Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: What moderates improvement?
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: Patients with obsessive-compulsive disorder (OCD) often only partially respond to serotonin reuptake inhibitors (SRIs). In such cases, American Psychiatric Association practice guidelines suggest augmenting SRIs with cognitive-behavioral therapy consisting of exposure and ritual prevention (EX/RP) or antipsychotic medication (i.e., risperidone). We examined moderators and predictors of these 2 augmentation strategies. METHOD: Data came from a randomized controlled trial that compared adding EX/RP or risperidone to SRIs in adults with OCD. Patients entered the study on a stable SRI dosage and were randomized to EX/RP (N = 40), risperidone (N = 40), or placebo (N = 20). Data were analyzed using multilevel modeling. RESULTS: Pretreatment OCD severity, age, and depression were significant moderators. Although OCD severity was unrelated to EX/RP response, individuals with more severe OCD had poorer outcomes and slower improvement with risperidone. Increasing age predicted better response to risperidone, but not EX/RP. Increased depression predicted poorer response to placebo, but not EX/RP or risperidone. Poorer functioning predicted worse outcome across all 3 conditions. Together, these moderators and predictor accounted for 33% of the variance in outcomes, above and beyond the 30.8% accounted for by treatment condition. CONCLUSIONS: SRI augmentation with EX/RP was more effective than risperidone across all of the demographic and clinical variables tested. EX/RP's superiority over risperidone increased with baseline OCD severity and with younger age. These data indicate that EX/RP should be the recommended SRI augmentation strategy, even for severe OCD. What determines the degree of EX/RP response in individual patients deserves further study.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it