SYMPTOMS AND PHYSIOLOGICAL MANIFESTATIONS IN OBSESSIVE-COMPULSIVE PATIENTS BEFORE AND AFTER TREATMENT WITH CLOMIPRAMINE

Background. Anxiety and hyperarousal constitute important aspects of o bsessive compulsive disorder (OCD). This study examined the effects of clomipramine on symptoms, arousal-related physiologic states, and str ess reactions in OCD patients. Method. Twenty-five OCD patients were r andomly assigned to a clomipramine or placebo group and were assessed for 10 weeks using a double-blind parallel design. They were assessed clinically with the Yale-Brown Obsessive Compulsive Scale, the Nationa l Institute of Mental Health Global Obsessive-Compulsive Scale, the pa tient- and investigator-rated Global Improvement Scales, and the Hamil ton Rating Scale for Depression. Prior to treatment, and again during the last day of medication, physiologic states (heart rate, respiratio n, skin conductance, blood pressure, and EMG) were measured at rest an d during both nonspecific (psychomotor tasks) and pathology-specific ( visualization) stressors. Results: Patients taking clomipramine, but n ot those taking placebo, improved significantly on all clinical measur es. With the exception of heart rate, treatment did not affect resting physiologic states. Heart rate increased in patients taking clomipram ine and decreased in patients taking placebo. Autonomic reactivity to nonspecific and to pathology-specific stressors was attenuated by clom ipramine, but not by placebo. Conclusion: Clinical improvement on clom ipramine treatment was independent of the physiologic state of the pat ients and was not associated with autonomic down-regulation. The atten uation of autonomic reactivity to stressors appears not to be patholog y-specific but may reflect either a direct pharmacologic effect of clo mipramine on the autonomic nervous system or a heightened indifference to psychological stressors in general.