The advantages of choosing antiobsessive therapy according to decision-making functioning.
OBJECTIVE
Previous studies stressed the role of decision-making functioning in predicting antiobsessive treatment outcome with serotonin reuptake inhibitors drugs in patients with obsessive-compulsive disorder. Nevertheless, the use of an augmentation strategy with atypical antipsychotic drugs has proved to be effective in obsessive-compulsive patients nonresponding to serotonin reuptake inhibitors treatment. We investigated whether the performance at the Iowa Gambling Task (IGT), a used neuropsychologic task which assesses decision-making, can be an effective criterion for pharmacologic treatment choice in these patients and whether the use of different treatment strategies, according IGT performance, can increase the rate of antiobsessive outcome.


METHODS
Thirty patients with obsessive-compulsive disorder were treated in a single-blind design with fluvoxamine plus placebo or fluvoxamine plus risperidone according to their IGT performance. Treatment outcome was recorded after 6 and 12 weeks.


RESULTS
Patients with good IGT performance showed a good antiobsessive treatment outcome with fluvoxamine only, while only adopting an augmentation strategy with risperidone, the number of responders patients within the subjects with bad IGT performance increased.


CONCLUSIONS
IGT performance may be considered an effective criterion for pharmacologic treatment choice in obsessive-compulsive patients given that antiobsessive treatment outcome is increased to 85% of responders choosing an appropriate drug strategy according to the IGT performance.
Cavedini
Paolo
P
Department of Neuropsychiatric Sciences, San Raffaele Hospital Scientific Institute, Vita-Salute San Raffaele University, School of Psychology, Milan, Italy. cavedini.paolo@hsr.it
Bassi
Tommaso
T
Zorzi
Claudia
C
Bellodi
Laura
L
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003657:Decision Making / Q000187:drug effects* / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D016666:Fluvoxamine / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000523:psychology*; D018967:Risperidone / Q000494:pharmacology / Q000627:therapeutic use*; D016037:Single-Blind Method
D018967:Risperidone; D016666:Fluvoxamine