-term follow-up study of patients with serotonin reuptake inhibitor-nonresponsive obsessive-compulsive disorder

Abstract

There is a paucity of data on the long-term outcome of serotonin reuptake inhibitor (SRI)-nonresponsive obsessive-compulsive disorder (OCD). We report long-term outcome of OCD in subjects who had not responded to at least 2 adequate trials of SRIs. This is a naturalistic follow-up of 36 (72%) of 50 SRI nonresponders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD, after about 4.5 years. Two had committed suicide (4%), and 12 (24%) could not be traced or refused consent. The study has a catch-up longitudinal design. The primary outcome measure was "remission," measured using the Psychiatric Status Rating Scale. Multiple logistic backward (Wald) regression analysis was used to identify predictors of remission. Of the 36 subjects, 14 were in remission (39%): 4 were in full remission (11%) and 10 were in partial remission (28%). Those who remitted were considered to have good outcome. Not having received cognitive behavior therapy (CBT) in the interval period, poorer quality of life at baseline, shorter duration of follow-up, and later age at onset predicted poor outcome. Study findings suggest that a substantial proportion of OCD patients with proven SRI nonresponse improve over a period, possibly because of continued efforts to treat them. The prognosis of SRI nonresponders need not be viewed pessimistically, and if treated aggressively with both medications and CBT, they may continue to show improvement. There is an urgent need to systematically examine the efficacy of various treatment options, particularly CBT in treating SRI nonresponders.