Refractory obsessive-compulsive disorder: state-of-the-art treatment.
Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.
Hollander
Eric
E
Department of Psychiatry, Compulsive, Impulsive, and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY 10029, USA. eric.hollander@mssm.edu
Bienstock
Carol A
CA
Koran
Lorrin M
LM
Pallanti
Stefano
S
Marazziti
Donatella
D
Rasmussen
Steven A
SA
Ravizza
Luigi
L
Benkelfat
Chawkie
C
Saxena
Sanjaya
S
Greenberg
Benjamin D
BD
Sasson
Yehuda
Y
Zohar
Joseph
J
D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D016666:Fluvoxamine / Q000627:therapeutic use; D006801:Humans; D009020:Morphine / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D014179:Neurotransmitter Uptake Inhibitors / Q000627:therapeutic use; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000628:therapy*; D000077152:Olanzapine; D010890:Pirenzepine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012196:Review Literature as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D018170:Sumatriptan / Q000627:therapeutic use; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D016666:Fluvoxamine; D009020:Morphine; D014179:Neurotransmitter Uptake Inhibitors; D000077152:Olanzapine; D010890:Pirenzepine; D017367:Selective Serotonin Reuptake Inhibitors; D018170:Sumatriptan