title: [Resistance and refractoriness in obsessive-compulsive disorder].
abstract: 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.
authors.affiliation: Consórcio Brasileiro de Pesquisa em Transtorno Obsessivo-Compulsivo, Brazil. ygoraf@terra.com.br
authors.forename: Ygor Arzeno
authors.initials: YA
authors.lastname: Ferrão
authors.forename: Juliana Belo
authors.initials: JB
authors.lastname: Diniz
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Lopes
authors.forename: Roseli Gedanke
authors.initials: RG
authors.lastname: Shavitt
authors.forename: Benjamin
authors.initials: B
authors.lastname: Greenberg
authors.forename: Euripedes
authors.initials: E
authors.lastname: Miguel
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors