Clinical predictors of drug nonresponse in obsessive-compulsive disorder.
OBJECTIVE
Obsessive-compulsive 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.


METHODS
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 sub-scale (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.


CONCLUSIONS
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 SRI nonresponders.
Shetti
Chandrashekhar N
CN
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
Reddy
Y C Janardhan
YC
Kandavel
Thennarasu
T
Kashyap
Kartik
K
Singisetti
Srinivas
S
Hiremath
Avinash S
AS
Siddequehusen
Mulia Umar-Faruq
MU
Raghunandanan
Samar
S
D000328:Adult; D017668:Age of Onset; D015897:Comorbidity; D003192:Compulsive Behavior / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006920:Hygiene; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010262:Paraphilic Disorders / Q000453:epidemiology / Q000523:psychology; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors