Treatment Strategies for Chronic and Refractory Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD), despite our increasing understanding of its causes and itseffective treatment, remains a chronic and underdiagnosed disorder. Both treatment with SSRIs andthe behavioral treatment strategy of exposure with response prevention have been proved by clinicaltrials to be effective and safe in treating OCD; however, even these treatments sometimes elicit onlymoderate patient response, and some OCD patients do not respond to them at all. Preliminary datasuggest that OCD has lifelong persistence and that discontinuation of pharmacotherapy often leads torelapse. Nonetheless, further prospective, controlled, maintenance studies of OCD are needed to determinefactors in and predictors of recovery, remission, and relapse. Finally, new procedures fortreatment-refractory patients are needed; neurosurgical and new pharmacologic approaches haveshown promise in treating these patients and should be studied in controlled trials.