TREATMENT STRATEGIES FOR CHRONIC AND REFRACTORY OBSESSIVE-COMPULSIVE DISORDER

Obsessive-compulsive disorder (OCD), despite our increasing understand ing of its causes and its effective treatment, remains a chronic and u nderdiagnosed disorder. Both treatment with SSRIs and the behavioral t reatment strategy of exposure with response prevention have been prove d by clinical trials to be effective and safe in treating OCD; however , even these treatments sometimes elicit only moderate patient respons e, and same OCD patients do not respond to them at all. Preliminary da ta suggest that OCD has lifelong persistence and that discontinuation of pharmacotherapy often leads to relapse. Nonetheless, further prospe ctive, controlled, maintenance studies of OCD are needed to determine factors in and predictors of recovery, remission, and relapse. Finally , new procedures for treatment-refractory patients are needed; neurosu rgical and new pharmacologic approaches have shown promise in treating these patients and should be studied in controlled trials.