Treatment Trajectory And Its Effects On Outcomes Among Inpatients With Obsessive-Compulsive Disorder From 2006 To 2017

BackgroundObsessive-compulsive disorder(OCD)is a mental disorder characterized by obsessions or compulsions,often with a chronic waxing and waning course.It is associated with a wide range of functional impairments,including the quality of life and social and occupational function,increasing the medical burden,and also bring about economic and psychological stress to their family.But the pathogenesis of which is still unknown.The popular view in the 1960 s was that this psychiatric disorder was untreatable,but soon afterwards people found that clomipramine,a drug which had a serotonin reuptake blocking effect,could alleviate the symptoms of OCD in the 1980 s.In the same period,there were strong evidences that cognitive-behavioral therapy(CBT)mainly composed of exposure and prevention(ERP)was also effective for obsessive-compulsive disorder.In the following years,several serotonin reuptake blockers(SRIs)were approved for the treatment of OCD,the majority of SRIs and CBT are regarded as the first-line treatment for OCD at present.Since 40%-60% of the patients of OCD could not response to the first-line treatment,“next strategy agents” has becomes one of the main therapies,also with some new psychotherapy being tried to improve the efficacy of OCD.With the time going on,more treatment methods including medication and psychotherapy have been emerged,but there is little evidence about whether the treatment for the inpatients of obsessive-compulsive disorder has been changed over time or not.According to the above,it is necessary to conduct such a research and focus on the efficacy.ObjectiveTo investigate whether the treatment of obsessive-compulsive disorder has been changed over time;to observe whether changes on the treatment have influences on the efficacy in OCD;to provide some choice for the treatment of obsessive-compulsive disorder in the future.MethodsThe author designed a questionnaire items according to the literature research and conducted this retrospective study.The sample was the inpatients of obsessive-compulsive disorder who were hospitalized continuously in a hospital from January 2006 to December2017.What were collected including the socio-demographic characteristics,clinical features,treatment methods(mainly medication)and efficacy when discharge.After the data were completed,the author conducted the statistical analysis using independent sample t test,analysis of variance,correlation analysis and ordinal regression and so on,in IBM SPSS 23.0 statistical software.Results1.All inpatients(n=749)with obsessive-compulsive disorder were treated with drugs(100%).Correlation analysis showed that the proportion of patients who received other treatments such as psychotherapy and those who received electroconvulsive therapy were not significantly correlated with the year(P>0.05).2.Correlation analysis between the prescription rates of various drugs and hospitalized year showed the selective serotonin reuptake inhibitors(SSRIs)(r=0.813,P=0.001),second-generation antipsychotic drugs(SGAs)(r=0.786,P=0.002)and non-BDZs(r=0.753,P=0.005)were positively correlated with the hospitalized year.The prescription rates of first-generation antipsychotics(FGAs)(r=-0.896,P=0.000)and Li salt(r=-0.851,P=0.000)was negatively correlated with the hospitalized year.The prescription rates of other drugs were not significantly correlated with the hospitalized year(P>0.05).3.The number who received combined therapy wsa 736 cases(98.3%).Correlation analysis showed that SSRIs+AP+AA+MS were positively correlated with the year(r=0.601,P=0.039).The number of synergists administered by the patients was positively correlated with the hospitalized year(r=0.592,P=0.043).4.Non-parametric test showed that there was no significant difference in the efficacy for obsessive-compulsive patients in different years(χ2=9.785,P=0.550).The results of correlation analysis indicated that the non-response rate was not significantly correlated with the hospitalized year(r=-0.105,P=0.745).The response rate was positively correlated with the hospitalized year(r=0.823,P=0.001).The remission rate was negatively correlated with the year(r=-0.856,P=0.000).In addition,the rate of adverse drug reaction was positively correlated with the hospitalized year(r=0.816,P=0.001).5.The results of ordinal regression analysis suggest that the factors influence the efficacy were taking SRIs(OR=5.063,95%CI:1.135～22.583),combination therapy(OR=8.091,95%CI:2.204 ～ 29.706),and length of hospital stay(OR=1.011,95%CI:1.006 ～1.015).Social demographic characteristics and clinical features was not associated with the efficacy when discharge(P>0.05).ConclusionsLower proportion of those in-patients had ever accepted one or more psychotherapies(e.g.Morita therapy);synergists were confusing and the number of which was high;For the past 12 years,the efficacy of the patients when discharge has not improved significantly,Moreover,the adverse drug reaction has gradually increased;In the future,clinician could try to strengthen psychotherapy,“stepped’’ treatment should be adopted and medication should be standardized and rationalized.,the treatment of obsessive-compulsive disorder requires a more effective method.