ABSTRACT
Recent studies have enhanced our knowledge of the treatment and pathophysiology of obsessive compulsivedisorder (OCD; Greist, Jefferson, Koback, Katzelnick, & Serlin, 1995; Leonard, 1997; Liebowitz & Hollander, 1991). With pharmacological agents such as clomipramine, fluoxetine, sertraline, paroxetine, citalopram, and fluvoxamine, pharmacological augmenting strategies, such as dopamine antagonists for patients with concurrent tic disorders or schizotypal features, and nonpharmacological techniques, such as behavioral therapy, approximately 60% to 70% of patients significantly improve. Given recent indications of prevalence (Karno, Sorensen, & Burnam, 1988; Weissman et al., 1994), however, this still leaves hundreds of thousands of patients failing to show any benefit from treatment. In addition, even among the patients who improve, treatment response may be meaningful but limited, such that the patient is still left with marked or severe OCD. The overly optimistic view of outcome in OCD of the recent past has been replaced by a sobering awareness that a significant number of OCD patients either do not benefit at all from current therapies or achieve only a limited improvement in morbidity. In the United States, these treatment-refractory patients have only one other treatment option: neurosurgery. Although neurosurgery for OCD is a potentially valuable treatment option, it is not widely available, has not yet been tested in a well-controlled design, and may lead to secondary frontal lobe dysfunction (Mindus, Rasmussen, & Lindquist, 1994). Expanding the options for these treatment-refractory patients is critical.
