Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder with prevalence of 1-3 % in general population.¹ OCD is characterized by recurrent obsessions, such as persistent thoughts, impulses or mental images, that promote anxiety, and uncontrolled compulsions such as repetitive behaviours or mental acts that are performed in response to the obsessions with the intent of reducing anxiety. Of the multiple symptom domains, obsessions of contamination and compulsive hand washing are amongst the commonest. These domains respond well to pharmacotherapy and psychotherapy, it tends to relapse in case of stress due to external or environmental cues.²

Adam Abba et al,³ reported that the prevalence of OCD symptoms increased during the early phase of the COVID-19 pandemic, at a rate significantly higher than pre-pandemic rates in the general population. Also, other studies have suggested that there could be significant worsening of (OCD) in the context of the current COVID-19 pandemic.^4,5,6,7 One study reported that psychoeducation of the patients and families, facilitating tele-consults and psychotherapy, enhancing medication compliance and social worker input potentially reduce the worsening of symptoms in this population.⁵

Hence the aim of this study was to understand the impact of Covid-19 on the mental health of patients with OCD in an Indian setting and find out if there is a need to modify or intensify their treatment.

The study was conducted in the psychiatry department of Chengalpattu medical college and hospital in Tamilnadu. Thirty patients with OCD who were already a part of a previous study were reassessed for severity of OCD symptoms in June and July 2020. These scores were compared with that from the earlier assessment of severity done in January & February 2020. The protocol was approved by the institute ethics committee and patients provided informed consent to be part of this study.

The spread of fear, anxiety and even panic due to the COVID-19 pandemic can lead to a worsening of preexisting psychiatric disorders (Yao et al., 2020).⁹ There are few studies in India regarding the changes in OCD symptoms following COVID 19.

In our sample of 30 patients only 20% of the patients had increase in the severity of symptoms following COVID 19. As a whole group, there was no significant differences in severity of symptoms before and after the onset of COVID 19. This is different to the findings of another studies by Davide et al, of 30 patients, where they found that there was overall worsening of symptoms.¹⁰ That study included only patients with contamination symptoms whereas, in this sample patients with all subtypes were included. The mean YBOCS score before the COVID 19 was 15. 97 which is like our sample score 16. 04. The mean YBOCS score during pandemic was 20. 6 in their sample which is higher than in our sample which was 15.03.

In a cross-sectional study conducted by Benatti et al, 36% of the patients had clinical worsening of symptoms which is little higher than our sample were only 20% had worsening of symptoms. 39 % were employed in their study which is contradictory to our sample were 60 % were employed. Most common obsession was aggressive type and compulsions were cleaning type which is similar to our sample.¹¹

There could be a few reasons why there was no significant worsening in the study sample. The clients with OCD in this study were continuing their treatment for a longer duration (majority with an illness duration of more than five years). They might represent a group with better understanding of their condition, significant clinical improvement, resilience and better ability to deal with the challenges posed by the pandemic. Most of the patients were on regular follow up and treatment even during the lockdown and for those who couldn’t reach the hospital, tele-therapy was started and based on the symptoms patients were advised to get drugs from nearby hospitals.

Our study had a small sample size from a tertiary care hospital and results cannot be generalized. There is high risk of selection bias as those who follow up regularly might be a group with better prognosis. Half of the patients in our sample had mild to moderate severity, so the impact on those with severe illness could be underestimated.

The effects of pandemic on the mental health in OCD patients might be variable. It is necessary that the patients to be in regular follow up and treatment during pandemic. Follow up study with large sample size to be included. That will allow comparison between those with predomination contamination obsessions and others. It will be useful to study if the understanding of CO VID 19 reduces the risk of worsening.