Language
English
Publication Date
5-7-2026
Journal
BMC Psychiatry
DOI
10.1186/s12888-026-08073-2
PMID
42098690
PMCID
PMC13330284
PubMedCentral® Posted Date
5-7-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Background: This study evaluated medication utilization in children, adolescents, and adults with obsessive-compulsive disorder (OCD), a chronic psychiatric condition characterized by intrusive thoughts and repetitive behaviors. Although first-line treatments include selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT), the heterogeneous biological underpinnings contribute to suboptimal outcomes, with 40-60% of individuals not responding to SSRIs. This complex phenotype often leads to psychotropic polypharmacy, which may be mitigated by incorporating combinatorial pharmacogenomic (PGx) testing into protocol-based care to identify potential gene-drug interactions.
Methods: A retrospective review was conducted of individuals with OCD aged 8 to 65 years who received either PGx testing or treatment as usual (TAU). Co-primary outcomes were polypharmacy rate and quality of life. Secondary outcomes included length of stay, medication utilization, and OCD and depression severity. Individuals prescribed at least one daily psychotropic medication with a gene-drug interaction were classified as "incongruent" (PGx-I). Individuals without gene-drug interactions for all prescribed psychotropic medications were categorized as "congruent" (PGx-C).
Results: A total of 363 individuals with OCD were analyzed. Of these, 241 received TAU and 122 underwent PGx testing. Within the PGx cohort, 67% were prescribed medications with potential gene-drug interactions at discharge. The polypharmacy rate was 71% in the PGx-I cohort, compared with 35% in the PGx-C cohort. Quality-of-life measures revealed similar levels of improvement in the PGx-C and PGx-I cohorts.
Conclusions: Psychotropic polypharmacy rates were associated with a higher likelihood that individuals would be prescribed at least one medication with a gene-drug interaction, most notably among adults. Clinical outcomes improved among all cohorts, regardless of PGx testing or medication congruence. These findings suggest that combinatorial PGx testing may be useful as an adjunctive clinical decision support tool when evaluating individuals who admit to higher levels of psychiatric care on multiple psychotropic medications.
Keywords
Humans, Obsessive-Compulsive Disorder, Polypharmacy, Retrospective Studies, Female, Child, Middle Aged, Male, Adolescent, Adult, Pharmacogenetics, Young Adult, Psychotropic Drugs, Aged, Quality of Life, Pharmacogenomic Testing, Age Factors, OCD, CYP2D6, Depression, Anxiety, Pharmacogenomics, PGx, GeneSight, Polypharmacy, Antipsychotics, Antidepressants
Published Open-Access
yes
Recommended Citation
Garrison, Sheldon R; Boyer, Matthew W; Zoghbi, Anthony W; et al., "Pharmacogenomic-Guided Prescribing and Polypharmacy Across Age Groups in Obsessive-Compulsive Disorder: A Retrospective Study" (2026). Faculty, Staff and Students Publications. 7183.
https://digitalcommons.library.tmc.edu/baylor_docs/7183