S. Bellino, S. Ziero, A. Ceregato, S. Colla, F. Bogetto - Vol. 7, Marzo 2001, num.1
Testo Immagini Bibliografia Summary Riassunto Indice
Il disturbo ossessivo-compulsivo con scarso
insight: indagine clinica su un gruppo di pazienti ambulatoriali
Obsessive-compulsive disorder with poor insight: a clinical investigation
of a group of outpatients
Classical authors like Lewis and Schneider pointed out that some patients with obsessive-compulsive disorder (OCD) had a significantly decreased ability to recognise the senselessness of their symptoms. This condition was variously defined, until it was recently included as OCD with poor insight in the DSM-IV diagnostic criteria. Data on the characteristics of this OCD type are still sparse; the objective of this study was to assess clinical differences between a group of obsessive-compulsive patients with poor insight and a control group with normal insight.
46 consecutive outpatients with a DSM-IV diagnosis of OCD were included; they were divided into two subgroups: 16 patients with poor insight and 30 patients with normal insight. OCD with poor insight was identified using DSM-IV criteria and a score of at least 3 at item 11 (insight) on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). All patients were examined using a semistructured interview to investigate socio-demographic and clinical characteristics and familial comorbidity; the Y-BOCS; The National Institute of Mental Health-Obsessive Compulsive Scale (NIMH-OCS); the Hamilton scales for depression (HDRS) and anxiety (HARS); the Brown Assessment of Beliefs Scale (BABS). The BABS is a rating scale assessing patient’s beliefs and insight with respect to his/her own thoughts. Axis I and II lifetime comorbidity has also been investigated.
Statistical analysis of data from the two groups of patients showed the following differences: patients with poor insight had high levels of education, as well as high total and compulsion subtotal Y-BOCS scores; high NIMH-OCS and BABS scores; they had also a higher OCD family rate and a higher frequency of concomitant Cluster A personality disorder, in particular schizotypal; on the other hand, the frequency of a concomitant obsessive-compulsive personality disorder was found to be significantly higher in the group with normal insight.
Our data support the hypothesis that OCD with poor insight is a distinct subtype of the disorder. Furthermore, the association with schizotypal personality disorder may have important therapeutic implications. Further investigations on larger populations are required to confirm our results.