Department & Institute of Psychiatry, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2011;66(3):387-93. doi: 10.1590/s1807-59322011000300004.
In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments.
This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients.
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.
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.
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.
在强迫症中，早期治疗中断可能会影响一线治疗的效果。
本研究旨在探讨强迫症患者早期治疗中断的临床相关性。
一组在完成前 12 周（总共 n = 41；认知行为治疗 n = 16，SSRIs n = 25）之前停止服用选择性 5-羟色胺再摄取抑制剂（SSRIs）或停止参加认知行为治疗的患者与一组配对的依从性患者（n = 41）进行比较。使用结构化临床访谈在基线时获得人口统计学和临床特征。当需要时使用卡方检验和曼-惠特尼检验。对组间差异 p 值 <0.15 的变量进行选择，纳入使用以治疗脱落为因变量的交互模型的逻辑回归分析。
只有一名（2.4%）完成 12 周治疗的患者出现广场恐怖症，而六名（15.0%）脱落的患者出现该症状（p = 0.044）。在完成 12 周治疗的 8 名（19.5%）患者和 18 名（45%）脱落的患者中出现社交恐怖症（p = 0.014）。在完成 12 周治疗的 8 名（19.5%）患者和 20 名（50%）脱落的患者中出现广泛性焦虑症（p = 0.004），而在完成 12 周治疗的任何患者中均未出现躯体化障碍，然而，在六名（15%）脱落的患者中出现该症状（p = 0.010）。根据逻辑回归模型，治疗方式（p = 0.05）、广场恐怖症、布朗信念量表评分（p = 0.03）和贝克焦虑量表评分（p = 0.02）与治疗中断的概率显著相关，与其他变量的相互作用无关。
在我们的治疗环境中，强迫症患者早期治疗中断是一种常见现象。精神共病与特定治疗的停药率有关。未来的研究可能会利用这些信息来改善管理，以提高依从性和治疗效果。
