Early intervention in obsessive-compulsive disorder: From theory to practice

Area of Science:

• Psychiatry
• Neuroscience

Background:

• Obsessive-compulsive disorder (OCD) is a common and disabling condition, often subject to diagnostic and treatment delays.
• These delays can lead to undesirable consequences, including illness progression and increased complexity.

Approach:

• This paper reviews the rationale for early intervention in OCD, considering both subclinical obsessive-compulsive symptoms (OCS) and full-blown OCD.
• It highlights the need for research into 'at risk' phenotypes and scalable preventative treatments for subclinical OCS.
• It also emphasizes the importance of prompt identification and treatment for established OCD, given its progressive nature.

Key Points:

• Most individuals with subclinical OCS do not develop full-blown OCD, necessitating research into predictive factors like polygenic risk scores.
• Preventative strategies for subclinical OCS should be cost-effective, well-tolerated, and scalable, such as lifestyle interventions.
• OCD is increasingly recognized as a progressive disorder where illness duration correlates with biological changes, comorbidities, and poorer treatment outcomes.

Conclusions:

• Early intervention services for OCD should target children and adolescents.
• These services must provide established treatments for full-blown OCD promptly.
• Crucially, early intervention necessitates comprehensive psychoeducation for patients, families, and educators to improve outcomes.