Clinical features associated to refractory obsessive–compulsive disorder

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.MethodsTo 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.ResultsThe 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.ConclusionA 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.