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Title: Medical status of outpatients with obsessive-compulsive disorder in psychiatric department and its influencing factors.
Author: Zheng H, Zhang Z, Huang C, Luo G.
Journal: Zhong Nan Da Xue Xue Bao Yi Xue Ban; 2022 Oct 28; 47(10):1418-1424. PubMed ID: 36411693.
Abstract:
OBJECTIVES: Obsessive-compulsive disorder (OCD) is a chronic and refractory mental disorder with early onset, low response rate, and poor prognosis. Studies have shown that the age of onset, severity, course of disease, and untreated course of disease may affect its clinical efficacy. At present, there are few studies on the duration of untreated illness (DUI) of OCD patients. The current medical status and untreated course of OCD patients in China are still unclear. This study aims to investigate the current medical status of OCD patients in psychiatric outpatients of a general hospital, including the course of disease and DUI as well as its influencing factors. METHODS: A total of 310 outpatients with OCD who visited the Department of Mental Health, Guangdong Provincial People's Hospital for the first time, were recruited and interviewed. The information including age, gender, years of education, marital status, work status, age of onset, comorbid mental disorders, age of first treatment, course of disease, and DUI were collected. We also calculated the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Global Assessment Function (GAF) scores for total sample to analyze the demographic characteristics and clinical data of patients with OCT. The median DUI was used as the cut-off value, and the patients were divided into a short DUI group and a long DUI group. The differences in demographic characteristics and clinical data between the 2 groups were compared, and the factors affecting the DUI were analyzed. RESULTS: There were 158 males (51%) and 152 females (49%). The age of onset was (19.48±7.97) years. The years of education were 13.49±3.13; 215 (69.4%) were single and 95 (30.6%) were married; 103 (33.2%) were employed and 207 (66.8%) were unemployed. The median course of OCD was 4 years and the median DUI was 3 years. There were 177 cases in the short DUI (≤3 years) group and 133 cases in the long DUI (>3 years) group. Compared with the long DUI group, the patients in the short DUI group were younger (P<0.01); they had mild obsessive-compulsive symptoms (P<0.05) and a shorter education period and course of disease (P<0.01 and P<0.001, respectively); and they were more unemployed and single (both P<0.001). Correlation analysis showed that DUI was positively correlated with age, course of disease, years of education, and Y-BOCS score (r=0.45, P<0.001; r=0.74, P<0.001; r=0.27, P<0.001; r=0.17, P<0.01). When the DUI of OCD patients was used as the dependent variable, Y-BOCS, age, course of disease, whether to work, marital status, and years of education were used as the independent variables for binary logistic regression analysis, which showed that the duration of illness could predict the short and long DUI of OCD [Wald χ²=49.78, Exp(B)=1.34, P<0.001]. CONCLUSIONS: Investigation for the medical status of OCD patients in the psychiatric outpatients of a general hospital in Guangdong, China shows that the duration of illness of OCD patients in the psychiatric outpatients and the DUI of OCD patients are generally shorter than previous foreign reports. The DUI of OCD patients is affected by the course of disease, age, severity of symptoms, and other factors. In the future, large sample, multi-center, and follow-up studies could be considered to further explore the influencing factors for the DUI of OCD and the impact on the prognosis of the disease, to help improve the status of delayed treatment for OCD and improve the effective rate of OCD treatment. 目的: 强迫症是一种具有慢性和难治性特点的精神心理障碍，其起病早，治疗有效率低，预后差，研究表明发病年龄、严重程度、病程、未治疗病程等都可能影响其临床疗效。目前对强迫症患者未治疗病程的研究较少，中国强迫症患者就医现状及未治疗病程尚不清楚。本研究旨在了解综合医院精神科门诊强迫症患者就医现状，包括病程、未治疗病程状况及其影响因素。方法: 对首次就诊于广东省人民医院的310名门诊强迫症患者进行一般情况调查和访谈，包括年龄、性别、受教育年限、婚姻状况、工作情况、发病年龄、共病精神障碍、首次治疗年龄、病程、未治疗病程(duration of untreated illness，DUI)等，及耶鲁-布朗强迫症量表(Yale-Brown Obsessive-Compulsive Scale，Y-BOCS)和总体功能量表(Global Assessment Function，GAF)评分，分析门诊强迫症患者总体人口学特征及临床资料。以DUI中位数作为界值，将患者分为短DUI组和长DUI组。