Obsessive–compulsive disorder with poor insight: A three-year prospective study
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- 作者：Francesco Catapano ; Francesco Perris ; Michele Fabrazzo ; Valeria Cioffi ; Domenico Giacco ; Valeria De Santis ; Mario Maj
- 关键词：Insight ; Long-term outcome ; Obsessive– ; compulsive disorder ; Serotonin reuptake inhibitors
- 刊名：Progress in Neuro-Psychopharmacology and Biological Psychiatry
- 出版年：2010
- 出版时间：17 March 2010
- 年：2010
- 卷：34
- 期：2
- 页码：323-330
- 全文大小：178 K
文摘
Available evidence about the relationship between poor insight and other clinical characteristics in patients with obsessive–compulsive disorder (OCD) is inconclusive and conflicting. There is also a paucity of data on the long-term course and treatment outcome of OCD patients with poor insight. The present study reports the findings of a relatively large sample (n = 106) of outpatients fulfilling DSM-IV criteria for OCD, treated with serotonin reuptake inhibitors (SRIs) and prospectively followed up for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. Insight was assessed by means of the Brown Assessment of Beliefs Scale (BABS). Eighty-three patients were followed prospectively and evaluated systematically by validated measures of psychopathology. Compared to their good insight counterparts, the OCD patients with poor insight (22 % ) showed a greater severity of obsessive–compulsive and depressive symptomatology; an earlier age at onset; a higher rate of schizophrenia spectrum disorder in their first-degree relatives; a higher comorbidity with schizotypal personality disorder. During the follow-up period, poor insight OCD patients were less likely to achieve at least a partial remission of obsessive–compulsive symptoms; required a significantly greater number of therapeutic trials; received more frequently augmentation with antipsychotics. The results suggest that the specifier “poor insight” helps to identify a subgroup of patients at the more severe end of OCD spectrum, characterized by a more complex clinical presentation, a diminished response to standard pharmacological interventions, and a poorer prognosis. Further research is needed to identify alternative strategies for the management of these patients.