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Title: Is body dysmorphic disorder a predictive factor for poor response to sequential pharmacological treatment strategies in OCD patients?
Citation: EUROPEAN NEUROPSYCHOPHARMACOLOGY, v.22, suppl.2, p.S376-S376, 2012
Abstract: In obsessive-compuslive disorder (OCD), body dysmorphic disorder (BDD) is a common concurrent diagnosis that is associated with poorer insight of OCD symptoms, higher prevalence of hoarding symptoms and higher number of psychiatric comorbidities [1]. Although the combination of OCD and BDD has been shown to be associated with more severe features and worse prognosis, in one study that investigated the impact of BDD on OCD treatment response similar response patterns were observed in OCD patients with and without comorbid BDD [2]. Objectives: We aimed to investigate the impact of BDD on the treatment response to sequential pharmacological strategies in adult patients whose main diagnosis was OCD (DSM-IV-TR criteria). Methods: We conducted a post hoc analysis of the results of a sequential trial involving initial fluoxetine monotherapy followed by add-on treatment strategies with fluoxetine (up to 40mg) plus clomipramine (up to 75mg), quetiapine (up to 200mg) or fluoxetine (up to 80mg) plus placebo. The original clinical trial was better described elsewhere [3]. One hundred thirty-eight patients received fluoxetine up to the maximum tolerated dosage for 12 weeks. Seventy patients who were non-responders to fluoxetine monotherapy (less than a 35% reduction in initial Yale-Brown Obsessive Compulsive Scale (YBOCS) scores) were invited to participate in the add-on trial. Fifty-four patients (men=25, women=29; mean age=34, SD=11, range=18−64; mean age at onset=11, SD=5, range=5−27; mean initial YBOCS score=27, SD=5, range=13−38) accepted to participate and were followed for additional 12 weeks. Eighteen patients were allocated to each treatment group by a minimization procedure. At endpoint, patients were considered responders to augmentation treatment if they had an additional reduction of at least 25% of the YBOCS scores. Logistic regression was used having response status to add-on therapy as the dependent variable and age, gender, treatment group, age at OCD onset, comorbid tics and/or depression, maximum tolerated fluoxetine dosage, response to fluoxetine monotherapy, initial YBOCS severity and BDD status as covariates. Results: Thirty-nine patients (OCD with BDD, n=14; OCD without BDD, n=25) completed the study. OCD patients with BDD were more prone to be classified as non-responders (n=11; 84.6%) than OCD patients without BDD (n=13; 50%; Pearson Chi Square=3.9, p=0.049). Comorbid BDD was the only variable associated with non-response in the regression model (b=−3.3; p-value=0.044). Discussion: We found that BDD is a potential predictorofworsetreatmentresponsetosequentialOCDtreatment strategies irrespectively of the type of pharmacological intervention. These findings are coherent with the association of BDD with markers of higher severity in OCD patients but replication in future studies is still warranted. Limitations of this study include the small sample size, the short period of follow-up and high co-occurrenceofBDDandSocialPhobia.Inaddition,no conclusions could be drawn in regards to each individual add-on treatment strategy.
Appears in Collections:

Comunicações em Eventos - FM/MPS
Departamento de Psiquiatria - FM/MPS

Comunicações em Eventos - HC/IPq
Instituto de Psiquiatria - HC/IPq

Comunicações em Eventos - LIM/21
LIM/21 - Laboratório de Neuroimagem em Psiquiatria

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