Treatment strategies for obsessive-compulsive disorder.
BACKGROUND
In the last decades, the treatment of obsessive-compulsive disorder (OCD) has improved significantly with the introduction into the clinical practice of the selective serotonin reuptake inhibitors (SSRIs): this has led to a renewed interest in this condition and development of appropriate therapeutic strategies, including non-pharmacological techniques.


METHODS
The aim of this paper is to present a comprehensive and critical review of pharmacological and non-pharmacological treatments usually adopted in the management of OCD. MEDLINE and PubMed (1980 - 2009) databases were searched for English-language articles by using the following keywords: OCD, clomipramine, SSRIs, resistance, predictor of response, cognitive-behavioral therapy, exposure and response prevention, repetitive transcranial magnetic stimulation, deep brain stimulation, neurosurgery, electroconvulsive therapy.


RESULTS
The reader will gain an exhaustive review of the advantages and disadvantages of the treatments usually adopted in OCD, with a special focus on resistance and clinical features that can be used as predictors of response.


CONCLUSIONS
Obsessive-compulsive disorder is a common psychiatric condition that can be adequately managed with the currently available therapeutic options. Although a certain percentage of patients do not achieve complete clinical remission, improvement of some of their core symptoms permits them to live more satisfying lives and to reach a better social adjustment.
Marazziti
Donatella
D
University of Pisa, Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Via Roma 67, 56100 Pisa, Italy. dmarazzi@psico.med.unipi.it
Consoli
Giorgio
G
D002986:Clinical Trials as Topic; D002997:Clomipramine / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004599:Electric Stimulation Therapy; D004565:Electroconvulsive Therapy; D004597:Electroshock; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000528:radiation effects
D002997:Clomipramine