Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy

Background: The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictor s of clinical outcome. Method: Sixty outpatients meeting DSM-III-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prol onged pharmacologic therapy with an SRI. Results: Thirty-seven patients (61.7%) completed an adequate behavioral tre atment. At long-term assessment, 22 patients (36.7%) exhibited a global Yal e-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a fina l reduction in Y-BOCS global score of less than 35% and were considered non responders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no signifi cant differences in either Y-BOCS global or obsessions subscale scores betw een those who did and those who did not undergo behavioral therapy were det ected. Obsessions of sexual/religious content were the unique factor relate d to a poorer long-term outcome. Conclusion: A substantial number of OCD patients showed persistent disablin g symptoms at the long-term follow-up in spile of combined pharmacologic an d behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions pr edicted poorer long-term outcome, whereas shortterm response to SRI treatme nt failed to achieve predictive value in the long-term course of OCD.