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Obsessive Compulsive Disorder |
Overcoming Anxiety (Home) > Obsessive Compulsive Disorder > Treatment Resistant OCD Treatment Resistant OCDDespite the abundance of reports concerning the efficacy of various agents in OCD, about 20–30% of patients do not respond at all and another 20–30% display only partial response. Possible reasons for treatment refractoriness in OCD are presented below. Inadequacy of trial
Coexisting condition limits drug efficacyIncorrect diagnosis?Exogenous countertherapeutic influences
Underlying biological heterogeneity
Search for putative subtypesIn treating these partial or complete non-responders, sound clinical choices are called for. However, as well-controlled, double-blind studies are lacking, many of theseclinical decisions are based on case reports and uncontrolled studies, and therefore, these recommendations should be treated cautiously. Athough the focus here is on the pharmacological approach, we suggest that in cases of partial or non-response, an attempt should be made to combine behavioral therapy (BT) with the pharmacological treatments. BT involves imaginary flooding and in vivo exposure and response prevention. In cases of non-response, family therapy, too, should be suggested, in order to assess the family dynamics and to determine whether there is a family member who cooperates with the patient’s disorder—for example, impedes exposure trials—hence preventing any improvement.
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