The natural history of lifetime psychiatric disorders in patients with obsessive-compulsive disorder followed over half a century.

OBJECTIVE: Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century. METHODS: During 1947-1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954-1956. In 1989-1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years. RESULTS: The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD. CONCLUSION: Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.

Prevalence of obsessive-compulsive disorder in relation to depression and cognition in an elderly population.

OBJECTIVES: We examined the 1-month prevalence of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) not fulfilling OCD criteria in relation to sex, age, social and mental function, comorbid depression, and cognitive functioning in an elderly nondemented population. SETTINGS AND PARTICIPANTS: Population-based sample (N = 900), stratified into two age groups: 70-year-olds (335 women and 224 men) and those aged 78 and above (341 women). MEASUREMENTS: Semi-structured interviews. Psychiatric symptoms were assessed with the Comprehensive Psychopathological Rating Scale and Mini-International Neuropsychiatric Interview, mental and social function with the GAF-scale, memory function with the Word Recall Task and general cognition with MMSE. OCD and Depression were diagnosed according to DSM-IV. RESULTS: The one-month prevalence of OCD was 2.9%; a further 21% had OCS. Among 70-year-olds, the prevalence of OCD was 1.3% in men and 4.5% in women. Depression was more common among those with OCD (34.6%) than among those with (12.7%) and without (8.0%) OCS. GAF-score was lower among those with OCD (74.8) and OCS (82.9) compared with individuals without obsessions and compulsions (88.2). The association between OCD and GAF-score remained after adjustment for age, sex, and depression. The OCD subgroup with checking behavior had more memory and concentration problems and did worse on Word Recall Task than other groups in our sample. CONCLUSIONS: We found that OCD and OCS are common among the elderly. Both conditions are related to depression and poorer mental and social functioning. Physicians who meet elderly patients need to be aware of OCD as it is potentially treatable.

The prevalence of psychotic symptoms and paranoid ideation in non-demented population samples aged 70-82 years.

OBJECTIVES: Recent population(Q3) studies have reported an approximate 10% prevalence of psychotic symptoms among elderly aged 85 years and older. Psychotic symptoms may be less prevalent among younger elderly. We examined the prevalence of psychotic symptoms in a population-based sample of non-demented elderly aged 70-82 years. METHODS: A systematic Swedish population sample of 894 non-demented elderly (response rate 68%) representing three birth cohorts (340 women and 224 men aged 70 years and 330 women aged 78 and 82 years) was examined using the Comprehensive Psychopathological Rating Scale (CPRS), during a semi-structured psychiatric interview. A key informant interview was also conducted. Psychotic symptoms were classified according to the DSM-IV Glossary of technical terms. RESULTS: The 1-year prevalence of any psychotic symptom was 0.9% among non-demented women and men aged 70 years, and 1.2% among women aged 78 and 82 years. Psychotic symptoms were not related to sex or age. The prevalence of paranoid ideation was 1.0%. Among women, any paranoid symptom (persecutory delusions or paranoid ideation) was more common in 70-year-olds (2.6%) than in 78-82-year-olds (0.6%) (p = 0.04). CONCLUSIONS: Psychotic symptoms affected only 1% of this non-demented population aged 70, 78 and 82 years, which is lower than the 7-10% previously found among 85- and 95-year-olds. This might reflect a lower prevalence of psychotic symptoms compared to older elderly or secular changes resulting in lower prevalence of psychotic symptoms in later-born birth cohorts.

Prevalence of social phobia in non-demented elderly from a swedish population study.

OBJECTIVE: To examine the prevalence of social phobia, and how the different Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic components of social phobia influence prevalence rates, among a population sample aged 70 years and older. DESIGN: A general population sample was investigated in 2000-2001 with semistructured psychiatric examinations, including the Comprehensive Psychopathological Rating Scale, the Mini International Neuropsychiatric Interview, the Global Assessment of Functioning (GAF) scale, and the Mini Mental State Examination. SETTING: General population Participants: Randomized sample of 914 nondemented elderly, response rate 68%. The sample was stratified into two age groups: 70-year olds (N = 338 women and 224 men) and aged 78 and above (N = 352 women). MEASUREMENTS: Social phobia according to DSM-IV requiring: a) fearing social situations, b) experiencing the fear as unreasonable or excessive, c) avoiding feared social situations or enduring them with intense anxiety or distress, and d) that this causes social consequences. RESULTS: The 1-month prevalence of social phobia was 1.9% (N = 17), an additional 1.6% (N = 15) fulfilled criteria a, c, and d, but not b. Thus, 3.5% had "social phobia" that caused social consequences. This was related to lower GAF-score and concurrent depression,panic attacks, and agoraphobia. Almost one fourth (N = 220) of the total sample feared social situations. This was more common in 70-year-old women compared with 70-year-old men (29.9% versus 20.5%), and to women aged 78-92 years (21.0%). CONCLUSIONS: Our results indicate that DSM-IV criteria exclude a large group of individuals with social phobia. It could be discussed whether DSM-IV criteria should be revised to also encompass these individuals.