دانلود مقاله اضطراب در دوره بلند مدت اختلال وسواس فکری - جبری
خلاصه
1. معرفی
2. روش ها
3. نتایج
4. بحث
نقش منابع مالی
افشای
بیانیه مشارکت نویسنده CRediT
اعلامیه منافع رقابتی
سپاسگزاریها
منابع
Abstract
1. Introduction
2. Methods
3. Results
4. Discussion
Role of the funding
Disclosure
CRediT authorship contribution statement
Declaration of competing interest
Acknowledgements
References
چکیده
هدف: مطالعه حاضر با هدف بررسی اضطراب و ارتباط آن با علائم وسواس در طول دوره طولانی مدت اختلال وسواس فکری- جبری (OCD) انجام شد.
روش‌ها: ما از داده‌های مطالعه انجمن OCD هلند (NOCDA)، که شامل 419 شرکت‌کننده مبتلا به OCD (سن 79-18 سال) بود، استفاده کردیم. شدت علائم وسواس و اضطراب در ابتدا و بعد از دو، چهار و شش سال وارد سه مدل شد که با استفاده از مدل‌سازی معادلات ساختاری مورد تجزیه و تحلیل قرار گرفت: 1) مدل تاخیر متقاطع که فرض می‌کند علائم اضطراب و وسواس دو گروه متمایز از علائم هستند که مستقیماً در درازمدت با هم تعامل دارند. 2) مدل صفات پایدار، که فرض می کند اضطراب و علائم وسواس فکری ناشی از دو عامل پنهان متمایز هستند که در طول زمان پایدار هستند و با یکدیگر تعامل دارند. و 3) مدل عامل مشترک، که فرض می کند اضطراب و علائم وسواس فکری-اجباری تظاهرات همان عامل پنهان هستند.
یافته‌ها: مدل تاخیر متقاطع و مدل صفات پایدار هر دو مدل‌های معتبر با برازش مدل خوب بودند. مدل عامل مشترک برازش مدل ضعیفی داشت و رد شد
محدودیت ها: مدت زمان OCD بین شرکت کنندگان (0 تا 64 سال) بسیار متفاوت بود. اکثریت از چندین سال علائم وسواس فکری-اجباری را تجربه کردند، که ممکن است نتایج را بر روند اضطراب و تعامل بین اضطراب و علائم وسواس- اجباری تحت تأثیر قرار دهد.
نتیجه‌گیری: علائم اضطراب و وسواس در بیماران OCD از یک عامل زمینه‌ای مشترک ناشی نمی‌شوند، بلکه گروه‌های علامتی متقابل متقابلی هستند که احتمالاً توسط عوامل پنهان متمایز در تعامل هستند.
Abstract
Objective
The study aimed to investigate anxiety and its relation with obsessive-compulsive symptoms during the long-term course of obsessive-compulsive disorder (OCD).
Methods
We used data from the Netherlands OCD Association (NOCDA) study, which included 419 participants with OCD (aged 18–79 years). Severity of obsessive-compulsive symptoms and anxiety at baseline and after two, four, and six years were entered into three models, which were analyzed using structural equation modeling: 1) the cross-lagged model, which assumes that anxiety and obsessive-compulsive symptoms are two distinct groups of symptoms interacting directly on the long-term; 2) the stable traits model, which assumes that anxiety and obsessive-compulsive symptoms result from two distinct latent factors, which are stable over the time and interact with each other; and 3) the common factor model, which assumes that anxiety and obsessive-compulsive symptoms are presentations of the same latent factor.
Results
The cross-lagged model and the stable traits model both were valid models with a good model fit. The common factor model had a poor model fit and was rejected.
Limitations
The duration of OCD varied widely between the participants (0–64 years). The majority experienced obsessive-compulsive symptoms since several years, which may have affected results on the course of anxiety and the interaction between anxiety and obsessive-compulsive symptoms.
Conclusions
Anxiety and obsessive-compulsive symptoms in OCD patients do not result from a shared underlying factor but are distinct, interacting symptom groups, probably interacting by distinct latent factors.
Introduction
Obsessive-compulsive disorder (OCD) is defined by recurrent, intrusive thoughts, urges or images (obsessions) and repetitive and often ritualistic behaviors (compulsions) (DSM-5, APA, 2013). According to the learning theory obsessions provoke distress, which often presents as anxiety. Subsequently, compulsions are performed to diminish the distress or anxiety. Several studies and theories address the short-term relation between obsessions leading to anxiety leading to compulsions (e.g., Hartmann et al., 2019; Starcevic et al., 2011; Salkovskis, 1985; Rachman and Hodgson, 1980), but anxiety in OCD also occurs unrelated to the immediate distress response (Citkowska-Kisielewska et al., 2019; van Schalkwyk et al., 2016).
In fact, anxiety has a significant role in the clinical picture of OCD (Citkowska-Kisielewska et al., 2019). More severe anxiety is related to chronicity (Nakajima et al., 2018; van Oudheusden et al., 2018; Ferrão et al., 2006), impaired quality of life (Remmerswaal et al., 2020; Velloso et al., 2018; Subramaniam et al., 2013) and more functional impairment (Velloso et al., 2018; Storch et al., 2009). It is also associated with more severe obsessive-compulsive symptoms cross-sectionally (Klein Breteler et al., 2021; Sulkowski et al., 2008). In treatment studies, no effect of anxiety on treatment outcome was observed (Kathmann et al., 2022; Knopp et al., 2013; Farrel and Boschen, 2011; Steketee et al., 2019), possibly because most therapeutic interventions for OCD, such as cognitive behavioral therapy and serotonergic antidepressants, also effectively reduce anxiety (Anand et al., 2011; Blair Simpson et al., 2008). Therefore, natural follow-up studies may be preferred to study the long-term relation between anxiety and obsessive-compulsive symptoms.
Results
3.1. Clinical characteristics
At baseline, 419 participants completed the interviews and questionnaires. Due to drop-out, at follow-up after two years 311 patients (74.2 %) still participated, at follow-up after four years 295 patients (70.4 %), and at follow-up after six years 268 patients (64 %). Complete questionnaires of the baseline and all follow-up assessments of the Y-BOCS and BAI were available for 187 participants (44.6 %). At baseline, the group of completers did not differ significantly from the group with missing data regarding age, sex, current diagnosis of OCD, current OCD symptom dimensions, Y-BOCS and BAI scores. Characteristics of all participants at baseline are summarized in Table 1.