ADAA 2009: Intensive Residential Treatment for Severe OCD Helps Patients After Discharge

March 16, 2009

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 McLean Hospital, in Belmont, Massachusetts, found that patients' OCD symptoms did not significantly worsen, and improvements were maintained up to 6 months following discharge.

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 Texas, said the study findings were exciting and described for the first time what happens over time to such patients.


"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.


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