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Treatment-Resistant Obsessive-Compulsive Disorder 

Treatment-Resistant Obsessive-Compulsive Disorder
Treatment-Resistant Obsessive-Compulsive Disorder

Robert Hudak

, Priya Gopalan

, and Darin D. Dougherty

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date: 20 November 2018

Obsessive-compulsive disorder (OCD) is the fourth most common psychiatric disorder, affecting approximately 2%–3% of the population. This chronic illness causes significant morbidity, and full remission of symptoms is relatively rare. Treatment resistance is commonly encountered when treating OCD as more than half of patients will not respond to standard treatments. A short review of the protocols for standard treatment of serotonin reuptake inhibitors combined with exposure and response prevention therapy is provided. A more extensive description follows of the steps that clinicians would employ in the case that the standard treatment proves to be insufficient. Strategies for changing medications and behavioral therapy in treatment-resistant patients are described. Augmentation with second-generation antipsychotic medications is reviewed as are the use of other augmenting agents. Because of the high rate of treatment resistance in OCD, a discussion of novel medications is provided, focusing on medications regulating glutamate, the most active area of OCD research at this time.

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