EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multicentre study.

Health-related quality of life (HRQoL) scores assess symptom burden in pulmonary arterial hypertension (PAH) but data regarding their role in prognostication and risk stratification are limited. We assessed these relationships using the emPHasis-10 HRQoL measure.1745 patients with idiopathic PAH (IPAH), drug-induced PAH (DPAH), heritable PAH (HPAH) (collectively "(I/D/H)PAH"), or connective tissue disease-associated PAH (CTD-PAH), who had completed emPHasis-10 questionnaires at one of six UK referral centres between 2014 and 2017, were identified. Correlations with exercise capacity and World Health Organization (WHO) functional class were assessed, and exploratory risk stratification thresholds were tested.Moderate correlations were seen between emPHasis-10 scores and 6-min walk distance (r=-0.546), incremental shuttle walk distance (r=-0.504) and WHO functional class (r=0.497) (all p<0.0001). Distribution of emPHasis-10 score differed significantly between each WHO functional class (all p<0.0001). On multivariate analysis, emPHasis-10 score, but not WHO functional class, was an independent predictor of mortality. In a risk stratification approach, scores of 0-16, 17-33 and 34-50 identified incident patients with 1-year mortality of 5%, 10% and 23%, respectively. Survival of patients in WHO functional class III could be further stratified using an emPHasis-10 score ≥34 (p<0.01). At follow-up, patients with improved emPHasis-10 scores had improved exercise capacity (p<0.0001) and patients who transitioned between risk groups demonstrated similar survival to patients originally in those risk groups.The emPHasis-10 score is an independent prognostic marker in patients with (I/D/H)PAH or CTD-PAH. It has utility in risk stratification in addition to currently used parameters. Improvement in emPHasis-10 score is associated with improved exercise capacity.

Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years.

OBJECTIVE: Studies suggest that obsessive-compulsive disorder (OCD) is an unremitting disorder. We report a prospective, longitudinal investigation into OCD and sub-diagnostic OC syndrome (OCS) over a 30-year period to determine the extent to which individuals with clinically relevant OC symptomatology cumulatively remit, as well as the remission latency. METHODS: Five hundred and ninety-one participants drawn from the general population of Zurich, Switzerland, participated in a series of seven interviews over a period of 30 years. RESULTS: Median duration for OCD, OCS and unimpairing OC symptoms was 16, 14 and 6 years, respectively, suggesting a better prognosis for remission for less severe illness. Individuals with a longer duration of illness, greater number of OC-burdened years and those seeking professional help experienced significantly delayed remission. In addition, these factors together with the presence of comorbid anxiety disorders were associated with significantly reduced remission rates. We found a trend towards statistical significance for comorbid affective disorders and reduced remission rates. CONCLUSIONS: Our findings suggest a lack of diagnostic stability over the long-term and a high chance of eventual remission, albeit often after several years of illness, for obsessive-compulsive syndromes including OCD. However, roughly one-third of OCD cases do not remit by 50 years of age.

Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics.

OBJECTIVE: This study aims to expand the available knowledge on Obsessive Compulsive Disorder (OCD)-comorbidity by investigating the prevalence and clinical impact on a group of individuals with OCD or subthreshold OC syndrome (OCS), prospectively followed-up over an extended period. METHODS: A stratified sample of the general population of the canton of Zurich, Switzerland (n = 591), participated in a series of seven interviews over a 30-year period. Clinically significant comorbid subgroups of OCD/OCS were compared to cases of OCD/OCS without respective comorbidity, in order to determine differences in socio-demographic and other clinical characteristics. RESULTS: Lifetime rates of psychiatric comorbidity were high and increased in prevalence across the OC severity spectrum. Bipolar affective disorder was significantly associated with OCD whereas unipolar major depression and both alcohol and drug misuse disorders were not. Most forms of comorbidity increased distress and impacted negatively on family and work relationships, though disorder-specific effects were observed. Thus, agoraphobia and GAD were associated with increased OCD-severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour. CONCLUSIONS: Despite the statistical limitations imposed by the small sample-size, our findings highlight the negative impact of psychiatric comorbidity on health and psychosocial function.

A prospective population-based cohort study of the prevalence, incidence and impact of obsessive-compulsive symptomatology.

OBJECTIVE: Prospective longitudinal studies of obsessive-compulsive disorder (OCD) and sub-diagnostic obsessive-compulsive symptomatology in the non-clinical population, using age-defined cohorts, are rare. This study aimed to investigate the effect of OC symptoms on distress and psychosocial function and the effect of early-onset OC symptoms. METHODS: 591 subjects drawn from the general population of Zurich, Switzerland were interviewed seven times between 1979 (at age 20/21) and 2008 (age 49/50). Data for socio-demographic variables and psychosocial impairment was also collected and compared with a control-group without OC symptoms drawn from the same population. RESULTS: The unweighted cumulative one-year rate of OCD in this sample was 5.1% and 21.7% reported some degree of clinically-relevant OC symptomatology (OCD or OCS). OCD appeared more prevalent in females whereas OCS and OC symptoms were more prevalent in males. The weighted cumulative prevalence rates, representative of the general population, for OCD, OCS and OC symptoms were 3.5%, 9.7%, and 11.2%, respectively. We could not identify OCD occurring before the age of 10 years, though sub-threshold cases were reported as early as age 2 years, whereas by the age of 22 years, around two thirds of OCD cases had emerged and no new cases developed OCD after around 37 years. Males were statistically significantly younger than females at onset of any OC symptomatology. CONCLUSIONS: Clinically-relevant OC syndromes start early and are associated with substantial distress, treatment-seeking activity and in the case of OCD, functional disability.