Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo

Abstract

Response of symptom dimensions in obsessivecompulsive disorder to treatment with citalopram or placebo Resposta das dimensões dos sintomas no transtorno obsessivo-compulsivo ao tratamento com citalopram ou placebo Hoarding/symmetry was associated with male gender, longer duration of obsessive-compulsive disorder and early onset, whereas contamination/cleaning was associated with female gender. Citalopram was more effective than placebo, but high scores on the symmetry/hoarding and contamination/cleaning subscales predicted worse outcome at the end of study while high scores on the aggressive/religious/sexual subscale predicted better outcome. Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist symptom clusters yielded a 4 factor solution, but confirmed that symmetry/ordering was associated with male gender, early onset, and long duration of obsessive-compulsive disorder while high scores on the hoarding subscale predicted worse response to pharmacotherapy. Conclusion: Citalopram shows good efficacy across the range of obsessive-compulsive disorder symptom dimensions. The relatively worse response of symmetry/hoarding to a selective serotonin reuptake inhibitor is consistent with other evidence that this symptom dimension is mediated by the dopamine system. There may be associations between symmetry/hoarding, male gender, early onset, tics, and particular genetic variants; further work is, however, needed to delineate fully obsessive-compulsive disorder subtypes and their underlying neurobiology. Descriptors: Obsessive-compulsive disorder; Yale-Brown Obsessive-Compulsive Scale; Citalopram; Serotonin; Serotonin uptake inhibitors Resumo Objetivo: Há crescentes evidências de que os sintomas do transtorno obsessivo-compulsivo residem em dimensões discretas. Alguns estudos têm sugerido que esses fatores possuem suportes neurobiológicos específicos. No entanto, poucos trabalhos têm explorado a relação entre tais fatores e a resposta à farmacoterapia. Método: Foi realizada a análise fatorial dos itens individuais e categorias de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown e foi analisado o impacto da dimensão dos sintomas no desfecho dos tratamentos. Resultados: A análise fatorial exploratória dos itens individuais da Escala de Obsessão e Compulsão de YaleBrown produziu cinco fatores (contaminação/limpeza, dano/verificação, agressividade/sexual/religioso, colecionismo/simetria e somático/ hipocondríaco). Colecionismo/simetria foi associado ao sexo masculino, longa duração do transtorno obsessivo-compulsivo e início precoce, ao passo que contaminação/limpeza foi associado ao sexo feminino. O citalopram foi mais eficaz do que placebo, mas altos escores nas subescalas de simetria/colecionismo e de contaminação/limpeza predisseram desfecho pior ao final do estudo, ao passo que altos escores na subescala agressividade/sexual/religioso predisseram melhor desfecho. Uma análise fatorial de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown produziu uma solução com quat...

Gender differences in obsessive-compulsive disorder: a literature review

“…22,36,37 In male, symmetry obsessions would be more common, 23,24,38 as well as ordering, 36,38 repeating, 19 checking, 23 and hoarding compulsions. 39,40,41 Torresan et al 25 found among Brazilian men more sexual, religious, and symmetry obsessions, as well as more mental rituals. Chacon et al 42 evaluated OCD symptom dimensions in 40 pairs of Brazilian siblings with OCD.…”

“…37 Different ways of clustering symptoms hamper the comparisons between OCD studies to some extent. Some of them, for example, analyze aggressive obsession along with sexual and religious obsessions, 36,[38][39][40][41][42] which are more common among males. Such symptoms are called by some authors "forbidden" or "taboo" thoughts, 43 usually manifested as ego-dystonic impulses.…”

Structural magnetic ressonance imaging in anxiety disorders: an update of research findings

“…51 The efficacy of selective serotonin re-uptake inhibitors (SSRIs) in controlling obsessive-compulsive symptoms strongly suggests the involvement of abnormalities of serotoninergic transmission in the pathophysiology of OCD. 9,58 Szesko et al monitored 11 children with a diagnosis of OCD before and after treatment with paroxetine and demonstrated that, in addition to these patients having asymmetry of the amygdala before treatment (the left one larger than the right one), their left amygdala volume was reduced after the use of this SSRI in a study using a semi-automated ROI-based method. 59 Serotoninergic transmission in this brain area has been associated with the modulation of fear and of conditioned anxiety, factors that seem to play an important role in OCD.…”

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“…Selective serotonin reuptake inhibitors [13][14][15][16], Serotoninnorepinephrine reuptake inhibitors [17], Central nervous system stimulants [18] and atypical antipsychotic agents [19] have been administered for HD, but results from pharmaceutical treatment trials for hoarding are equivocal.…”