Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder
L. Baer, M. A. Jenike, D. W. Black, C. Treece, R. Rosenfeld and J. Greist
Massachusetts General Hospital, Boston 02114.
We used the Structured Interview for DSM-III Personality Disorders to
diagnose DSM-III personality disorders systematically in 55 patients with
obsessive-compulsive disorder in the active-treatment cell of a controlled
trial of clomipramine hydrochloride. Patients with a cluster A personality
disorder had significantly higher obsessive-compulsive disorder severity
scores at baseline, and the number of personality disorders was strongly
related to baseline severity of obsessive-compulsive disorder symptoms. At
the conclusion of the 12-week study, we found no significant difference in
treatment outcome with clomipramine between those patients with at least
one personality disorder and those with no personality disorders. However,
the presence of schizotypal, borderline, and avoidant personality
disorders, along with total number of personality disorders, did predict
poorer treatment outcome. These variables were strongly related to having
at least one cluster A personality disorder diagnosis, which was also a
strong predictor of poorer outcome. Implications of these findings are
discussed.
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