Clinical features associated to refractory obsessive–compulsive disorder

• Published in: Journal of affective disorders Vol. 94; no. 1; pp. 199 - 209
• Main Authors: Ferrão, Ygor A., Shavitt, Roseli G., Bedin, Nádia R., de Mathis, Maria Eugênia, Carlos Lopes, Antônio, Fontenelle, Leonardo F., Torres, Albina R., Miguel, Eurípedes C.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.08.2006; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Brazil; Case-Control Studies; Chronic Disease; Codependency (Psychology); Cognitive Therapy; Combined Modality Therapy; Comorbidity; Electroconvulsive Therapy; Female; Hospitalization; Humans; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Middle Aged; Mood disorders; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - epidemiology; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Obsessive-compulsive disorders; Obsessive–compulsive disorder; Predictive factors; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Life - psychology; Serotonin Uptake Inhibitors - therapeutic use; Socioeconomic Factors; Treatment Failure; Treatment response; Brazil; Predictive factors; Obsessive–compulsive disorder; Treatment response; Obsessive compulsive disorder; Treatment; Anxiety disorder; Obsessive-compulsive disorder; Predictive factor
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2006.04.019

Some patients with obsessive–compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature. To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD. The factors associated with refractoriness of OCD were higher severity of symptoms since the onset of OCD ( p < 0.001), chronic course ( p = 0.003), lack of a partner ( p = 0.037), unemployment ( p = 0.025), low economic status ( p = 0.015), presence of obsessive–compulsive symptoms of sexual/religious content ( p = 0.043), and higher scores on family accommodation ( p < 0.001). Only the three latter variables remained significantly associated with treatment-refractoriness after regression analyses. Limitations: small sample size, the biases and drawbacks inherent to a case-control study, and the inclusion criteria used to define the study groups may have limited the generalisation of the results. A major strength of this study is the systematic and structured evaluation of a vast array of variables related to the clinical expression of OCD, including epigenetic factors and ratings derived from instruments evaluating family accommodation. The presence of sexual/religious symptoms, low economic status and high modification on family function due to OCD were independently associated with treatment-refractoriness. Future longitudinal studies are warranted to verify if these variables represent predictive factors of treatment non-response.