One exception was that patients with a cluster C personality disorder responded less well to nortriptyline than to fluoxetine.

Another example is the study by Denys et al26 on the development of a scale for early prediction of obsessive-compulsive disorder response to treatment. The accuracy of the scale was reasonable, with an area under the receiver operator characteristic (ROC) curve of 0.71. Here again, no attempt was made to obtain a prediction from the clinicians. Clinical trials represent Inhibitors,research,lifescience,medical a valuable source of information concerning Trichostatin A manufacturer predictors of outcome. For example, the retrospective analysis of 1839 patients in five placebo-controlled studies of venlafaxine prescribed for general anxiety disorders showed that sleep disturbance Inhibitors,research,lifescience,medical predicted positive response, while restlessness predicted poor response. Some variables, such as difficulty in concentrating or substance abuse history, predicted positive response to the placebo.27 The predictive variables measured in the above

studies have an obvious clinical nature, and the absence of evaluation of clinicians’ performance in predicting outcome represents Inhibitors,research,lifescience,medical an unfortunate missing aspect of these protocols. Biological predictors of outcome Physiological measures (eg, sleep architecture), pharmacological challenges (eg, the administration of psychostimulants), neuroendocrine baseline values (eg, monoamines,

metabolites in plasma, Inhibitors,research,lifescience,medical urine, or spinal fluid), neuroendocrine challenge studies (eg,dexamethasone or corticotropin-releasing factor [CRF] tests) have been studied Inhibitors,research,lifescience,medical in biological psychiatry research studies for decades. Several predictors of evolution have been identified in these studies, and in a few cases, these predictors explained one-quarter to one-half of the variance of outcome. More recently, developments in pharmacogenomics of have opened new avenues for applying predictive medicine techniques to psychiatric disorders. These biological predictive variables are described elsewhere in this issue of Dialogues in Clinical Neuroscience. Discussion The concordance between psychiatrists’ predictions, based on clinical impression and intuition, and the actual outcome of psychiatric patients has not been studied correctly. Our search of the medical literature databases (Medline, Excerpta Medica, and Psyclit) may have been incomplete since it was limited to journal articles and did not include chapters in books, but we doubt that this was important.