In addition, high scorers on the sexual/religious dimension responded less well to CBT. In a meta-analysis, patients with primary obsessive thoughts without rituals tended to improve less with CBT than those who had overt motor rituals.73 In a study by Alonso and colleagues,74 the presence of sexual and/or religious obsessions predicted poorer long-term

outcome, but, because most patients received both SSRIs and CBT, it was not clear from this study whether these symptoms predicted poorer outcome with SSRIs, CBT, or both. Similar studies Inhibitors,research,lifescience,medical need to be undertaken in pediatric populations. In adult studies, controlled trials with SSRIs have demonstrated a selective efficacy in OCD. However, up to 40% to 60% of patients

do not have a satisfactory outcome.75,76 Nonresponse to treatment in OCD is associated with serious social disability. These selleckchem differences Inhibitors,research,lifescience,medical in treatment outcome emphasize the heterogeneity of OCD and the need for identifying predictors of treatment response. While definitive studies have not been undertaken, recent studies have suggested that, a symptom-based dimensional approach may prove to be valuable for identifying significant predictors of treatment, outcome. For example, at least five studies have shown that patients with high scores on the hoarding dimension respond more poorly to SSRIs.13,14 In another study, high scores on the sexual/religious obsessions Inhibitors,research,lifescience,medical factor identified by Matrix-Cols and colleagues were associated with poorer long-term

outcome with SSRIs and behavior therapy in 66 adult outpatients who were followed up for 1 to 5 years.77 Two other groups have recently Inhibitors,research,lifescience,medical reported that the presence of sexual obsessions was a predictor of nonresponse to SSRIs.74,78 In future studies, if individuals with sexual obsessions and related compulsions are shown to be less likely to Inhibitors,research,lifescience,medical respond to SSRIs than individuals with obsessions about, harm and related compulsions, this may argue for retaining sexual obsessions and related compulsions as a separate dimension as first, proposed by Mataix-Cols et al.77 .Finally, preliminary studies from adult subjects indicate that patients with worries about harm (aggressive obsessions and compulsions) respond better to SSRIs than the remaining OCD patients.79 Again, these studies need to be extended to adolescents Sitaxentan with OCD and care needs to be taken to ensure the safety of these agents in prepubertal children.80 The importance of subclinical OCD Obsessions and compulsions are frequently encountered in children and adults without OCD. The rate in children may be as high as 8%.81 Tlic rate in adults without, a mental disorder may be as high as 13% to 15%, based on recent, data.81 Subclinical OCD can cause significant interference. For individuals with anxiety and mood disorders, the presence of fears of doing harm (Forbidden thoughts) is frequently associated with help-seeking behavior.