title: Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder.
abstract: BACKGROUND
  In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments.
  
  
  OBJECTIVE
  This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients.
  
  
  METHODS
  A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs) or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs) were compared with a paired sample of compliant patients (n = 41). Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chi-square and Mann-Whitney tests were used when indicated. Variables presenting a p value <0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable.
  
  
  RESULTS
  Agoraphobia was only present in one (2.4%) patient who completed the twelve-week therapy, whereas it was present in six (15.0%) patients who dropped out (p = 0.044). Social phobia was present in eight (19.5%) patients who completed the twelve-week therapy and eighteen (45%) patients who dropped out (p = 0.014). Generalized anxiety disorder was present in eight (19.5%) patients who completed the twelve-week therapy and twenty (50%) dropouts (p = 0.004), and somatization disorder was not present in any of the patients who completed the twelve-week therapy; however, it was present in six (15%) dropouts (p = 0.010). According to the logistic regression model, treatment modality (p = 0.05), agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03) and the Beck Anxiety Inventory (p = 0.02) scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables.
  
  
  CONCLUSIONS
  Early treatment discontinuation is a common phenomenon in obsessive-compulsive disorder patients from our therapeutic setting. Psychiatric comorbidities were associated with discontinuation rates of specific treatments. Future studies might use this information to improve management for increased compliance and treatment effectiveness.
authors.affiliation: Department & Institute of Psychiatry, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil. julianabelo.diniz@gmail.com
authors.forename: Juliana Belo
authors.initials: JB
authors.lastname: Diniz
authors.forename: Dante Marino
authors.initials: DM
authors.lastname: Malavazzi
authors.forename: Victor
authors.initials: V
authors.lastname: Fossaluza
authors.forename: Cristina
authors.initials: C
authors.lastname: Belotto-Silva
authors.forename: Sonia
authors.initials: S
authors.lastname: Borcato
authors.forename: Izabel
authors.initials: I
authors.lastname: Pimentel
authors.forename: Euripedes Constantino
authors.initials: EC
authors.lastname: Miguel
authors.forename: Roseli Gedanke
authors.initials: RG
authors.lastname: Shavitt
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance / Q000523:psychology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors