Clinical Predictors of Drug Nonresponse in Obsessive-Compulsive Disorder
J Clin Psychiatry 2005;66(12):1517-1523
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disorder (OCD) is often a chronic and disabling
illness with high comorbidity. Serotonin reuptake
inhibitors (SRIs) are effective in treating OCD. However, 40% to 60% of patients with OCD
do not respond adequately to SRIs. This study aims to identify the clinical predictors of
nonresponse to SRIs in OCD by comparing SRI
responders and nonresponders.
Method: 122 subjects with a diagnosis
of DSM-IV OCD of at least 1 year's duration and with treatment history of adequate trials with
at least 2 SRIs were recruited from December 2002 to March 2004. Of these, 67 were SRI
responders and 55 were SRI nonresponders; they were
compared on various clinical parameters. Nonresponse was defined as a score of > = 3 on
the Clinical Global Impressions-Improvement subscale (CGI-I) after at least 2 adequate trials
with SRIs. Response was defined as a score of 1 or
2 on the CGI-I.
Results: In regression analysis, baseline
severity of OCD (p = .049), comorbid major depressive disorder (p = .005), presence of sexual
obsessions (p = .002), and washing (p = .008) and miscellaneous compulsions (p = .013) were
identified as predictors of nonresponse to SRIs.
Early age at onset showed a trend toward prediction
of nonresponse (p = .056). In the univariate
analysis, mixed OCD (p = .001) and poor insight
(p = .023) were associated with nonresponse.
Conclusion: This study has identified
clinical predictors of nonresponse to SRIs. These
predictors may have to be taken into consideration
and assessed carefully when SRIs are prescribed to treat OCD. Future studies should aim at
identifying treatment modalities that are effective in