Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic...

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Background:

• Selective serotonin reuptake inhibitors (SRIs) show limited efficacy in 40-60% of patients with obsessive-compulsive disorder (OCD).
• Treatment non-response in OCD leads to significant social disability and is complicated by diagnostic ambiguities, potential subtypes, and high comorbidity.
• Current research on non-responders is limited by a lack of standardized definitions, hindering generalizability and data aggregation.

Purpose of the Study:

• To clarify challenges in defining treatment response and non-response stages in OCD.
• To propose a systematic nosology for treatment-refractory OCD through comprehensive analysis.
• To enable better patient stratification and facilitate multisite data collection for future research.

Main Methods:

• Review of existing literature on treatment response and non-response in OCD.
• Analysis of diagnostic criteria, subtypes, and comorbidity impacting treatment outcomes.
• Examination of recent pharmacological and psychological therapeutic approaches for refractory OCD.

Main Results:

• Lack of an operational definition for non-response limits current study generalizability.
• Ambiguities in diagnosis, subtypes, and comorbidity complicate patient clustering.
• A systematic nosology is needed to characterize non-responders and guide future research.

Conclusions:

• Improved characterization of treatment responders and non-responders is crucial for OCD management.
• Developing a clear nosology will enhance patient clustering and multisite research collaboration.
• Further research into pharmacological and psychological interventions is necessary for refractory OCD cases.