Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder

Diniz, Juliana Belo; Malavazzi, Dante Marino; Fossaluza, Victor; Belotto-Silva, Cristina; Borcato, Sonia; Pimentel, Izabel; Miguel, Eurí­pedes Constantino; Shavitt, Roseli Gedanke

doi:10.1590/s1807-59322011000300004

Cited by 13 publications

(7 citation statements)

References 28 publications

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“…SAD is also mentioned as a predictor of worse response to both pharmacotherapy and psychotherapy for OCD in a sample that overlaps with ours (Belotto-Silva et al, 2012) and as a factor associated with early treatment abandonment (Diniz et al, 2011a). In a recent study by Kelly et al (Kelly et al, 2012), patients with comorbid BDD and SAD showed greater functional impairment than the BDD only and SAD only groups.…”

Section: Discussionmentioning

confidence: 99%

The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 99%

The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder

et al. 2013

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“…They also observed better outcomes, in terms of compliance, with an increased frequency of consultations in the initial phase of their study. 106 …”

Section: Treatment Of Refractory Obsessive-compulsive Disordermentioning

confidence: 99%

Current management of obsessive and phobic states

Goljevscek

Carvalho²

2011

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Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors) are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.

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“…Regarding the chance of abandonment of pharmacological treatment, comorbid major depression has been decribed to diminish the chance of abandonment [17]. While another study has shown that comorbid agoraphobia, social phobia, generalized anxiety disorder and somatization disorder increase the chance of abandonment [18].…”

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confidence: 99%

“…Regarding pharmacological intervention, there is some evidence that reducing the length of intervals between medical appointments (seeing patients every 2 weeks instead of every month) might be helpful to prevent early treatment abandonment [18]. Likewise, as OCD patients with comorbid generalized anxiety and somatization disorder are more prone to abandon treatment due to medications' side effects, it might be helpful to assign these patients to psychotherapy whenever possible and to carefully choose drugs with better side-effect profiles for each specific patient [18]. There is also evidence that selective SRIs are associated with better treatment adherence than clomipramine due to the side-effect profile of the later [22].…”

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confidence: 99%