Long-term treatment of obsessive-compulsive disorder following acute response: A comparison of fluoxetine versus placebo

Abstract

Age at onset (AAO) in obsessive compulsive disorder (OCD) may differentiate genetically and clinically heterogeneous subtypes. The current cross-sectional study compared the characteristics of early-onset OCD (onset age ≤ 18 years) and late-onset OCD (onset age > 18 years). The AAO cut-off was based on the onset distribution observed in our systematically recruited patients with OCD.Six hundred and two (including 339 men and 263 women) outpatients meeting DSM-IV criteria of OCD were recruited from the Shanghai Mental Health Center and were screened by a battery of instruments: Yale–Brown Obsessive Compulsive Scale (YBOCS) attached Y–BOCS Symptom Checklist, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and State-Trait Anxiety Inventory (STAI). The demographic and clinical characteristics of the 275 early-onset patients were compared to those of the 327 late-onset patients.Compared to patients with late-onset OCD, early-onset patients with OCD were significantly more likely to be male (66.9% vs. 47.4%, X2 = 23.1, p < 0.001), to have a positive family history of mental illnesses (26.5% vs. 19.0%, X2 = 4.9, p = 0.026), and to have a longer duration of illness [80.0 (SD = 80.7) vs. 65.5 (SD = 78.3) months, t600 = 3.17, p = 0.002]. Early-onset patients also had significantly higher scores on the HAMA, HAMD, STAI2, and obsessive in Y–BOCS. The sexual and symmetry/exactness obsessions and the washing/cleaning compulsions were significantly more prevalent in the early-onset group.The study of a large sample from mainland China confirms the findings from previous studies and supports the hypothesis that early-onset OCD is a demographically and clinically distinct subtype of OCD.