[Is it time for revision of the section on obsessive-compulsive disorder in the Guideline on Anxiety Disorders?]

The multidisciplinary Guideline on anxiety disorders was published in December 2003. It may now be time for the section on ocd (obsessive-compulsive disorder) to be brought up to date.

To obtain insight into what the literature has contributed to the treatment of ocd since the publication in 2003 of the multidisciplinary Guideline on anxiety disorders.

The study took the form of a descriptive search of the literature. A literature search was conducted via Medline (PubMed) using the search terms 'obsessive-compulsive disorder' in combination with 'therapy'. The search was restricted to RCTS (randomized clinical trials) published between 1 December 2003 until 1 January 2006.

The new SNRIs (selective noradrenaline reuptake inhibitors), mirtazapine and venlafaxine, seem to be effective, but replication studies are needed. The combination of behaviour therapy and SSRIs (selective serotonin reuptake inhibitors) is effective. Cognitive therapy appears to be effective on the long term. In the case of refractory ocd, an effective form of treatment seems to consist of adding an SSRI, an SNRI or an atypical antipsychotic to an SSRI that the patient is already taking. Atypical antipsychotics seem to be effective in obsession.

SNRIs can be used as an alternative for SSRIs. Cognitive therapy should become the preferential form of treatment for ocd. More research is needed to validate the results of augmentation studies. There are several good reasons for updating the section on obsessive-compulsive disorder of the Guideline on anxiety disorders.