Quality of Life in Obsessive-Compulsive Disorder: Impact of the Disorder and of Treatment.

Quality of Life in Obsessive-Compulsive Disorder: Impact of the Disorder and of Treatment.

CNS Drugs. 2013 Apr 12;
Subramaniam M, Soh P, Vaingankar JA, Picco L, Chong SA

Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder characterized by two distinct phenomena: obsessions which are recurrent, intrusive thoughts, images or impulses, and/or compulsions which are repetitive covert or overt actions that are carried out to decrease anxiety. OCD commonly affects young adults, is associated with other comorbid mental illnesses and often has a large treatment gap (the proportion of individuals who have OCD and require care but do not receive treatment). OCD thus runs a chronic and disabling course which compromises an individual’s functioning and well-being and ultimately has a rather detrimental impact on the lives of both patients and their families. Researchers and clinicians are increasingly paying attention to humanistic outcomes to encompass broader indicators of disease burden and outcome, one of which is quality of life (QoL). In this review, we provide a summary of the current knowledge of QoL in OCD, its socio-demographic and clinical correlates, and the effects of therapeutic interventions on QoL among those with OCD. Overall, studies indicate that those with OCD had diminished QoL across all domains relative to normative comparison subjects. Patients with OCD scored better on QoL domains than patients with major depressive disorder (MDD), whereas they showed no difference or scored worse than patients with schizophrenia. Although research on socio-demographic correlates of QoL in OCD is largely contradictory, most studies suggest that symptom severity and comorbid depression or depressive symptoms are predictors of decreased QoL in OCD, with numerous studies showing this association across multiple domains associated with QoL. Studies assessing QoL as an outcome of treatment have found an improvement in QoL in people with OCD after treatment with pharmacotherapy or cognitive behavioural therapy with some studies suggesting that this improvement in QoL is correlated with improvement in symptoms. A few studies have also evaluated other forms of treatment like partial hospitalisation programmes and deep brain stimulation for those with treatment-resistant OCD and found that QoL scores improve with treatment. A major gap in the field is the lack of instruments that measure QoL specifically in patients with OCD. It is evident that OCD affects specific domains and thus there is a pressing need for the development of multidimensional instruments that are reliable and valid. There is also a need for studies assessing QoL in individuals with OCD among both clinical and community samples with adequate sample size to examine socio-demographic and clinical correlates simultaneously. These populations ought to be followed longitudinally to examine QoL with the clinical course of the illness, and to help establish temporal relationships. Studies that examine improvements in QoL with treatment need to be designed carefully: sample size requirements should be met, raters must be blinded, and randomly assigning subjects to different arms would ensure that some of the inherent biases in open-label studies are avoided. QoL is an important component that measures the impact of OCD on an individual and QoL goals must be incorporated as an outcome measure of therapeutic interventions. HubMed – depression


Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans.

J Gen Intern Med. 2013 Apr 12;
Ganzini L, Denneson LM, Press N, Bair MJ, Helmer DA, Poat J, Dobscha SK

BACKGROUND: To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process. OBJECTIVE: To explore Veterans’ perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts. DESIGN: Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach. PARTICIPANTS: Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010. KEY RESULTS: Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts. CONCLUSION: In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts. HubMed – depression


[Mental distress in primary care patients : German patients compared with patients of Turkish origin.]

Nervenarzt. 2013 Apr 12;
Sariaslan S, Morawa E, Erim Y

BACKGROUND: In Germany empirical research on the (mental) health of immigrants is still insufficiently investigated. METHODS: The symptom severity of depressiveness (Beck Depression Inventory, BDI) and of somatoform complaints (Screening for Somatoform Symptoms, SOMS-2) were measured in 254 Turkish and 164 German patients in primary care. RESULTS: Turkish patients showed a higher age-adjusted severity of depressive and somatoform symptomatology compared with German patients. The most pronounced depressive symptoms of the Turkish patients were fatigue and irritability and of the German patients sleep disorders and fatigue. Of the Turkish patients 19.29? % achieved the cut-off value for a clinically relevant depression (??18 points) but this was achieved by only 7.93?% of the German sample (p?=?0.001). The most common somatoform symptoms of the Turkish patients were back pain and pain in the arms or legs and in the German patients back pain and joint pain dominated. CONCLUSIONS: The results indicate a higher mental distress in Turkish compared to native German patients. HubMed – depression


[Are members of fibromyalgia syndrome self-help groups “different”? : Demographic and clinical characteristics of members and non-members of fibromyalgia syndrome self-help groups.]

Z Rheumatol. 2013 Apr 13;
Jung E, Erbslöh-Möller B, Gesmann M, Kühn-Becker H, Petermann F, Langhorst J, Weiss T, Thoma R, Winkelmann A, Häuser W

BACKGROUND: No data were available on demographic and clinical characteristics of members of fibromyalgia syndrome (FMS) self-help groups in Germany. MATERIAL AND METHODS: The study was carried out from November 2010 to April 2011. A set of questionnaires was distributed by the German League Against Rheumatism and the German Fibromyalgia Association to members and to all consecutive FMS patients at nine clinical centres of different levels of care. The set included a self-developed questionnaire on demographic and medical data and on previously and currently used therapies, the patient health questionnaire (PHQ 4) and the fibromyalgia survey questionnaire. RESULTS: Members of FMS self-help groups (N?=?1,014) were older and reported a longer duration of chronic widespread pain, less anxiety and depression and a more frequent current use of aerobic exercise, relaxation training and complementary alternative medication than participants not affiliated with FMS self-help groups (N?=?630). CONCLUSIONS: Membership in FMS self-help groups was associated with less psychological distress and a more frequent use of active self-management strategies. HubMed – depression