Obsessive compulsive disorder
Although obsessive compulsive disorder (OCD) is a common disorder (seen at a rate of 1.6-2.2 % in the general population), for various reasons its diagnosis is usually delayed.
OCD is a disorder that leads to severe loss of social and professional functionality, affects quality of life and has a chronic progression. However, it can be treated.
Treatment of OCD should primarily involve the use of antidepressants. All of the selective serotonin reuptake inhibitors (SRI) (fluvoxamin, fluoxetine, sertraline, paroxetine, citalopram, escitalopram) and chlormipramine amongst the tricyclic antidepressants have been found to be effective. Studies showed that apart from chlomipramine, the other tricyclic antidepressants, lithium, benzodiazepines, buspirone and electroconvulsive therapy have not been effective.
Approximately 40-60% of cases improved by 30-60% with the use of SRI, however there are many patients who require a therapy combining several drugs. The use of SRI together with antipsychotics, pindolol, chlomipramine is amongst effective strengthening strategies.
Treatment of this disorder has to be long-term. In fact, in patients who responded well to chlomipramine treatment and discontinued treatment after 1 year, the rate of recurrence within the first 7 months was found to be 90 %.
20% of patients are resistant in spite of receiving various treatments. Patients who have not responded to more than one drug therapy of appropriate dosage and duration are regarded as resistant. From a psychotherapy aspect the most beneficial treatment is behavioural therapy.
The application of drug treatment combined with behavioural therapy is an effective treatment method. The level of proof that invasive treatment methods like electroconvulsive therapy, vagus nerve stimulation or transcranial magnetic stimulation (TMS) are effective in resistant patients, is at present very weak.