Il trattamento del disturbo ossessivo-compulsivo resistente

Introduction

Obsessive-compulsive disorder (OCD) is a common psychiatric illness with a lifetime prevalence in the general population of 1.9%-3%. OCD has peculiar clinical and psychopathological features and is classified among the anxiety disorders. With adequate (in terms of dose and duration) drug therapy, remission of symptoms occurs in 50-60% of patients. However, in a significant proportion of cases, other therapeutic strategies are needed for optimal control of obsessive-compulsive symptoms and achievement of acceptable overall functioning. This review analyzes data in the literature regarding therapeutic strategies that can be used for patients with resistant forms of OCD.

Materials and methods

Emphasis will be placed on those strategies that have been validated in controlled, double-blind studies.

Results

Two strategies have proved to be effective in double-blind studies: augmentation with atypical antipsychotics and the addition of cognitive-behavioral therapy. Alternatives whose efficacy has been documented in open label studies include switching to another antidepressant (SSRIs, clomipramine or venlafaxine) or to intravenous administration (citalopram or clomipramine). In extremely refractory cases, alternative experimental therapies are available.

Discussion

Clinicians now have several validated strategies to choose from for the management of resistant OCD, although there are several questions that remain to be answered.