New Approaches In Treatment Of Obsesive-compulsive Disorder: A Case Report

Obsessive-compulsive disorder(OCD) is a kind of chronic,recurrent neurosis.The lifetime prevalence of OCD is between 2% and 3% in the general population.Today patients with OCD could not achieve true remission with a certain treatment.Pharmacotherapy and psychotherapy are the two main ways to treat this disease. Nonpharmacologic biological approaches, such as electroconvulsive therapy, repetitive transcranial magnetic stimulation as well as neurosurgery are reported. Clomipramine is traditionally considered the standard of therapy for OCD, but many patients have to stop taking this medicine because of its anticholinergic and antiadrenergic side effects. The selective serotonin reuptake inhibitors(SSRls), such as paroxetine,fiuoxetine,fluvoxamine and sertraline have proven efficacy and have been approved by the U.S. Food and Drug Administration(FDA) for use in patients with OCD. And the latter two drugs are safe when used in children and adolescents cases. The general efficacy of SSRIs for the treatment of OCD is 65% to 70%, but only 50% to 60% of the symptoms remise.SSRIs are recommended as first line medication because they have fewer anticholinergic adverse effects.It is reported that patients who do not respond to one SSRI often have favorable response to another SSRI.Be sure both the dosage and the course of treatment are adequate before switching.Because the adequate dose for OCD is often the maximum tolerated amount and it will take 4 to 8 weeks for a patient to response to the initial drug,the effect will reach tomaximum at about the 20th week.SSRIs combining with medication such as clomipramine, risperdal, clozapine or olanzapine can be used to treat refractory cases,but the interaction between the drugs should be paid more attention to avoid serotonin syndrome. Psychotherapy includes supportive psychotherapy and behavioral therapy, and about 80% patients can get relief of symptoms under this treatment. For treatment of patients with OCD it is important that medicine is used firstly to regulate the abnormal serotonergic regulation, then psychotherapy given at the same time and last for a long time is necessary.