Dimensional predictors of response to SRI pharmacotherapy in obsessive-compulsive disorder.
BACKGROUND
Obsessive-compulsive disorder (OCD) is clinically heterogeneous. Previous studies have reported different patterns of treatment response to serotonin reuptake inhibitors (SRI) based on symptom dimension. Our objective was to replicate these results in OCD patients who participated in one of four randomized, placebo-controlled, clinical trials (RCT).


METHODS
A total of 165 adult OCD subjects participated in one or more eight-week RCT with clomipramine, fluvoxamine, or fluoxetine. All subjects were classified as having major or minor symptoms in four specific OC symptom dimensions that were derived in a previous factor analytic study involving many of these same patients. Ordinal logistic regression was used to test the association between OC symptom dimensions and SRI response.


RESULTS
We found a significant association between the symptom dimension involving sexual, religious and harm-related obsessions as well as checking compulsions (AGG/SR) and improved SRI response. This increased rate of SRI response was experienced primarily by individuals with harm-related obsessions. Over 60% of patients with AGG/SR OCD symptoms were rated as very much improved after SRI treatment.


CONCLUSIONS
As some of the RCTs included were conducted prior to the development of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), improvement in OCD severity was assessed using the Clinical Global Improvement (CGI) Scale. Data from the double-blind and open-label continuation phases of these trials was collapsed together to increase statistical power.


CONCLUSIONS
Patients with OCD vary in their response to SRIs. The presence of AGG/SR symptoms is associated with an initial positive response to SRIs. These data add to the growing body of work linking central serotonin systems with aggressive behavior.
Landeros-Weisenberger
Angeli
A
Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA. angeli_landeros@yahoo.com
Bloch
Michael H
MH
Kelmendi
Ben
B
Wegner
Ryan
R
Nudel
Jake
J
Dombrowski
Philip
P
Pittenger
Christopher
C
Krystal
John H
JH
Goodman
Wayne K
WK
Leckman
James F
JF
Coric
Vladimir
V
D000328:Adult; D002997:Clomipramine / Q000009:adverse effects / Q000627:therapeutic use; D003237:Connecticut; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D016666:Fluvoxamine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D002997:Clomipramine; D005473:Fluoxetine; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors