title: The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder.
abstract: Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.
authors.affiliation: Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil julianadiniz@usp.br.
authors.forename: Juliana B
authors.initials: JB
authors.lastname: Diniz
authors.affiliation: Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Daniel Lc
authors.initials: DL
authors.lastname: Costa
authors.affiliation: Mathematics and Statistics Institute, University of São Paulo, São Paulo, Brazil.
authors.forename: Raony Cc
authors.initials: RC
authors.lastname: Cassab
authors.affiliation: Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil Mathematics and Statistics Institute, University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos Ab
authors.initials: CA
authors.lastname: Pereira
authors.affiliation: Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Euripedes C
authors.initials: EC
authors.lastname: Miguel
authors.affiliation: Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Roseli G
authors.initials: RG
authors.lastname: Shavitt
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001938:Brazil; D002997:Clomipramine / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D000069348:Quetiapine Fumarate / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D005473:Fluoxetine; D000069348:Quetiapine Fumarate; D002997:Clomipramine
keywords: Body dysmorphic disorder; comorbidity; generalized estimating equations; obsessive-compulsive disorder; psychopharmacology; recruitment; sequential treatment; study design; study participation