Long-term outcome following Intensive Residential Treatment of Obsessive–Compulsive Disorder S. Evelyn Stewart a,b,c, * , Denise Egan Stack a , Svetlana Tsilker a , Jen Alosso a , Matt Stephansky a , Dianne M. Hezel a,b , Eric A. Jenike a,b , Stephen A. Haddad b , Jared Kant b , Michael A. Jenike a,b,c a Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States b Massachusetts General Hospital, 185 Cambridge Street, PNGU, 6th Floor, Boston, MA 02114, United States c Harvard University Medical School, Boston, MA, United States article info Article history: Received 10 November 2008 Received in revised form 19 March 2009 Accepted 27 March 2009 Keywords: Obsessive–Compulsive Disorder Intensive Residential Treatment Long-term outcome Inpatient Effectiveness abstract Background: IRT has been demonstrated as an effective treatment for severe, refractory OCD. Methods: Consecutive IRT subjects were ascertained over a 12 month period (female N = 26, male N = 35). Psychometric measures were completed at admission and discharge from the McLean/MGH OCD Insti- tute IRT, including the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and the Work and Social Adjustment Scale (WSA)(N = 61). These measures were repeated at one (N = 57), three (N = 42) and six months (N = 36) following discharge. This study was IRB approved. Results: OCD mean severity did not significantly worsen from discharge to the one (17.4, SD 6.5), three (16.5, SD 7.4) or six month (16.2, SD 7.3) follow-up (p > 0.25). Furthermore, the significant improvement from admission was maintained at each of the one (17.4, SD 6.5), three (16.5, SD 7.4) and six month (16.2, SD SD 7.3) follow-up time points (p < 0.001). Relapsers were significantly more likely to be living alone following discharge (p = 0.01), and were less likely to have comorbid illnesses (p = 0.02). There were no significant differences found between study dropouts and completers with regards to YBOCS scores (P > 0.47). Conclusion: In the first OCD IRT long-term follow-up study to date, findings have indicated that mean treatment gains were maintained at one, three, and six months post-discharge. This finding is important as it suggests that improvements of OCD severity were subsequently retained in home and work environ- ments. Improvement of depression severity from admission was also maintained. Ó 2009 Elsevier Ltd. All rights reserved. 1. Introduction Intensive Residential Treatment (IRT) has been identified as an effective treatment for severe Obsessive–Compulsive Disorder (OCD). McKenzie and Marks found that 218 patients improved by 30–50% on symptom and disability scores after undergoing IRT (McKenzie and Marks, 2003). In the largest IRT study to date for OCD, mean Yale-Brown Obsessive–Compulsive Scale (YBOCS) scores decreased 30.1% from 26.6 at admission to18.6 at discharge, demonstrating a clinically significant improvement in 403 patients (Stewart et al., 2005). Beck depression severity scores also de- creased significantly, from 21.0 to 15.3 (p < 0.001). Within the same IRT OCD population, outcome predictors were identified to be gender, depression severity, psychosocial functioning, and the presence of comorbid tic disorders (Stewart et al., 2006). In the aforementioned studies by Stewart et al., the average duration of IRT was 66 days. What remains to be determined is whether treat- ment gains are retained in a naturalistic setting after discharge and maintained over time. Hembree et al. (2003) have examined long-term outcomes of a variety of OCD treatment modalities, including SSRIs alone, expo- sure/ritual prevention alone (E/RP), and E/RP in combination with SSRIs (N = 62). At 17 months follow-up, no significant overall dif- ferences in OCD symptoms existed among the three groups. How- ever, the E/RP groups with and without medication performed significantly better on most measures than the medication alone group. Their study suggested that E/RP leads to better long-term maintenance of improvement compared to medication alone, although analyses did not control for treatments received in the follow-up period (Hembree et al., 2003). For more severe refrac- tory patients who do not respond to these first-time treatments, the efficacy of deep-brain stimulation in 10 refractory OCD pa- tients has been examined, with the average improvements in YBOCS scores from 34.6 ± 0.6 (severe) to 22.3 ± 2.1 (moderate) after 36 months (Greenberg et al., 2006). Neurosurgury was also 0022-3956/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2009.03.012 * Corresponding author. Address: Massachusetts General Hospital, 185 Cam- bridge Street, PNGU, 6th Floor, Boston, MA 02114, United States. Tel.: +1 617 724 5897; fax: +1 617 726 0830. E-mail address: stewart@pngu.mgh.harvard.edu (S.E. Stewart). Journal of Psychiatric Research 43 (2009) 1118–1123 Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/jpsychires