Management of Treatment - Resistant Obsessive - Compulsive Disorder

Opinion StatementPurpose of review Many individuals with obsessive-compulsive disorder (OCD) do not fully respond to first-line treatments (psychotherapy consisting of exposure and response prevention [EX/RP] and serotonin reuptake inhibitor [SRI] pharmacotherapy). These cases are often considered “treatment-resistant” OCD. In this article, we offer a heuristic guide for treating clinicians for such cases.Recent findings Clinical options for treatment-resistant OCD include augmenting first-line treatments with medications, psychotherapy, and neuromodulatory approaches. These augmentation and novel monotherapy interventions offer promise in allowing more patients to improve. For the most refractory cases, neurosurgery may be considered, though only as a last resort after less invasive treatments have been given adequate trials.Summary In the future, advances in our understanding of OCD and its brain mechanisms may refine existing interventions and yield new treatment options. Ultimately, these efforts may lead to a precision medicine approach to treating OCD by allowing clinicians to match optimal treatment strategies to each individual patient.
Source: Current Treatment Options in Psychiatry - Category: Psychiatry Source Type: research