Neuropsychological predictors of response to randomized treatment in obsessive–compulsive disorder

Abstract

In general, OCD patients with better cognitive and executive abilities at baseline were more prone to respond to either CBT or fluoxetine. Our finding that neuropsychological measures of mental flexibility predicted response to treatment in opposite directions for CBT and fluoxetine suggests that OCD patients with different neuropsychological profiles may respond preferentially to one type of treatment versus the other. Further studies with larger samples of OCD patients are necessary to investigate the heuristic value of such findings in a clinical context.

The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators

“…Specifically, although men and women receiving ERP both showed lower post-treatment OCD severity than men and women receiving stress management training, the benefit of ERP over stress management training was significantly larger for men than women. In contrast, in the OCD study comparing fluoxetine to CBGT (D'Alcante et al, 2012), sex neither moderated nor predicted outcomes.…”

“…Whereas none of the three OCD studies discussed immediately above (D'Alcante et al, 2012;de Haan et al, 1997;Maher et al, 2010) found that level of depressive symptoms moderated or predicted outcomes, baseline depressive symptoms interacted with treatment type to moderate outcomes in a fourth OCD study (Hohagen et al, 1998). Specifically, post-hoc tests demonstrated that for those receiving behavioral therapy plus fluvoxamine, baseline depression levels did not affect outcomes.…”

“…Years of education failed to impact outcomes either when comparing CBGT to fluoxetine for OCD (D'Alcante et al, 2012). Although age did not impact outcomes when comparing combination therapies for OCD (Maher et al, 2010), older adults responded better to fluoxetine and younger adults responded better to CBGT in another OCD study (D'Alcante et al, 2012).…”

“…Yet neither of the two studies comparing pharmacotherapy to a cognitive or behavioral therapy found that baseline severity moderated outcomes (D'Alcante et al, 2012;de Haan et al, 1997). Therefore, the extant data, restricted to OCD samples, fails to uphold this assumption.…”

“…One OCD study examined neuropsychological factors as moderators of fluoxetine versus CBGT outcomes, although no post hoc tests were conducted (D'Alcante et al, 2012). Higher verbal IQ predicted better response to both treatments than lower verbal IQ, but to a greater extent in CBGT than in fluoxetine.…”