No worsening of severity in illness for OCD patients during COVID-19: NIMHANS study

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The worst of the COVID-19 pandemic may be behind us, but its impact continues to be felt differently by all sections. With all the emphasis on personal hygiene and social distancing, one would assume that those battling Obsessive Compulsive Disorder (OCD) would have suffered from worsening symptoms. Contrary to this perception, a study by the NIMHANS, ‘Impact of the COVID-19 pandemic on the short-term course of Obsessive-Compulsive Disorder,’ showed that there was no worsening in the severity of illness during the pandemic, and very few patients developed COVID-19–related obsessive-compulsive symptoms.

The study, published in The Journal of Nervous and Mental Disease, was conducted by the team from NIMHANS’s OCD Clinic, which is marking its 25th year now.

Methodology

According to the study, the OCD pandemic cohort consisted of a consecutive group of patients who attended the OCD clinic for a follow-up visit between October 1, 2019, and February 29, 2020. They were telephonically interviewed over two weeks between April 26 and May 12, 2020, which is approximately two months after COVID-19 was declared a pandemic by the WHO.

“We also reviewed the clinical charts of an independent group of patients with OCD (historical controls) who were followed up at the OCD clinic a year before the “pandemic cohort” (i.e., between October 2018 and February 2019) and had another follow-up visit between April and May 2019 to compare their relapse rate with that of the pandemic cohort. In all, our sample included 240 pandemic OCD subjects and 207 historical OCD controls,” said the authors.

What they found was, what the authors term, “counterintuitive and reassuring,” because most subjects with OCD on stable medication seem to have withstood the impact of COVID-19, at least in the short term.

“We systematically evaluated the impact of the COVID-19 pandemic on OCD in a large sample of patients with OCD who were mostly stabilised on treatment, with over half having responded to medication. The main findings of our study are: subjects with OCD did not seem to have any worsening in the severity of illness during the pandemic compared with historical controls during the same period in the previous year; relapse rates among the pandemic OCD group are similar to those in the historical control group; and very few patients developed COVID-19–related obsessive-compulsive symptoms.”

Not big numbers

Y.C. Janardhan Reddy, Head, Department of Psychiatry and OCD Clinic, NIMHANS, told The Hindu, “During COVID-19, there was much emphasis on social distancing and washing hands in a ritualised manner. Doing therapy became difficult all over the world. Some people developed OCD. There was some increase, but not in our clinic. We were expecting a big number.”

The authors of the study point to the important clinical implications of the findings: “Most of our patients were on stable doses of  Serotonin Re-uptake Inhibitors (SRIs) and/or augmenting agents and were largely adherent to treatment. It implies that continued treatment with medications may have prevented worsening/relapse during the pandemic and lockdown. In the background of continued and understandable concern about the possibility of OCD worsening due to the pandemic, our study offers some solace in the fact that SRIs may have a protective role against a relapse/worsening of the severity of illness,” say the authors.

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