Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies

Although the majority of patients with obsessive compulsive disorder can be helped significantly by modern pharmacotherapy, usually in combination with behavioral techniques of exposure and response prevention, some remain very ill and refractory to treatment. Although there are few controlled data to guide the clinician on how to manage these patients, substantial anecdotal evidence suggests ways to manage them. Pharmacologic, behavioral, and neurosurgical approaches are reviewed. While researchers are seeking more effective treatments and a clearer understanding of the pathophysiology of obsessive compulsive disorder, it is important for clinicians to optimally utilize the tools currently available.