title: Clinical features associated to refractory obsessive-compulsive disorder.
abstract: Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature.
  
  
  METHODS
  To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD.
  
  
  RESULTS
  The factors associated with refractoriness of OCD were higher severity of symptoms since the onset of OCD (p<0.001), chronic course (p=0.003), lack of a partner (p=0.037), unemployment (p=0.025), low economic status (p=0.015), presence of obsessive-compulsive symptoms of sexual/religious content (p=0.043), and higher scores on family accommodation (p<0.001). Only the three latter variables remained significantly associated with treatment-refractoriness after regression analyses.
  
  
  CONCLUSIONS
  small sample size, the biases and drawbacks inherent to a case-control study, and the inclusion criteria used to define the study groups may have limited the generalisation of the results.
  
  
  CONCLUSIONS
  A major strength of this study is the systematic and structured evaluation of a vast array of variables related to the clinical expression of OCD, including epigenetic factors and ratings derived from instruments evaluating family accommodation. The presence of sexual/religious symptoms, low economic status and high modification on family function due to OCD were independently associated with treatment-refractoriness. Future longitudinal studies are warranted to verify if these variables represent predictive factors of treatment non-response.
authors.affiliation: Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. ygoraf@terra.com.br
authors.forename: Ygor A
authors.initials: YA
authors.lastname: Ferrão
authors.forename: Roseli G
authors.initials: RG
authors.lastname: Shavitt
authors.forename: Nádia R
authors.initials: NR
authors.lastname: Bedin
authors.forename: Maria Eugênia
authors.initials: ME
authors.lastname: de Mathis
authors.forename: Antônio
authors.initials: A
authors.lastname: Carlos Lopes
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.forename: Albina R
authors.initials: AR
authors.lastname: Torres
authors.forename: Eurípedes C
authors.initials: EC
authors.lastname: Miguel
mesh_terms: D000328:Adult; D001938:Brazil; D016022:Case-Control Studies; D002908:Chronic Disease; D017004:Codependency, Psychological; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D004565:Electroconvulsive Therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012959:Socioeconomic Factors; D017211:Treatment Failure
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors