Effectiveness of a tertiary specialist obsessive–compulsive disorder (OCD) service in improving clinical outcomes for patients with treatment-resistant/complex OCD

Abstract

Abstract Introduction: Obsessive-compulsive disorder (OCD) is a chronic condition that can result in significant distress and impaired quality of life (QoL). This retrospective cohort study investigates the effectiveness of individually tailored pharmacotherapy, exposure and response prevention (ERP), and socioeconomic and family interventions on clinical outcomes at a specialist clinic focused on treatment-resistant/complex OCD. Methods: Patients with treatment-resistant/complex OCD treated at the Institute of Mental Health OCD clinic, Singapore, between January 2015 and March 2019 were invited. The interventions included pharmacotherapy and 12–60 intensive cognitive behavioural therapy/ERP sessions. Interventions also targeted socio-occupational dysfunction and family accommodation. Y-BOCS and Q-LES-Q-SF scales were administered pre- and post-treatment. Linear regression and one-way analysis of variance were used for data analysis. Results: Overall, there was a significant reduction in Y-BOCS score of 9.2 (P = 0.000) and an improvement in Q-LES-Q-SF score of 11.6 (P = 0.000). Of 70 participants, 35 (50%), 12 (17%), and 23 (33%) achieved full, partial, and no treatment response, respectively. Improvement in OCD symptoms was associated with lower baseline Y-BOCS scores and being married. Improvement in QoL was associated with higher baseline Q-LES-Q-SF scores. Conclusion: Interventions at the clinic improved OCD symptoms and QoL in patients with treatment-resistant/complex OCD, likely due to the simultaneous socio-occupational support services available.