The natural history of lifetime psychiatric disorders in patients with obsessive-compulsive disorder followed over half a century

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2024-02-08 DOI:10.1111/acps.13665

Isak Fredén Klenfeldt, Gunnar Skoog, Johan Skoog, Ingmar Skoog

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Abstract

Objective

Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century.

Methods

During 1947–1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954–1956. In 1989–1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years.

Results

The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD.

Conclusion

Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.

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强迫症患者终生精神障碍的自然病史历时半个多世纪。

研究目的很少有长期研究对强迫症（OCD）患者一生中合并精神疾病的患病率进行调查。因此，我们研究了随访近半个世纪的强迫症患者合并精神疾病的频率及其与发病和预后的关系：1947-1953年间，瑞典哥德堡一所大学医院收治了285名强迫症患者。其中 251 人（88%）接受了 1954-1956 年的结构化综合精神检查。1989-1993 年，176 名幸存者符合条件，其中 144 人（回复率为 82%）接受了复查。两次检查由同一位精神科医生进行。强迫症的诊断依据施耐德标准，其他精神障碍的诊断依据 DSM-IV。自发病以来的平均随访时间为 47 年：抑郁症的终生发病率为 84.7%（重度抑郁症为 43.8%），广泛性焦虑症（GAD）为 71.5%，恐慌性焦虑症为 47.9%，广场恐惧症为 52.1%，特殊恐惧症为 64.6%，社交恐惧症为 47.9%，妄想症为 40.3%（29.1% 妄想症），精神病为 15.3%，酗酒为 13.2%（男性为 39%，女性为 3%），药物滥用为 17.4%。特异性恐惧症多在强迫症之前发病，而抑郁症的发病与强迫症的关系各不相同。社交恐惧症、广场恐惧症、严重情感障碍、酗酒和药物滥用、精神障碍和妄想症最常见于强迫症之后。GAD、精神障碍和药物滥用会加重强迫症的预后：结论：在强迫症患者中，合并精神疾病很常见，并且在整个病程中都会发病。强迫症预示着其他精神疾病的易感性，在临床实践中发现这些疾病非常重要，因为它们会对预后产生负面影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.