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| Author(s): |
Cristina Belotto da Silva
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | São Paulo. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) |
| Defense date: | 2009-03-04 |
| Examining board members: |
Euripedes Constantino Miguel Filho;
Marcio Antonini Bernik;
Christina Hajaj Gonzalez;
Beny Lafer;
Denis Roberto Zamignani
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| Advisor: | Euripedes Constantino Miguel Filho |
| Abstract | |
Introduction: Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) are considered the first line treatments for Obsessive-Compulsive Disorder (OCD) in randomized controlled trials (RCT). However, most of these trials exclude a great amount of patients (around 50%) for presenting psychiatric comorbidities. Pragmatical and effectiveness clinical trials simulate natural clinical environments and compare active treatments in samples that represent the real population. These trials are of great importance for decision makers of the health public system, and only a few trials have investigated the effectiveness of treatments to OCD. The aim of this study was to compare the first line OCD treatments in a sample closer to the OCD real population, and to evaluate clinical characteristics associated to responses to treatments. Methodoly: Patients (1865 years; baseline Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with group CBT (GCBT; n=70) or pharmacological treatment (SSRI; n=88). GCBT consisted in twelve two hours weekly sessions with groups of 6 to 8 patients, based in a validated manual (Cordioli, 2002). Medication utilized in SSRI group was fluoxetine, 80mg/day. Response to treatment was analyzed as continuous variable (percent reduction on YBOCS) and as categorical variable (reduction of at least 35% on YBOCS and CGI 1 much better or 2 better. Results: Mean Y-BOCS scores fell by 23.13% in the GCBT and 21.54% in the SSRI group. Symptom reduction did not differ between groups (p = 0.875). A reduction of at least 35% in baseline Y-BOCS score and a CGI rating of 1 (much better) or 2 (better) was achieved by 33.3% of patients in the GCBT and 27.7% in the SSRI group (p=0.463). Patients presented 2.7 mean number of psychiatric comorbidity, and 81.4% showed at least one additional disorder. The YBOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than those with pure OCD (34.62%) (p = 0.034). Low responses to treatments were found to be associated to: being male, presenting a high initial Beck-A score, comorbid major depression, dysthymia and abandoning treatment, independently of the treatment received. The development of effective interventions to a real population is necessary (AU) | |