Novel ensemble method for the prediction of response to fluvoxamine treatment of obsessive–compulsive disorder

Abstract

ObjectiveAbout 30% of obsessive–compulsive disorder (OCD) patients exhibit an inadequate response to pharmacotherapy. The detection of clinical variables associated with treatment response may result in achievement of remission in shorter period, preventing illness development and reducing socioeconomic costs.MethodsIn total, 330 subjects with OCD diagnosis underwent 12-week pharmacotherapy with fluvoxamine (150–300 mg). Treatment response was ≥25% reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score. In total, 36 clinical attributes of 151 subjects who had completed their treatment course were analyzed. Data mining algorithms included missing value handling, feature selection, and new analytical method based on ensemble classification. The results were compared with those of other traditional classification algorithms such as decision tree, support vector machines, k-nearest neighbor, and random forest.ResultsSexual and contamination obsessions are high-ranked predictors of resistance to fluvoxamine pharmacotherapy as well as high Y-BOCS obsessive score. Our results showed that the proposed analysis strategy has good ability to distinguish responder and nonresponder patients according to their clinical features with 86% accuracy, 79% sensitivity, and 89% specificity.ConclusionThis study proposed an analytical approach which is an accurate and a sensitive method for the analysis of high-dimensional medical data sets containing more number of missing values. The treatment of OCD could be improved by better understanding of the predictors of pharmacotherapy, which may lead to more effective treatment of patients with OCD.

<p>Fluvoxamine treatment response prediction in obsessive-compulsive disorder: association rule mining approach</p>

“…Pharmacotherapy was defined as a 12-week treatment with fluvoxamine (150–300 mg), which has been described previously 28. Briefly, the escalating fluvoxamine daily dose was initiated from 25 mg/day and increased up to 100 mg/day in the third week.…”

“…Others were excluded because of refusal to come for follow-up (N=108), not taking medication properly (N=38), discontinuity in pharmacotherapy due to complications, including allergy to the drug (N=8), meeting exclusion criteria during pharmacotherapy (N=6), and other reasons (N=19). Since we used the previously published data set to investigate the association rule data mining approach, the CONSORT diagram which summarizes the flow of participants through different stages of the trial was presented previously 28. The excluded and included patients showed no significant differences in mean baseline scores considering their demographic (sex and marital status) and clinical characteristics (history of psychiatric disorders, age at assessment, age of onset, obsession severity, compulsion severity, and total severity) as well as symptom dimensions from the Y-BOCS symptom checklist (data not shown, all P >0.1).…”

Association of two specific haplotypes of serotonin transporter gene with fluvoxamine treatment outcomein Iranian patients with obsessive compulsive disorder

“…The socio-demographic data and OCD severity were collected through a structured interview using socio-demographic questionnaire and the Persian version of Y-BOCS severity scale, respectively. Pharmacotherapy was defined as 12 weeks treatment with fluvoxamine (150-300mg) as it has been described previously (Hasanpour et al, 2018). Briefly, the escalating fluvoxamine daily dose was initiated from 25mg/day, increased up to 100mg/day for the 3rd week.…”

Remission of treatment-resistant obsessive-compulsive disorder with 600 milligrams of fluvoxamine daily: a case report

“…The medication must be continued for at least 12 weeks with an effective dosage to find the most effective SSRI (Hasanpour et al , 2018). When SSRIs and clomipramine are used in the treatment of OCD, the drug dose should be titrated to the highest tolerated dose (Harris et al , 2019). In this article, we report remission with 600 mg (high dose) of fluvoxamine, which was tolerated and effective for a patient with OCD.…”

“…The first-line drugs for OCD pharmacotherapy are selective serotonin reuptake inhibitors (SSRIs). The medication must be continued for at least 12 weeks with an effective dosage to find the most effective SSRI (Hasanpour et al, 2018). When SSRIs and clomipramine are used in the treatment of OCD, the drug dose should be titrated to the highest tolerated dose (Harris et al, 2019).…”