[The ABC:s of obsessive-compulsive disorder].

Area of Science:

• Neuroscience and Psychiatry
• Clinical Psychology

Background:

• Obsessive-compulsive disorder (OCD) affects 1.3% of adults, marked by obsessions and compulsions that impair daily life.
• OCD is often underdiagnosed, with proposed causes including maladaptive learning, genetic factors, and abnormalities in cortico-striato-thalamo-cortical brain circuits.

Purpose of the Study:

• To outline the current understanding and treatment landscape of obsessive-compulsive disorder (OCD).
• To detail the diagnostic characteristics and etiological models of OCD.
• To review the spectrum of therapeutic interventions for OCD, from first-line treatments to options for treatment-resistant cases.

Main Methods:

• Review of established treatment guidelines and research findings for obsessive-compulsive disorder (OCD).
• Description of first-line treatments: exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRIs).
• Discussion of second-line and advanced treatments, including augmentation with antipsychotics, clomipramine, deep transcranial magnetic stimulation (dTMS), and deep brain stimulation (DBS) for refractory OCD.

Main Results:

• Exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs) are primary treatments for OCD.
• Treatment augmentation with antipsychotics or switching to clomipramine is considered for inadequate response.
• Deep transcranial magnetic stimulation (dTMS) and deep brain stimulation (DBS) offer therapeutic possibilities for severe, treatment-resistant OCD cases.

Conclusions:

• A stepwise approach to OCD treatment is effective, starting with ERP and SSRIs.
• Advanced neuromodulation techniques like dTMS and DBS provide critical options for patients with severe, refractory OCD.
• Continued research into OCD etiology and treatment is essential for improving patient outcomes and addressing underdiagnosis.