[Treatment of obsessive-compulsive disorder]

Area of Science:

• Psychiatry
• Neuroscience
• Pharmacology

Background:

• Obsessive compulsive disorder (OCD) treatment has seen limited evolution since 2000.
• Current management relies on a hierarchical, step-by-step therapeutic strategy.
• Patient assessment using validated scales is crucial for determining treatment intensity.

Purpose of the Study:

• To outline the current evidence-based treatment guidelines for obsessive compulsive disorder (OCD).
• To describe the efficacy and sequencing of various therapeutic interventions for OCD.
• To highlight advanced and refractory treatment options for OCD.

Main Methods:

• Review of current literature and clinical guidelines for OCD treatment.
• Assessment of treatment efficacy based on symptom severity scores (e.g., Yale-Brown Obsessive Compulsive Score [Y-BOCS]).
• Evaluation of pharmacological interventions, including Selective Serotonin Reuptake Inhibitors (SSRIs) and augmentation strategies.
• Consideration of behavioral and cognitive therapies (BCT), particularly exposure and response prevention.
• Analysis of outcomes for treatment-refractory OCD, including neurosurgery.

Main Results:

• Low-intensity OCD (Y-BOCS ~15) primarily managed with BCT, especially exposure with response prevention.
• Moderate to severe OCD requires pharmacotherapy, with SSRIs recommended in monotherapy at higher doses than for depression.
• Treatment response is often slow, with significant improvement defined as a 50% reduction in symptom intensity; complete remission is rare.
• Clomipramine may offer a slight advantage over SSRIs.
• Maintenance treatment duration of 18-24 months is advised after improvement.
• Switching SSRIs or combining with BCT can aid non-responders.
• Augmentation with risperidone or olanzapine shows efficacy in refractory OCD.
• Deep brain stimulation is a potential option for rare, malignant OCD cases.

Conclusions:

• A tiered treatment approach, from BCT to pharmacotherapy and advanced interventions, is essential for managing OCD.
• SSRIs are first-line pharmacotherapy for moderate to severe OCD, requiring higher doses and prolonged treatment duration.
• Novel strategies, including augmentation and neurosurgery, offer hope for treatment-refractory and severe OCD cases.