[Resistance and refractoriness in obsessive-compulsive disorder].

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Context:

• Obsessive-compulsive disorder (OCD) presents a significant clinical challenge, with a substantial portion of patients not achieving remission with standard treatments.
• Understanding treatment resistance and refractoriness is crucial for improving patient outcomes in OCD management.

Purpose:

• To review current concepts of treatment resistance and refractoriness in OCD.
• To identify intrinsic and extrinsic factors influencing treatment response in OCD.
• To propose a therapeutic algorithm for managing treatment-resistant and refractory OCD.

Summary:

• At least 30% of OCD patients exhibit resistance to conventional treatments, influenced by intrinsic and extrinsic phenomenological aspects.
• Various psychopharmacological, biological, and psychotherapeutic interventions exist as alternatives or augmentations.
• More research is required to establish definitive pathways for achieving symptom remission in refractory OCD.

Impact:

• This review provides a framework for understanding and managing treatment-resistant OCD.
• It highlights the need for personalized treatment approaches based on individual patient phenomenology.
• The proposed therapeutic fluxogram can guide clinicians in selecting appropriate interventions for refractory cases.