New developments in the treatment
of obsessive-compulsive disorder

Leonard HL
Department of Psychiatry and Human Behavior,
Brown University School of Medicine,
Rhode Island Hospital, Providence 02903, USA.
J Clin Psychiatry 1997; 58 Suppl 14:39-45; discussion 46-7


The treatment of obsessive-compulsive disorder (OCD) has changed dramatically in the last 10 years. Currently, the serotonin reuptake inhibitors (SRIs) and the serotonin selective reuptake inhibitors (SSRIs) are considered the "first choice" agents for pharmacologic treatment of OCD, although few head-to-head comparisons exist between any two specific agents. Strategies for nonresponders and partial responders to the SRI/SSRIs are reviewed. The only agents that have shown significant improvement as augmenting agents to an SRI/SSRI in systematic trials have been clonazepam and haloperidol. Predictors of response to pharmacotherapy have been limited, but several reports have found that an early age at onset of OCD has been associated with a poorer response to medications. Long-term maintenance medication may be necessary for some, although behavioral therapy may improve the need for extended pharmacotherapy. Cognitive behavioral therapy, specifically exposure with response prevention, still remains an effective and important component of treatment for many. One of the newest developments is the identification of a pediatric subtype of OCD characterized by prepubertal acute onset after group A beta-hemolytic streptococcal pharyngitis. Investigation trials with these children include immunomodulatory therapies and penicillin treatment and prophylaxis. If a unique subgroup of children with OCD can be identified, then novel treatments may prove effective and have a role in long-term prophylaxis.
OCD treatments
Opiates to treat OCD
SSRIs + clomipramine
Compulsive disorders
St John's wort and OCD
Canine compulsive disorder
Drugs for treatment-resistant OCD
Venlafaxine versus paroxetine for OCD
Obsessive-Compulsive Disorder (OCD): mechanisms
OCD and selective serotonin reuptake inhibitors (SSRIs)

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