Early recognition of obsessive-compulsive disorder.

The early course in clinical and neurobiological terms of obsessive-compulsive disorder (OCD) is almost completely unknown. The disease often begins in early childhood and adolescence, but the first behavioral changes and symptoms preceding OCD have not been assessed to date. In this retrospective approach, 40 patients with OCD (23 females/17 males; 39.4 [10.1] years old in average; with scores on the Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] of 19 [9.3]) were given an author-developed questionnaire. Twenty-three patients reported first changes before having reached the age of 20 years. Rather unspecific symptoms such as "anxiety" and "lacking self-trust" seem to have been more frequent as first signs of developing OCD. Further specific symptoms indicating OCD were "enhanced feeling of responsibility," "exact attention concerning details," "being eager for order and cleanness," "difficulties with decisions," and "repetitive controlling," but were less remembered. There was no significant relationship between these first changes and later OCD-related psychopathology as measured with the Y-BOCS, but there was a relationship with later depressive comorbidity (Hamilton Depression Rating Scale). This substantiates the view that OCD-similar to other psychiatric disorders such as schizophrenia and bipolar disorder-seems to be characterized by a psychopathologically less specific prodrome with rather depressive symptoms. However, this was a retrospective study with preliminary data, which has to be replicated prospectively with a larger sample.

Patient satisfaction with specialized mental health service for obsessive-compulsive disorder.

BACKGROUND: Patient satisfaction is an important outcome variable that is increasingly used in mental health service evaluation. There are no results available for patients with obsessive-compulsive disorder (OCD) yet. METHODS: Using the Verona Service Satisfaction Scale, patient satisfaction with a specialized mental health service was examined in patients with OCD. RESULTS: OCD patients were overall satisfied with the professional help provided, whereas satisfaction with the professional involvement of relatives within the treatment and health care process was found to be quite low. Patients with more severe OCD, as measured by the Yale-Brown Obsessive-Compulsive Scale, as well as chronically ill and more disabled patients were more likely to be dissatisfied with the overall care they received. Patient satisfaction plays an important role in the long-term course of an illness such OCD. This seems to be decreased so longer illness is not or badly treated. There is a stronger need for involvement of family members in the treatment and health care of patients with OCD. CONCLUSIONS: More OCD-specific treatment offers have to be established for patients with this long-term illness such as psychotherapy in groups.