比较两组患者在人口学特征及临床资料上的差异，并将DUI与患者的临床资料进行相关分析，采用二元logistic回归模型分析DUI的影响因素。结果: 入组门诊强迫症患者男性158人(51%)，女性152人(49%)；发病年龄为(19.48±7.97)岁；受教育年限为13.49±3.13；单身215人(69.4%)，已婚95人(30.6%)；就业103人(33.2%)，未就业207人(66.8%)。门诊强迫症患者的中位病程为4年，中位DUI为3年，短DUI(≤3年)组177例、长DUI(>3年)组133例。与长DUI组患者比较，短DUI组患者较年轻(P<0.01)，受教育年限较短(P<0.01)，病程较长(P<0.001)，强迫症状程度较轻(P<0.05)，尚未工作(P<0.001)、单身(P<0.001)占比较高。相关分析发现强迫症患者DUI与年龄、病程、教育年限、Y-BOCS评分呈正相关(分别r=0.45，P<0.001；r=0.74，P<0.001；r=0.27，P<0.001；r=0.17，P<0.01)。以强迫症患者DUI作为因变量，以Y-BOCS评分、年龄、病程、是否工作、婚姻状态、受教育年限作为自变量进行二元logistic回归分析，结果提示病程是预测强迫症患者DUI的独立影响因素[Wald χ²=49.78，Exp(B)=1.34，P<0.001]。结论: 中国广东一家综合医院精神科门诊强迫症患者的病程、DUI较国外以往报道短；强迫症患者的DUI受到病程、年龄、症状严重程度等因素影响。未来可考虑进行大样本、多中心及追踪随访研究，进一步探讨强迫症DUI的影响因素及对疾病预后的影响，为改善强迫症延迟治疗的现状及提高强迫症治疗有效率提供帮助。. OBJECTIVE: Obsessive-compulsive disorder (OCD) is a chronic and refractory mental disorder with early onset, low response rate, and poor prognosis. Studies have shown that the age of onset, severity, course of disease, and untreated course of disease may affect its clinical efficacy. At present, there are few studies on the duration of untreated illness (DUI) of OCD patients. The current medical status and untreated course of OCD patients in China are still unclear. This study aims to investigate the current medical status of OCD patients in psychiatric outpatients of a general hospital, including the course of disease and DUI as well as its influencing factors. METHODS: A total of 310 outpatients with OCD who visited the Department of Mental Health, Guangdong Provincial People’s Hospital for the first time, were recruited and interviewed. The information including age, gender, years of education, marital status, work status, age of onset, comorbid mental disorders, age of first treatment, course of disease, and DUI were collected. We also calculated the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Global Assessment Function (GAF) scores for total sample to analyze the demographic characteristics and clinical data of patients with OCT. The median DUI was used as the cut-off value, and the patients were divided into a short DUI group and a long DUI group. The differences in demographic characteristics and clinical data between the 2 groups were compared, and the factors affecting the DUI were analyzed. RESULTS: There were 158 males (51%) and 152 females (49%). The age of onset was (19.48±7.97) years. The years of education were 13.49±3.13; 215 (69.4%) were single and 95 (30.6%) were married; 103 (33.2%) were employed and 207 (66.8%) were unemployed. The median course of OCD was 4 years and the median DUI was 3 years. There were 177 cases in the short DUI (≤3 years) group and 133 cases in the long DUI (>3 years) group. Compared with the long DUI group, the patients in the short DUI group were younger (P<0.01); they had mild obsessive-compulsive symptoms (P<0.05) and a shorter education period and course of disease (P<0.01 and P<0.001, respectively); and they were more unemployed and single (both P<0.001). Correlation analysis showed that DUI was positively correlated with age, course of disease, years of education, and Y-BOCS score (r=0.45, P<0.001; r=0.74, P<0.001; r=0.27, P<0.001; r=0.17, P<0.01). When the DUI of OCD patients was used as the dependent variable, Y-BOCS, age, course of disease, whether to work, marital status, and years of education were used as the independent variables for binary logistic regression analysis, which showed that the duration of illness could predict the short and long DUI of OCD [Wald χ²=49.78, Exp(B)=1.34, P<0.001]. CONCLUSION: Investigation for the medical status of OCD patients in the psychiatric outpatients of a general hospital in Guangdong, China shows that the duration of illness of OCD patients in the psychiatric outpatients and the DUI of OCD patients are generally shorter than previous foreign reports. The DUI of OCD patients is affected by the course of disease, age, severity of symptoms, and other factors. In the future, large sample, multi-center, and follow-up studies could be considered to further explore the influencing factors for the DUI of OCD and the impact on the prognosis of the disease, to help improve the status of delayed treatment for OCD and improve the effective rate of OCD treatment.

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