Medscape
Medical News 2009. © 2009 Medscape
ADAA 2009: Intensive Residential Treatment for Severe OCD Helps
Patients After Discharge
Mary
Beth Nierengarten
March 16,
2009 (Santa Ana Pueblo, New Mexico) — Individuals with severe, refractory
obsessive-compulsive disorder (OCD) treated in an intensive residential
treatment (IRT) program maintain improvements in symptoms 6 months after
discharge, a new study suggests.
Investigators
from
Presented
here at the Anxiety Disorders Association of America 2009 Annual Conference,
the research is the first long-term follow-up study examining outcomes in
patients with severe OCD after discharge from an IRT program.
"This
is exciting for us, as it shows that the improvement in symptoms after IRT are
maintained," said S. Evelyn Stewart, MD, research director of the OCD
Institute at McLean Hospital, adding that improvements in both OCD as well as
depression symptoms were maintained at follow-up.
Investigators
evaluated the efficacy of IRT by assessing a number of psychometric measures
over a 12-month period in 26 females and 35 males treated for severe,
refractory OCD.
Patients
completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Beck
Depression Inventory (BDI), and the Work and Social Adjustment Scale (WSA) upon
admission to and discharge from the McLean/Massachusetts General Hospital OCD
Institute. Following discharge, the measures were repeated at 1, 3, 6, and 12
months.
The study
found no significant worsening of the severity of OCD symptoms at 1, 3, or 6
months after discharge, with a mean severity (out of 40) of 17.4, 16.5, and
16.2, respectively (P > .25). Dr. Stewart noted that the sample size
at 12 months was too small due to patient dropouts for any meaningful
statistical analysis.
The study
also showed that significant improvements in OCD severity between admission and
discharge to the program were maintained at 1-, 3-, and 6-month follow-up
assessments after discharge (P < .001).
Living Alone, Comorbid Illness Predict Relapse
Two
variables that predicted relapse were living alone and having a comorbid illness. Of the 32 patients who relapsed, as
indicated by worse Y-BOCS scores in more than half of the follow-up visits,
significantly more were living alone after discharge than those who did not
relapse (7 vs 0; P = .01) and were more likely
to have a comorbid illness (13 vs
17; P < .02).
Based on
the finding that living alone after discharge was a risk factor for relapse,
Dr. Stewart said that she and her colleagues now recommend that if possible,
patients not live alone after discharge. Currently, this is not an official
part of their treatment protocol.
One
limitation of the study, said Dr. Stewart, was the number of patients who
dropped out. Despite this, however, no significant differences in Y-BOCS scores
were found between patients who dropped out of the study and those who
completed the study (P < .47). Tracking patients over time, she said,
remains difficult and challenging.
Thröstur Björgvinsson, PhD, from the
Houston OCD Program at the Anxiety and Depression Treatment Center of Houston,
in
"Most
patients will have improvement in quality of life while in IRT," he said.
"What is challenging is to know what is going to happen 6 months and 1
year down the road."
The study
by Stewart and colleagues, he says, provides a systematic look at this type of
needed follow-up. He and his colleagues at the Houston OCD Program are planning
a similar study in which they will track patients at 3, 6, and 12 months after
discharge.
Echoing
Dr. Stewart, Dr. Björgvinsson also said that tracking
patients will be a challenge.
To address
the support that many OCD patients need after discharge, Dr. Björgvinsson said that the Houston OCD Program includes a
step-down phase for patients who need help transitioning back into the
community.
Anxiety
Disorders Association of America 2009 Annual Conference: Poster 87. Presented March 13, 2009.