Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder.
OBJECTIVE
To identify neuropsychological predictors of treatment response to cognitive-behavioral therapy (CBT) and fluoxetine in treatment-naïve adults with obsessive-compulsive disorder (OCD).


METHODS
Thirty-eight adult outpatients with OCD underwent neuropsychological assessment, including tasks of intellectual function, executive functioning and visual and verbal memory, before randomization to a 12-week clinical trial of either CBT or fluoxetine. Neuropsychological measures were used to identify predictors of treatment response in OCD.


RESULTS
Neuropsychological measures that predicted a better treatment response to either CBT or fluoxetine were higher verbal IQ (Wechsler Abbreviated Scale of Intelligence) (p=0.008); higher verbal memory on the California Verbal Learning Test (p=0.710); shorter time to complete part D (Dots) (p<0.001), longer time to complete part W (Words) (p=0.025) and less errors on part C (Colors) (p<0.001) in the Victoria Stroop Test (VST). Fewer perseverations on the California Verbal Learning Test, a measure of mental flexibility, predicted better response to CBT, but worse response to fluoxetine (p=0.002).


CONCLUSIONS
In general, OCD patients with better cognitive and executive abilities at baseline were more prone to respond to either CBT or fluoxetine. Our finding that neuropsychological measures of mental flexibility predicted response to treatment in opposite directions for CBT and fluoxetine suggests that OCD patients with different neuropsychological profiles may respond preferentially to one type of treatment versus the other. Further studies with larger samples of OCD patients are necessary to investigate the heuristic value of such findings in a clinical context.
Obsessive-Compulsive Disorder Spectrum Project Clinic, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. chaubetca@hcnet.usp.br
Carina C
CC
D'Alcante
Juliana B
JB
Diniz
Victor
V
Fossaluza
Marcelo C
MC
Batistuzzo
Antonio C
AC
Lopes
Roseli G
RG
Shavitt
Thilo
T
Deckersbach
Leandro
L
Malloy-Diniz
Euripedes C
EC
Miguel
Marcelo Q
MQ
Hoexter
D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D007361:Intelligence Tests / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016896:Treatment Outcome
D005473:Fluoxetine