Evidence-Based Reviews

Innovative and practical treatments for obsessive-compulsive disorder

Current Psychiatry. 2002 February;1(2):30-37

References

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2. Catapano F, Sperandeo R, Perris F, Lanzaro M, Maj M. Insight and resistance in patients with obsessive compulsive disorder. Psychopathol. 2001;34(2):62-68.

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Neurosurgical treatment of OCD is reserved for patients with severe and debilitating illness who have failed an exhaustive array of other available treatment options and who provide informed consent or assent. Currently, the most commonly employed neurosurgical treatments for OCD include anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leukotomy. In recent prospective trials of cingulotomy and capsulotomy, approximately 45% of patients experienced a 35% or more symptom reduction.

With the advent of innovative surgical devices that allow functional neurosurgery without craniotomy (e.g., by gamma knife), the performance of ethical, double-blind, sham-controlled trials of neurosurgery for OCD is now feasible. A team of investigators from Brown University and Massachusetts General Hospital is conducting one such study that tests the efficacy of anterior capsulotomy.

There are no controlled data regarding the efficacy of ECT for OCD. Given the high comorbidity of major affective illness in OCD and the well-established efficacy of ECT for major depression, it is not surprising that some patients with OCD have reportedly shown clinical improvement after ECT. Several limited case series and anecdotal reports suggest that ECT may help in some circumstances, and such intervention would seem prudent in some cases where severe, comorbid affective illness is present.²³

Related resources

Jenike MA, Baer, L, Minichiello WE, eds. Obsessive Compulsive Disorders: Practical Management. 3rd ed. Boston: Mosby, 1998.
Jenike MA. An update on obsessive-compulsive disorder. Bulletin of the Menninger Clinic. 2001;65:4-25.
Obsessive-Compulsive Foundation, (203) 315-2190, www.ocfoundation.org

Drug brand names

Buspirone • BuSpar, BuSpar DIVIDOSE
Citalopram • Celexa
Clomipramine • Anafranil
Clonazepam • Ativar, Diastat, Halcion
Clonidine • Catapres, Catapres TTS-1
Clozapine • Clozaril
Fenfluramine • Pondimin
Fluoxetine • Prozac, Prozac Weekly
Fluvoxamine • Luvox
Paroxetine • Paxil
Phenelzine • Nardil, Parnate
Pindolol • Inderol, Corgard, Betaloc
Risperidone • Risperidal
Sertaline • Zoloft
Trazodone • Desyrel
Tryptophan* • L-Tryptophan, Alti-trytophan

Disclosure

Dr. Boxill and Ms. Shapiro report no affiliation or financial arrangement with any of the companies whose products are mentioned in this article.

Dr. Dougherty reports conflicts of interest with Pfizer Inc., Forest Pharmaceuticals, and Solvay Pharmaceuticals.