[The treatment of the resistant obsessive-compulsive disorder: an update].
Although the majority of patients with obsessive compulsive disorder (OCD) can be helped significantly by modern pharmacotherapy with serotonin uptake inhibitors (SUIs), usually in combination with behavioral techniques of exposure and response prevention, complete cure occurs infrequently and some remain very ill and refractory to treatment. In open-label reports, the addition of agents that enhance serotonin neurotransmission, such as lithium, tryptophan, fenfluramine, buspirone, clonazepam and other SUIs or tricyclic antidepressants to ongoing treatment in SUI-refractory patients has yielded encouraging results. However, the anti-obsessive efficacy of SRI-lithium and SRI-buspirone has not been confirmed in recent controlled trials. Preliminary evidence suggests that addition of low-dose dopamine antagonists appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chromic tic disorder and possibly for those with concurrent psychotic spectrum disorders. Mono Amino oxidase Inhibitors (MAOIs) have also had promising results in open studies. New and experimental drugs are briefly reviewed. Other biological approaches (e.g., electroconvulsive therapy and psychosurgery) are considered in terms of their narrowly defined roles in the treatment of patients with SRI-resistant OCD.