ABSTRACT
University of Florida College of Medicine Obsessive-compulsive disorder (OCD) is usually chronic, often debilitating, and more common than previously believed. Not long ago, it was widely viewed as untreatable. The 1980s witnessed renewed optimism about the prognosis of OCD as new, more effective forms of pharmacotherapy (i.e., potent serotonin reuptake inhibitors [SRIs]) and behavior therapy (i.e., exposure and response prevention) were introduced and successfully tested. Despite these advances in treatment, a substantial number of patients with OCD remain symptomatic or show no improvement at all. The effectiveness of SRIs is well established in OCD, but between 40% and 60% of patients are nonresponders (Greist, Jefferson, Kobak, Katzelnick, & Serlin, 1995). Even among “responders” to SRIs, the magnitude of response is usually incomplete, with few patients becoming asymptomatic. In clinical trials, a 25% to 35% decrease in mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989; Goodman, Price, Rasmussen, Mazure, Fleischmann, et al., 1989) scores from baseline is often used to define the threshold for a categorical response to treatment. Although this degree of change may represent a clinically meaningful reduction in symptom severity, there remains considerable room for further improvement.
