OBSESSIVE-COMPULSIVE DISORDER-RELATED DISORDERS - THE ROLE OF SELECTIVE SEROTONERGIC REUPTAKE INHIBITORS

Obsessive-compulsive spectrum disorders comprise a unique category of related disorders with important diagnostic, aetiological and therapeu tic implications. This group of disorders may overlap with obsessive-c ompulsive disorder (OCD) in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to se lective anti-obessional behavioural and pharmacotherapies. OCD related disorders can be viewed along a continuum with risk avoidance on the compulsive end and risk seeking at the other. This dimension may be de fined within a framework which relates hyperfrontality and increased s erotonergic sensitivity with compulsive disorders and hyperfrontality and low presynaptic serotonergic levels with impulsive disorders. Most biological models of OCD-related disorders stress the importance of s erotonin in their pathophysiology and these disorders have also been s hown to be preferentially responsive to selective serotonergic reuptak e inhibitors (SSRIs). This paper reviews the management of the OCD spe ctrum and the evidence for efficacy of the SSRIs and the differential treatment responses of the compulsive and impulsive disorders with reg ard to therapeutic dosage, response lag time and maintenance of sympto m remission.