New biological treatment approaches to obsessive compulsive disorder (OCD)

OCD is a prevalent and disabling lifespan disorder with a life time prevalence of between 2 and 3%. First line pharmacotherapy are selective serotonine reuptake inhibitors (SSRIs) or clomipramine in comparatively high dosages which have been shown to the effective in acute and long-term studies (1). However, a part of the patients do not respond to conventional pharmacotherapy and also in responders, the effect is limited to a mean reduction of symptoms of between 20 and 40% and remission rarely occurs. A couple of studies performed in the last years demonstrated that about 50% of therapy refractory patients with OCD improve with lower doses of atypical antipsychotics added to SSRIs. A further and highly interesting treatment approach is deep brain stimulation (DBS) which has been tested in several case series of patients with severe and treatment refractory OCD (2). Despite single reports on dra-matic effects results are still inconclusive. The implications of the studies with atypical antipsychotics and with DBS on the understanding of the pathophysiology of OCD will be ad-dressed.