Remission and response rates in obsessive-compulsive disorder: Naturalistic study

Despite established treatments for obsessive-compulsive disorder (OCD), many patients remain symptomatic under standard care.

To evaluate long-term remission and response rates in OCD patients treated with a multimodal approach combining intensive exposure and response prevention (ERP), off-label high-dose serotonin reuptake inhibitors (OLHD-SRIs), and family-focused intervention within a "virtual hospitalization" framework.

A retrospective naturalistic study was conducted on 105 adult outpatients (mean age 27.2) treated between 2013 and 2022. Treatment included thrice-weekly ERP sessions, digital adherence monitoring, and SRI doses exceeding regulatory limits. Outcomes were measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and compared to a benchmark meta-analysis of 1265 patients receiving standard care.

The mean Y-BOCS score decreased by 65.8%. A treatment response (≥35% reduction) was achieved by 86.7% of patients. Using a strict definition of remission (Y-BOCS ≤12), 67.6% of the cohort reached recovery. When compared to the benchmark study (Y-BOCS <16), our cohort demonstrated significantly higher odds of remission (78.1% vs. 53.0%; OR = 3.06, 95% CI 2.10-4.44, p < 0.0001). Multivariable logistic regression showed that longer duration of treatment was significantly associated with higher remission rates (p = 0.004).

A comprehensive, high-intensity framework integrating OLHD-SRIs and technologically enhanced ERP can achieve remission rates that exceed those typically reported in naturalistic studies. These findings offer a meaningful pathway for clinical recovery in patients who fail to respond to standard protocols.