Functionality in Clinically Recovered Subjects with Obsessive-Compulsive Disorder: A Case-Control Study: Capacité fonctionnelle des sujets atteints d’un trouble obsessionnel-compulsif qui obtiennent un rétablissement clinique – Étude cas-témoins

Abstract

Objective

A proportion of patients suffering from obsessive-compulsive disorder (OCD) achieves clinical recovery. However, research is sparse on the functional recovery of clinically recovered subjects with OCD. This study examines functionality in clinically recovered OCD subjects compared to healthy controls (HCs).

Method

Patients who had clinically recovered from OCD (n = 102) were compared to HCs (n = 52) with respect to global functioning, well-being, disability, and quality of life (QOL) using the Global Assessment of Functioning (GAF) Scale, the WHO-5 Well-Being Scale, the WHO-Disability Assessment Schedule, and the WHO-Quality of Life-Brief Version respectively. They also underwent a comprehensive neuropsychological assessment.

Results

Clinically recovered OCD patients had lower global functioning, higher disability scores, impaired environment QOL, and poorer neuropsychological performance in the domains of working memory and response inhibition compared to HCs. In the Spearman's correlation analysis, better global functioning in clinically recovered OCD patients correlated with a longer period of clinical recovery, receiving pharmacological augmentation, not receiving cognitive behavioural therapy, lower disability scores, a higher well-being score, and a higher total QOL score. Neuropsychological correlates of better functioning included faster processing speed and greater accuracy in working memory tasks. In a stepwise quantile (median) regression analysis, improved functioning was associated with an older age of onset, longer duration of remission, faster processing speed, better working memory, lower total disability scores, and higher total QOL scores.

Conclusions

Clinically recovered OCD patients have a lower functionality. Functional recovery may be defined as clinical recovery and a GAF score of >70 (no more than slight impairment in functioning and minimal symptoms, if any). It is important to identify those who have not achieved functional recovery and offer interventions, including cognitive remediation to improve functional outcomes.