Vol 6 n° 1 - Predictors of Response to Treatment in Neuropsychiatry
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ontrary to somatic medicine, psychiatric sympto- matology—with the possible exception of behavioral symptoms  and  social  consequences—is  not  readily described  by  objective  measures. Rather, psychiatric symptoms are produced by the patient’s perception and subjective experience. However, this does not preclude attempts to identify, describe, and correctly quantify this symptomatology. This can be achieved in a straightfor- ward manner through psychometric measures, cognitive and neuropsychological tests, and symptom rating scales. Associated laboratory findings can also provide data that correlate with clinical syndromes: in the last few decades, a range of laboratory measures has become commonly used in psychiatry, from neuroendocrine assays to brain imaging, either functional imaging (electroencephalog- raphy [EEG], quantitative EEG, evoked potentials, sleep studies, etc) or structural and functional imaging (mag- netic resonance imaging [MRI], single-photon emission computed  tomography  [SPECT],  positron  emission tomography [PET], etc). Psychiatric  treatment  encompasses  a  whole  array  of approaches, from psychotherapy to psychopharmacology, electroconvulsive therapy, and clinical hypnosis. It also includes various types of social intervention. Evaluating treatment response implies that the patient’s condition, at baseline and after a fixed duration of treatment, can be assessed in a scientific manner. Pharmacotherapy and cognitive-behavioral therapy (CBT) can easily meet this criterion. Traditionally, psychotherapy, with its emphasis on the individual case, is considered less amenable to evaluation of therapeutic response, although there have been many studies.1 In many medical situations, treatment aims at reducing or eliminating symptoms; its efficacy must be assessed with the same clinical and laboratory criteria that were used  to  characterize  the  disorder. In  psychiatry, the symptoms are often modified or improved, but not sup- pressed. Another pitfall is that treatment response does not depend only on the presenting disorder; it is also C l i n i c a l   r e s e a r c h Treatment goals: response and nonresponse Jean-Paul Macher, MD; Marc-Antoine Crocq, MD Keywords: treatment response; nonresponse to treatment; diagnosis; psychiatry Author  affiliations:  FORENAP,  Institute  for  Research  in  Neuroscience  and Neuropsychiatry, Rouffach, France Address for correspondence: Dr Jean-Paul Macher, MD, FORENAP, Institute for Research in Neuroscience and Neuropsychiatry, BP 29, 68250 Rouffach, France
(e-mail: jp.macher@ch-rouffach.fr) C Psychiatric symptomatology is often subjective, but it can be partly made more objective for the purposes of evaluation. Esquirol was the first modern psychiatrist to stress the need for a scientific approach to treatment evaluation.  The  kinetics  of  treatment  is  complex because different components of the clinical picture improve at a different pace. Assessment of treatment requires prior definition of end point, response, and nonresponse. Response is influenced by several factors, such as placebo effect, diagnostic category and sub- types, and patient heterogeneity. Treatment response may be predicted from clinical and biological parame- ters. This article lists the main causes of nonresponse, and suggests how to remedy them. © 2004, LLS SAS Dialogues Clin Neurosci. 2004;6:83-91. 8 3 Copyright © 2004 LLS SAS.  All rights reserved www.dialogues-cns.org