title: Clinical predictors of drug nonresponse in obsessive-compulsive disorder.
abstract: 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.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: Chandrashekhar N
authors.initials: CN
authors.lastname: Shetti
authors.forename: Y C Janardhan
authors.initials: YC
authors.lastname: Reddy
authors.forename: Thennarasu
authors.initials: T
authors.lastname: Kandavel
authors.forename: Kartik
authors.initials: K
authors.lastname: Kashyap
authors.forename: Srinivas
authors.initials: S
authors.lastname: Singisetti
authors.forename: Avinash S
authors.initials: AS
authors.lastname: Hiremath
authors.forename: Mulia Umar-Faruq
authors.initials: MU
authors.lastname: Siddequehusen
authors.forename: Samar
authors.initials: S
authors.lastname: Raghunandanan
mesh_terms: 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
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors