Phd in CLINICAL EXPERIMENTAL NEUROSCIENCE AND PSYCHIATRY

Thesis title: Studio osservazionale sulle associazioni tra sindrome da demoralizzazione, depressione, durata di malattia non trattata e decorso clinico in pazienti affetti da disturbo ossessivo compulsivo

INTRODUCTION: Obsessive-Compulsive Disorder (OCD) is a debilitating mental disorder that affects 2.5-3% of the general population. It is characterized by recurrent and intrusive thoughts (obsessions) and/or urgent urges to act and repetitive behaviors (compulsions). In recent years, the concept of Demoralization Syndrome has been introduced for patients suffering from chronic diseases, whether physical or mental, with peculiar characteristics such as the presence of feelings of hopelessness, loss of meaning and purpose in life. It differs from depression due to the persistence of hedonic capacity and because what is missing is hope, rather than happiness. The scientific literature is rich in evidence regarding the comorbidity between OCD and depression. However, considering that OCD is often a chronic and debilitating condition, in which pharmacological treatments are not always successful, it is possible to hypothesize that the symptoms of demoralization play a significant role in the affective dimension of patients affected by OCD. AIM OF THE STUDY: The aim of this study is to evaluate the presence and severity of demoralization symptoms in patients with OCD. The relationship between depression and demoralization syndrome and between demoralization and psychopathological dimensions of OCD at the first evaluation (T0) was also evaluated. Finally, possible factors that could influence the variation of demoralization between T0 and T1 were analyzed. MATERIALS AND METHODS: 43 patients affected by OCD were recruited, according to the diagnostic criteria of the DSM 5, and were administered at baseline and at a follow-up, carried out approximately two months later, PHQ-9, HAM-D and Demoralization Scale. The severity of obsessive-compulsive manifestations and their course were assessed using YBOCS. RESULTS: At baseline, 72.1% of patients presented significant depressive symptoms, according to the scores of the self-administered scale PHQ-9, 76.7% according to the HAM-D, 88.4% of the sample was severely demoralized. At T0, the DS (covarying for the PHQ≥8) was significantly associated with the total YBOCS score (rho=0.332, p=0.031) and the YBOCS score related to obsessions (rho=0.451, p=0.003), this correlation was also confirmed using the HAM-D≥8 as a covariate, total YBOCS score (rho=0.241, p=0.124), YBOCS score related to obsessions (rho=0.401, p=0.008). A statistically significant reduction in scores was found between To and T1 in all scales (p≤0.014). At T1, the significant correlation with the YBOCS obsessions score was confirmed, covarying for PHQ≥8 (rho=0.318, p=0.040) and also controlling for HAM-D≥8 (rho=0.446, p=0.003). Analyzing the correlations between baseline DS levels and the various scales, a correlation emerged only with delta levels of PHQ (rho= -0.315, p=0.039), similarly, delta levels of DS were significantly correlated with delta scores of PHQ (rho=0.621, p=0.001). The age of onset of OCD and the age at which the first adequate treatment was received were not directly correlated with the change in DS between T0 and T1. CONCLUSIONS: According to the results obtained, almost 9 out of 10 patients show a condition of severe demoralization, indicating how frequent are moods of despair, loss of meaning and purpose and feelings of failure in patients affected by OCD, despite the decreases in demoralization levels following treatment, 8 out of 10 patients still showed significant levels of demoralization. This could be attributed both to the phenomenological characteristics of OCD, to the common resistance and refractoriness to treatment and to the type of course of the disorder, often chronic and disabling, impacting significantly, beyond the severity of the symptoms, on the sense of identity, on the experiences of loss of hope and on the individual's ability to plan. Regardless of the frequent comorbidity with depressive disorders, given the prevalence of demoralization syndrome in patients with OCD, it is necessary to focus on the development of this comorbidity and provide adequate treatment for both OCD and the demoralization syndrome that often accompanies it.