Diagnosis and response The main purpose of classification is to identify groups of patients who share similar clinical features, so that suitable treatment can be planned and the likely outcome predicted.7 As shown in Table I,8-8 response rates vary widely in different disorders. In obsessive-compulsive disorder (OCD), up to 40% of patients are considered to be nonresponders Inhibitors,research,lifescience,medical to a specific pharmacological treatment.“ Treatment is notably arduous and protracted for certain ”refractory“ disorders. An example is anorexia nervosa, in which response rates should be evaluated taking into account

the fact that management is long; etiologies are also heterogeneous, and treatment methods are numerous and varied. Chronic conditions may become notoriously intractable, eg, the negative impact of the duration of untreated psychosis has been proven. Personality disorders may interfere Inhibitors,research,lifescience,medical with the treatment of a DSM-IV Axis I disorder. For instance, depression is much more difficult to treat in a patient with an obsessive-compulsive personality than in someone with a phobic personality. Some diagnostic categories are seldom seen in a pure and Enzastaurin molecular weight isolated state, but are usually associated with comorbid conditions, which complicate

management and are often difficult to treat. Comorbidity frequently raises the issue of Inhibitors,research,lifescience,medical a primary or secondary condition. An example is social phobia, which shows a high lifetime risk of comorbidity with other psychiatric disorders and conditions, eg, other anxiety disorders, major depression, and drug Inhibitors,research,lifescience,medical or alcohol abuse. Epidemiological studies have reported comorbidity in 70% to 80% of samples of patients with social phobia.12 Treatment may fail because it is directed at the secondary problem rather than the underlying social phobia. In all patients with depression, alcohol or drug problems, or panic attacks, the alert clinician should routinely ask about phobic avoidance and fear of scrutiny, in order to identify a possible underlying social phobia.10 Table I. Some examples of the proportion of patients responding adequately to treatment PTSD, posttraumatic stress disorder, Inhibitors,research,lifescience,medical NA, not applicable, CGI, Clinical

Unoprostone Global Impression scale, CAPS-2, Clinician-Administered PTSD scale, IES, Impact of Event Scale, CGI-S, … An important question is whether a specific symptomatic profile or a specific clinical subtype within a diagnostic category may better predict treatment response than a general diagnosis. Symptom profiles and diagnostic and patient subtypes Within a single diagnostic entity, subtypes respond differently to treatment. For instance, Fava et al14 proposed the existence of a subgroup of highly irritable and hostile depressed patients, who report anger attacks and have a psychological profile distinct from that of depressed patients without anger attacks; fluoxetine treatment appeared to reduce anger and hostility in these patients.