[Resistance and refractoriness in obsessive-compulsive disorder].
OBJECTIVE
Despite the existence of effective therapeutic alternatives for obsessive-compulsive disorder, a significant number of patients does not achieve or does not maintain remission after adequate treatment. The relief of these patients' suffering with the available treatments is a clinical challenge related to many unanswered questions. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness, to describe the intrinsic and extrinsic factors of obsessive-compulsive disorder's phenomenology that might influence treatment response to conventional treatment, and to present a fluxogram of therapeutic alternatives for resistant or refractory obsessive compulsive disorder patients.


CONCLUSIONS
The literature evinces that intrinsic and/or extrinsic phenomenological aspects of obsessive-compulsive disorder may collaborate to the fact that, at least 30% of obsessive-compulsive disorder patients do not respond to conventional treatment. Several therapeutic or augmentation alternatives, psychopharmacological, biological or even psychotherapeutical exist, but more studies are necessary to evince the correct way to symptom remission.
Ferrão
Ygor Arzeno
YA
Consórcio Brasileiro de Pesquisa em Transtorno Obsessivo-Compulsivo, Brazil. ygoraf@terra.com.br
Diniz
Juliana Belo
JB
Lopes
Antônio Carlos
AC
Shavitt
Roseli Gedanke
RG
Greenberg
Benjamin
B
Miguel
Euripedes
E
D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004351:Drug Resistance; D004361:Drug Tolerance; D005195:Family Relations; D006801:Humans; D015201:Meta-Analysis as Topic; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors