Ravizza L, Barzega G, Bellino S, Bogetto F, Maina G
Department of Psychiatry, University of Turin, Italy.
J Clin Psychiatry. 1995 Aug;56(8):368-73.
Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder (OCD), a considerable percentage of these patients do not respond. Very few studies focus on factors related to treatment response of OCD. The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD.
We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months, dividing the sample into "responders" and "nonresponders" to treatment. At admission, patients were evaluated using a semistructured clinical interview, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Rating Scale for Depression, and the Hamilton Rating Scale for Anxiety. We then compared acute-phase patient characteristics and response to drug treatment. Response was defined as a decrease of at least 40% in the Y-BOCS total score and a rating of "improved" or "very improved" on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations.
By the sixth month of treatment, 31 patients (58.5%) responded to either clomipramine or fluoxetine. Nonresponders had lower age at onset and longer duration of the disorder; in addition, they showed higher frequency of compulsions, washing rituals, chronic course, concomitant schizotypal personality disorder, and previous hospitalizations. A worse response to drug treatment was predicted in a stepwise multiple regression by (1) concomitant schizotypal personality disorder, (2) presence of compulsions, and (3) longer illness length.
Our findings suggest that there are distinct types of OCD with respect to drug treatment response. They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.
尽管大量证据表明药物治疗对强迫症（OCD）有效，但仍有相当比例的患者无反应。很少有研究关注与强迫症治疗反应相关的因素。本研究的目的是调查哪些临床因素与强迫症的药物治疗反应相关。
我们检查了53例接受氯米帕明或氟西汀治疗6个月的强迫症患者，将样本分为治疗“反应者”和“无反应者”。入院时，使用半结构化临床访谈、耶鲁-布朗强迫症量表（Y-BOCS）、汉密尔顿抑郁量表和汉密尔顿焦虑量表对患者进行评估。然后我们比较了急性期患者的特征和药物治疗反应。反应定义为在治疗16周内Y-BOCS总分至少降低40%，且在临床总体印象量表上评为“改善”或“显著改善”，并在连续三次评估中保持。
到治疗的第六个月，31例患者（58.5%）对氯米帕明或氟西汀有反应。无反应者发病年龄较小，病程较长；此外，他们表现出强迫行为、洗涤仪式、慢性病程、伴有分裂样人格障碍和既往住院的频率更高。在逐步多元回归中，预测药物治疗反应较差的因素为：（1）伴有分裂样人格障碍，（2）存在强迫行为，（3）病程较长。
我们的研究结果表明，在药物治疗反应方面存在不同类型的强迫症。通过识别对不同治疗方式有反应的特征，它们提供了治疗特异性的间接证据，这可能对选择替代治疗的患者有价值。
