Longitudinal Follow-Up Study of Obsessive Compulsive Disorder

描述(由申请人提供)：该研究是对395名强迫症患者的纵向病程和结果的独特前瞻性研究，将产生对患者、家庭和治疗临床医生具有实际临床意义的重要新数据。我们寻求额外五年的资金来测试对我们理解强迫症的精神病理学、病因学和治疗具有根本意义的假设，这些假设只能通过纵向设计来回答。有了这个纵向数据集，我们将能够测试疾病的新概念模型的有效性，该模型假设了强迫症的两个潜在的更高阶结构，这两个结构是导致OC症状的动机驱动因素，即伤害避免(HA)和不完整(INC)。这些结构已经证明了临床面孔的有效性，并被认为与恐惧(HA)和奖励(INC)电路有不同的关联。这一创新的模型以及为测试该模型而开发的空间仪器，将在未来探索复杂的遗传学、具有生物学意义的内表型以及该疾病的治疗结果研究中发挥重要作用。这些分组将提供有关预后、接受的治疗以及缓解和复发的比率和预测因素的信息，这些信息对公共卫生政策具有重大影响。我们将调查一些以前没有研究过的与SRIs维持治疗相关的问题，包括持续改善的参与者的特征，这可能会阐明是什么有助于实现和维持缓解。我们还将收集有关患有强迫症的儿童和青少年以及老年队列患者的疗程和治疗模式的独特前瞻性数据。我们的具体目标是：(1)评估伤害避免(HA)和不完全性(INC)的高潜在结构模型的概念有效性，并检验这些潜在结构、主要症状亚型、强迫症症状因素和气质在解释病程变异性方面的相对贡献(2)收集与长期治疗和病程相关的综合治疗数据(3)确定儿童和青少年强迫症临床样本的病程和结局模式。受试者将每隔一年接受一次评估，评估工具将获得有关症状状态和严重程度、诊断状态、接受的治疗、心理社会功能和其他领域的详细信息。我们建议增加新的评估，以衡量关键的潜在变量、潜在的情绪和焦虑相关特征以及症状严重程度。我们还将结构方程模型纳入我们的纵向数据分析中，以测试与症状、气质和高阶潜在结构(HA和INC)对过程方差的解释能力相关的新假设。为了有足够的统计能力来检验我们的假设，还需要5年多的前瞻性观察和50名额外的儿童和青少年参与者。BLOCK的继续将为临床和理论上重要的创新问题提供新的线索，这些问题是关于一种未被充分研究的主要精神疾病，以前的研究没有解决这些问题。

DESCRIPTION (provided by applicant): The BLOCS is a unique prospective study of longitudinal course and outcome of 395 participants with OCD that will generate important new data of practical clinical significance for patients, families and treating clinicians. We seek five additional years of funding to test hypotheses of fundamental significance to our understanding of the psychopathology, etiology and treatment of OCD, hypotheses that can only be answered in using a longitudinal design. With this longitudinal dataset we will be able to test the validity of a novel conceptual model of the illness that posits two latent higher order constructs of OCD that underlie the motivational drive leading to OC symptoms, harm avoidance (HA) and incompleteness (INC). These constructs have demonstrated clinical face validity and are thought to be differentially associated with fear (HA) and reward (INC) circuitry. This innovative model, and the dimensional instruments that have been developed to test the model, will be important in future explorations of the complex genetics, biologically meaningful endophenotypes, and treatment outcome studies of the disorder. The BLOCS will provide information about prognosis, treatment received, and rates and predictors of remission and relapse that have significant implications for public health policy. We will investigate a number of previously unstudied questions related to maintenance treatment with SRIs including the characteristics of participants with sustained improvement, which will potentially elucidate what contributes to achieving and sustaining remission. We will also gather unique prospective data on the patterns of course and treatment received for child and adolescent and aging cohorts with OCD. Our specific aims are: (1) To evaluate the conceptual validity of a higher latent construct model of harm avoidance (HA) and incompleteness (INC), and to test the relative contributions of these latent constructs, primary symptom subtypes, OCD symptom factors, and temperament in explaining variability in course (2) collect comprehensive treatment data related to long term treatment and course (3) to determine the patterns of course and outcome of a clinical sample of children and adolescents with OCD. Subjects will be evaluated at 1 year intervals with instruments that obtain detailed information on symptom status and severity, diagnostic status, treatment received, psychosocial functioning, and other domains. We propose to add new assessments that measure key latent variables, underlying mood- and anxiety-related traits, and symptom severity. We have also incorporated a structural equation model into our longitudinal data analysis to test novel hypotheses related to the explanatory power of symptoms, temperament and the higher order latent constructs (HA and INC) on the variance of course. To have sufficient statistical power to test our hypotheses, 5 more years of prospective observation and 50 additional child and adolescent participants are needed. Continuation of BLOCS will shed new light on clinically and theoretically important, innovative questions about an understudied major psychiatric disorder which have not been addressed by previous research.