Diagnosis and treatment of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD), a relatively common disorder, is underdiagnosed and undertreated despite the existence of effective treatments. OCD can be differentiated from other disorders with obsessive or compulsive features based on the content of the obsessions or the characteristics of the compulsions. Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy are proven treatments for OCD; they bring clinically significant reduction in symptoms, although complete remission is not common in clinical trials. The efficacy and safety of SRI treatment of OCD has been demonstrated by numerous double-blind, randomized, controlled trials. These trials suggest that it usually takes longer for response to begin and higher doses are required than for depressive disorders. Research also supports a trial of another SRI for patients who have failed a trial of one SRI. For refractory cases, augmentation with atypical antipsychotics such as risperidone or quetiapine is recommended.