Experimental therapeutics for refractory obsessive-compulsive disorder: translational approaches and new somatic...

Significant advances over the past 20 years in our understanding of the phenomenology and pathophysiology of obsessive-compulsive disorder, made in part from structural and functional neuroimaging and genetics research, can guide treatments that target brain regions, circuits, and neurotransmitter systems specific to obsessive-compulsive disorder, the disruption of which may alleviate obsessive-compulsive disorder symptoms. We discuss here our current understanding of the underlying neurobiology and heritability of obsessive-compulsive disorder and integrate that understanding with a review of the current pharmacological, neurosurgical, and brain stimulation treatments of refractory obsessive-compulsive disorder. Expanding on these studies, we hope that new pharmacological and psychological treatment strategies and research-driven targets for lesioning, stimulation, or other types of focal neuromodulation can be identified that could lead to future research directions. Cross-species translational research and neuroimaging of the physiological and anatomical pathways implicated in the pathophysiology and treatment response in obsessive-compulsive disorder will advance our understanding of the neural basis of obsessive-compulsive disorder and lead to more targeted and effective treatment options.