New developments in the treatment of obsessive-compulsive disorder.
The treatment of obsessive-compulsive disorder (OCD) has changed dramatically in the last 10 years. Currently, the serotonin reuptake inhibitors (SRIs) and the serotonin selective reuptake inhibitors (SSRIs) are considered the "first choice" agents for pharmacologic treatment of OCD, although few head-to-head comparisons exist between any two specific agents. Strategies for nonresponders and partial responders to the SRI/SSRIs are reviewed. The only agents that have shown significant improvement as augmenting agents to an SRI/SSRI in systematic trials have been clonazepam and haloperidol. Predictors of response to pharmacotherapy have been limited, but several reports have found that an early age at onset of OCD has been associated with a poorer response to medications. Long-term maintenance medication may be necessary for some, although behavioral therapy may improve the need for extended pharmacotherapy. Cognitive behavioral therapy, specifically exposure with response prevention, still remains an effective and important component of treatment for many. One of the newest developments is the identification of a pediatric subtype of OCD characterized by prepubertal acute onset after group A beta-hemolytic streptococcal pharyngitis. Investigation trials with these children include immunomodulatory therapies and penicillin treatment and prophylaxis. If a unique subgroup of children with OCD can be identified, then novel treatments may prove effective and have a role in long-term prophylaxis.
Leonard
H L
HL
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence 02903, USA.
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D002997:Clomipramine / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D010406:Penicillins / Q000627:therapeutic use; D010956:Plasmapheresis; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D018687:Antidepressive Agents, Second-Generation; D002997:Clomipramine; D002998:Clonazepam; D006220:Haloperidol; D016756:Immunoglobulins, Intravenous; D010406:Penicillins; D017367:Selective Serotonin Reuptake Inhibitors