A 5-year prospective follow-up study of patients with obsessive–compulsive disorder treated with serotonin reuptake inhibitors

Abstract

BackgroundAlthough obsessive–compulsive disorder is usually regarded as a chronic illness, there is limited data on the naturalistic long-term outcome of the disorder and on predictors of remission and relapse. The study examines the 5-year course prospectively in outpatients with the primary diagnosis of DSM-IV OCD who were mostly treated with serotonin reuptake inhibitors (SRIs). Method106 of 115 subjects recruited over a period of 2 years from the outpatient services of an OCD clinic in India were followed periodically up to 5 years. ResultsSubjects were moderately ill, mostly self-referred (89%), and less than a half was treatment-naive. Cumulative probability of at least partial remission and full remission at 5 years was 93% and 65% respectively. Most achieved remission by 2 years. In those who achieved either partial or full remission, cumulative probability of relapse by 5 years was 36%. Percentage of time on treatment and treatment-naive status at intake predicted at least partial remission, whereas only percentage of time on treatment predicted full remission. Full remission and doubts/checking dimension predicted lesser likelihood of a relapse. LimitationsPatients were recruited from a specialty OCD clinic and treatment was not controlled during the follow-up period. ConclusionsThe outcome of OCD seems to be better than generally assumed, at least in moderately ill outpatients. Regular treatment over extended period may enhance likelihood of remission. Full remission should be the goal of treatment since it is associated with lesser propensity for relapse. Most patients remit in the first 2 years of treatment; therefore, early detection and intervention may improve the outcome.