Obsessive-compulsive disorder: a critical review of therapeutic perspectives.
OBJECTIVE
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with profound implications for social functioning. Thirty per cent of all patients with OCD show insufficient improvement with state-of-the-art treatment. Conventional treatment and alternative treatment options for this population were investigated.


METHODS
A selective review of the relevant scientific literature on OCD treatment and treatment resistance was conducted.


RESULTS
In addition to serotonin reuptake inhibitors (SRIs) and cognitive-behavioural therapy, alternative monotherapies, SRI augmentation strategies with a variety of drugs and electroconvulsive therapy have shown results in individual cases, but no conclusive evidence has been found in placebo-controlled trials. While studies investigating neurosurgery for refractory OCD show positive results, most of these studies have methodological shortcomings.


CONCLUSIONS
Novel approaches currently under investigation that have shown promising effects for treatment-resistant OCD include SRI augmentation with atypical antipsychotics and chronic deep brain stimulation, a new surgical technique. Placebo-controlled trials for both treatment options will be needed to confirm preliminary findings.
Schruers
K
K
Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands. koen.schruers@pn.unimaas.nl
Koning
K
K
Luermans
J
J
Haack
M J
MJ
Griez
E
E
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D004599:Electric Stimulation Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors