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Long–term course and outcome of obsessive–compulsive patients after cognitive–behavioral therapy in combination with either fluvoxamine or placebo

A 7–year follow–up of a randomized double–blind trial

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Abstract

Longitudinal studies with very long follow–up periods of patients with obsessive–compulsive disorder (OCD) who have received adequate treatment are rare. In the current study, 30 of 37 inpatients (81%) with severe OCD were followed up 6–8 years after treatment with cognitive–behavioral therapy (CBT) in combination with either fluvoxamine or placebo in a randomized design. The significant improvements (with large effectsizes) in obsessive–compulsive symptoms from pre- to post–treatment (41% reduction on the Y–BOCS) remained stable at follow–up (45 %). Responder rates, defined as ≥35% reduction on the Y–BOCS, were 67% and 60%, respectively. Depressive symptoms decreased significantly not only from pre- to post–treatment but also during follow–up. Re–hospitalization, which occurred in 11 patients (37 %), was associated with more severe depressive symptoms at pre–treatment and living without a partner. Full symptom remission at follow–up, defined as both Y–BOCS total score ≤ 7 and no longer meeting diagnostic criteria for OCD, was achieved by 8 patients (27 %). Patients without full remission at follow–up had a significantly longer history of OCD, assessed at pretreatment, compared to remitted patients. The shortterm treatment outcome had no predictive value for the long–term course. Throughout the naturalistic follow–up, nearly all patients (29 patients) received additional psychotherapy and/or medication. This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods.

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Authors and Affiliations

  1. University Hospital of Hamburg, Centre of Psychosocial Medicine Dept. of Psychiatry and Psychotherapy , Hamburg

    M. Rufer MD, I. Hand, H. Alsleben, A. Braatz, J. Ortmann, B. Katenkamp, S. Fricke & H. Peter

  2. University Hospital of Zürich, Psychiatric Department, Culmannstrasse 8, 8091, Zürich, Schweiz

    M. Rufer MD

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  1. M. Rufer MD
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Rufer, M., Hand, I., Alsleben, H. et al. Long–term course and outcome of obsessive–compulsive patients after cognitive–behavioral therapy in combination with either fluvoxamine or placebo. Eur Arch Psychiatry Clin Neurosci 255, 121–128 (2005). https://doi.org/10.1007/s00406-004-0544-8

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  • DOI: https://doi.org/10.1007/s00406-004-0544-8

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