title: [Combined treatments in obsessive-compulsive disorder: current knowledge  and future prospects].
abstract: OBJECTIVE
  Serotonin reuptake inhibitors (SRIs) and/or cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). The study discuss whether: a) combining both treatments ab initio is more effective than either monotherapy alone; and b) a sequential treatment is effective both in responder and non responder patients.
  
  
  METHODS
  Have been carried out a search on Medline/PubMed database, selecting clinical randomized controlled studies in English. Have been examined 9 randomized controlled studies where combined treatment ab initio was compared to CBT alone, and 6 where combination treatment was compared to SRI alone. No controlled studies were found for sequential treatments in OCD. Have been then examined naturalistic studies, 2 including responder patients and 7 including non responder patients.
  
  
  RESULTS
  Of the 9 studies, 7 didn't find any additional benefit of combining treatments as compared to CBT alone; in 1 study the combination strategy resulted more effective than CBT alone in children and adolescents, and in another in severely depressed adult patients with OCD. As compared to SRIs alone, combining treatments was not more effective in 4 studies, while in 2 studies it was more effective. All studies concerning sequential treatments found evidence of efficacy of this strategy.
  
  
  CONCLUSIONS
  Combining ab initio CBT and SRI has not been found to be clearly superior of either therapy alone, except for patients with severe depression and for children and adolescents. On the contrary, a sequential strategy may be used successfully both to treat residual symptoms in responders and to determine clinical response in resistant patients.
authors.affiliation: Dipartimento di Neuroscienze, Universita di Torino, Italy. umberto.albert@unito.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Albert
authors.forename: Francesca
authors.initials: F
authors.lastname: Barbaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Aguglia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maina
authors.forename: Filippo
authors.initials: F
authors.lastname: Bogetto
mesh_terms: D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005544:Forecasting; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*