Escitalopram in obsessive-compulsive disorder: Response of symptom dimensions to pharmacotherapy
Date
2008
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Abstract
Introduction: There is a substantial body of evidence that obsessive-compulsive disorder (OCD) symptoms can be grouped into a series of discrete dimensions, and some evidence that not all OCD symptom dimensions respond equally well to pharmacologic or psychotherapeutic intervention. The response of OCD symptom dimensions to 12 weeks of treatment with escitalopram or placebo was investigated. Methods: Data from a randomized, double-blind, placebo-controlled study of escitalopram in 466 adults with OCD were analyzed. Exploratory factor analysis of individual items of the Yale-Brown Obsessive-Compulsive Scale checklist was performed and subscale scores based on the extracted factors were determined. Analyses of covariance were undertaken to determine whether inclusion of each subscale score in these models impacted on the efficacy of escitalopram versus placebo. Results: Exploratory factor analysis of individual Yale-Brown Obsessive-Compulsive Scale items yielded 5 factors (contamination/cleaning, harm/checking, hoarding/symmetry, religious/ sexual, and somatic/hypochondriacal). Analyses of covariance including all the subscales demonstrated that escitalopram was more effective than placebo. There was a significant interaction for the hoarding/symmetry factor, which was associated with a poor treatment response. Conclusion: Escitalopram shows good efficacy across the range of OCD symptom dimensions. Nevertheless, hoarding/symmetry was associated with a poorer treatment response. Hoarding/symmetry may be particularly characteristic of an early-onset group of OCD patients, with the involvement of neurotransmitters other than serotonin. Further work is needed to delineate fully the subtypes of OCD, and their correlates with underlying psychobiology and treatment responsivity.
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Keywords
escitalopram, paroxetine, placebo, adult, aged, article, controlled study, drug dose titration, drug efficacy, female, human, major clinical study, male, Obsessive-compulsive disorder, priority journal, rating scale, recommended drug dose, treatment response, Adult, Antidepressive Agents, Second-Generation, Citalopram, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Middle Aged, Obsessive-compulsive disorder, Paroxetine, Personality Assessment, Personality Inventory, Psychometrics, Treatment Outcome
Citation
CNS Spectrums
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