Faruk UĞUZ, Rüstem AŞKIN, ALİ SAVAŞ ÇİLLİ

Obsesif kompulsif bozuklukta ilaç tedavisine yanıtın öngörücüleri

Amaç: Bu çalışmada obsesif kompulsif bozuklukta (OKB) ilaç tedavisine yanıt ile sosyodemografik özellikler, klinik özellikler, eksen I ve II ek tanıları arasındaki ilişkilerin araştırılması amaçlandı. Yöntem: Çalışmaya DSM-IV tanı ölçütlerine göre OKB tanısı konulan 50 hasta alındı. DSM-IV Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme/Klinik Versiyon (SCID-I/CV), DSM-III-R Kişilik Bozuklukları için Yapılandırılmış Klinik Görüşme (SCID-II) ve Yale-Brown Obsesyon Kompulsiyon Ölçeği (YBOKÖ) ile yapılan ilk klinik değerlendirmeden sonra, bütün hastalar esnek dozda fluvoksamin, sertralin veya paroksetin ile 12 haftalık tedaviye alındı. Tedaviye yanıt 12 hafta sonunda YBOKÖ toplam puanında en az %35'lik azalma olarak tanımlandı. Bulgular: Çalışmayı 43 hasta tamamladı. Tedaviye yanıt vermeyen hastalarda herhangi bir eksen I bozukluğu sıklığı ile YBOKÖ belirti şiddeti ve içgörü puanları tedaviye yanıt verenlere göre anlamlı derecede yüksek bulundu. Lojistik regresyon analizi sonucunda, bu değişkenlerden sadece yüksek YBOKÖ toplam puanının ilaç tedavisine kötü yanıtın bağımsız öngörücüsü olduğu görüldü. Sonuç: Bulgularımız obsesif kompulsif belirtilerin daha şiddetli olmasının OKB'Iİ hastalarda ilaç tedavisine yanıtı olumsuz etkilediğini ve tedaviye kötü yanıtın öngörücüsü olduğunu göstermektedir.

Anahtar Kelimeler:

Paroksetin, Fluvoksamin, Farmakolojik etkiler, Sertralin, Demografi, İlaç tedavisi, Obsesif-kompulsif bozukluk, Anti-anksiyete ajanları

Predictors of response to pharmacotherapy in obsessive compulsive disorder

Objective: In this study, we aimed to investigate associations between response to pharmacotherapy in obsessive compulsive disorder (OCD) and sociodemographic and clinical characteristics, comorbid axis I and II disorders. Methods: Fifty patients with OCD diagnosed according to DSM-IV criteria were included in the study. After initial clinical evaluation with Structured Clinical Interview for DSM-IV/Clinical Version (SCID-I/CV), Struc¬tured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), all patients underwent a 12-week treatment with flexible-dose fluvoxamine, sertraline or paroxetine. Response to treatment was defined as a decrease at least a 35% on Y-BOCS total score at the end of 12-week treatment. Results: Forty-three patients completed the study. Nonresponders had a significantly higher frequency of any comorbid axis I disorder, and higher symptom severity and insight scores on Y-BOCS. When these variables were entered into logistic regression analyses, it was confirmed that a high Y-BOCS total score to be the independent predictor of poor response to pharmacotherapy. Conclusion: Our findings suggested that more severe obsessive-compulsive symptoms negatively influence response to pharmacotherapy and independent predictor of poor treatment response in patients with OCD.

Keywords:

Paroxetine, Fluvoxamine, Pharmacologic Actions, Sertraline, Demography, Drug Therapy, Obsessive-Compulsive Disorder, Anti-Anxiety Agents,

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