Shetti Chandrashekhar N, Reddy Y C Janardhan, Kandavel Thennarasu, Kashyap Kartik, Singisetti Srinivas, Hiremath Avinash S, Siddequehusen Mulia Umar-Faruq, Raghunandanan Samar
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
J Clin Psychiatry. 2005 Dec;66(12):1517-23. doi: 10.4088/jcp.v66n1204.
Obsessive-compulsive disorder (OCD) is often a chronic and disabling illness with high comorbidity. Serotonin reuptake inhibitors (SRIs) are effective in treating OCD. However, 40% to 60% of patients with OCD do not respond adequately to SRIs. This study aims to identify the clinical predictors of nonresponse to SRIs in OCD by comparing SRI responders and nonresponders.
122 subjects with a diagnosis of DSM-IV OCD of at least 1 year's duration and with treatment history of adequate trials with at least 2 SRIs were recruited from December 2002 to March 2004. Of these, 67 were SRI responders and 55 were SRI nonresponders; they were compared on various clinical parameters. Nonresponse was defined as a score of >/=3 on the Clinical Global Impressions-Improvement sub-scale (CGI-I) after at least 2 adequate trials with SRIs. Response was defined as a score of 1 or 2 on the CGI-I.
In regression analysis, baseline severity of OCD (p = .049), comorbid major depressive disorder (p = .005), presence of sexual obsessions (p = .002), and washing (p = .008) and miscellaneous compulsions (p = .013) were identified as predictors of nonresponse to SRIs. Early age at onset showed a trend toward prediction of nonresponse (p = .056). In the univariate analysis, mixed OCD (p = .001) and poor insight (p = .023) were associated with nonresponse.
This study has identified clinical predictors of nonresponse to SRIs. These predictors may have to be taken into consideration and assessed carefully when SRIs are prescribed to treat OCD. Future studies should aim at identifying treatment modalities that are effective in SRI nonresponders.
强迫症（OCD）通常是一种慢性致残性疾病，合并症发生率高。5-羟色胺再摄取抑制剂（SRIs）对治疗强迫症有效。然而，40%至60%的强迫症患者对SRIs反应不佳。本研究旨在通过比较SRIs反应者和无反应者，确定强迫症患者对SRIs无反应的临床预测因素。
2002年12月至2004年3月招募了122名诊断为DSM-IV强迫症且病程至少1年、有至少2种SRIs充分试验治疗史的受试者。其中，67名是SRIs反应者，55名是SRIs无反应者；对他们的各种临床参数进行了比较。无反应定义为在至少2次充分的SRIs试验后，临床总体印象改善量表（CGI-I）得分≥3分。反应定义为CGI-I得分为1或2分。
回归分析显示，强迫症的基线严重程度（p = 0.049）、合并的重度抑郁症（p = 0.005）、存在性强迫观念（p = 0.002）、洗涤（p = 0.008）和其他强迫行为（p = 0.013）被确定为对SRIs无反应的预测因素。发病年龄早显示出无反应预测的趋势（p = 0.056）。单因素分析中，混合性强迫症（p = 0.001）和自知力差（p = 0.023）与无反应相关。
本研究确定了对SRIs无反应的临床预测因素。在开SRIs治疗强迫症时，可能必须考虑并仔细评估这些预测因素。未来的研究应致力于确定对SRIs无反应者有效的治疗方式。
