key: cord-0868942-2cspc7mv
authors: Matsunaga, Hisato; Mukai, Keiichiro; Yamanishi, Kyosuke
title: The acute impact of the pandemic of COVID‐19 on the phenomenological features in the full or partial remitted patients with obsessive–compulsive disorder (OCD)
date: 2020-07-22
journal: Psychiatry Clin Neurosci
DOI: 10.1111/pcn.13119
sha: 1afcfe25bbe0613523e1379680ade92399247708
doc_id: 868942
cord_uid: 2cspc7mv

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overestimation of threat may include health anxiety-based symptoms such as obsessions with becoming ill or contaminating others 3) .

Additionally, the explicit recommendations by the health authorities on how to deal with its potential threats (including washing hands frequent and avoiding physical contact with other people and specific surfaces), which often overlap in "appearance" with OCD symptoms 4). Indeed, OCD individuals with fear of contamination may spend hours worrying about the possibility of contacting an infections illness, avoiding potential contaminants (such as not touching certain surfaces or decreasing social contacts), and/or engaging in compulsive washing behaviors of different sorts (such as taking excessively long showers or spending hours washing or disinfecting hands) 2, 4) . Thus, in such a situation, OCD patients especially those with contamination/washing compulsions may be most sensitive and vulnerable to COVID-19 fears, and at the risk of deterioration or recurrence of OCD symptoms 4) . The possibility has been suggested that OCD patients may change their symptomatic phenotype and the focus of their main preoccupations or may add obsessions or worries about the COVID-19 in addition to having greater hand washing compounded by increased avoidance 4) .

To clarify the issues, we preliminarily investigated the acute impact of the pandemic of COVID-19 on the changes of severity or symptomatology of OCD symptoms in 60 full or partial remitted OCD patients (mean age = 41.5 (S.D.=7.9) years, sex ratio (M/F); 25/35) consecutively treated for more than 3 years in our OCD clinic. All participants met the DSM-5 criteria for OCD, directly visited our clinic from April 7 to May 2, 2020 in the state of emergency in Japan, and provided us informed consent to participate in this study. Of the subjects, 24 subjects (40%) had full-remitted (FR) OCD (total score on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) <8) and 36 subjects (60%) were assessed as partial remitted (PR) (9<Y-BOCS<15) 5) , and their principle OCD symptoms were categorized according to the symptom dimension typology 6) , such as contamination/ washing (N=29), aggressive/checking (N=20), and symmetry/repeating and ordering (N=11) at the latest assessment before the spread of COVID-19 (before December 2019).

Their OCD symptoms were reassessed at the time when they came up to our clinic in the state of emergency as described above.

The mean Y-BOCS total scores changed from 5.5(1.4) to 5.7 (1.5) in the FR group, and from 12.2(2.2) to 13.0 (2.3) in the PR group before and after the spread of COVID-19, This article is protected by copyright. All rights reserved.

respectively (Values are expressed as mean (S.D.)). Only a few people (N=4 (1 in the FR and 3 in the PR group); 6.7%) exhibited additional or renewed OCD symptoms associated with COVID-19 such as contamination obsessions or washing compulsions, even though there were no subjects exhibited the symptom transition of their principle symptoms. In addition, 6 of the participants (10%) experienced the deterioration of the symptom severity of OCD as assessed by increase of Y-BOCS total score>3, especially the "time spent performing compulsions" score rather than "time occupied by obsessive thoughts" score on the Y-BOCS without any significant group-differences of the prevalence between the FR (8.3%) and the PR (11.1%) groups. All of the 6 subjects with deteriorated OCD except for a subject assessed as predominantly having symmetry/repeating and ordering symptoms had principle OCD symptoms associated with contamination/washing. Finally, those subjects with OCD symptoms badly affected by COVID-19 were significantly more likely to have higher trait anxiety, depressive status, higher prevalence of generalized anxiety disorder and contamination/washing symptoms specifically associated with virus respiratory infection such as Influenza infections at the assessment before the spread of COVID-19.

In this preliminary study, there were some crucial limitations such as sample bias (only including the subjects who visited our clinic in the state of emergency), cross-sectional assessment, and lower number of subjects. Moreover, determining diagnostic threshold for OCD along with severity of OCD symptoms especially associated with contamination/washing symptoms should be substantially affected by the attention in the media, because excessive washing behaviors for more than 30 sec has been recommended and endorsed by Japanese health agencies.

Nevertheless, at least in the acute phase along with full or partial remitted samples, there may be a little acute impact on the phenomenological features and severity of OCD. These findings seem consistent with the long-term stability of OCD symptom dimensions 7) and also seem to support the possible inflexibility of symptom-specifically biological bases of the long-term enduring symptom structure 8) . Further studies should be needed to prospectively clarify the more long-term effect of fear or anxiety regarding COVID-19 on the onset or deterioration of OCD symptoms in a larger number of subjects including general population.

This article is protected by copyright. All rights reserved.

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