Treatment

Recent therapeutic advances have stimulated a considerable increase in research on OCD. Much of this research has focused on the serotonergic system and the neu-robiology of the corticostriato-thalamocortical circuitry. Not only have changes in regional brain function been demonstrated among OCD patients responding to phar-macologic treatment but also among those with a good response to cognitive behavior therapy (Baxter et al., 1992; Schwartz et al., 1996). The finding that both behavior therapy and pharmacotherapy are able to alter biologic systems is further evidence that OCD is a "brain-based" disorder.

The treatment of OCD requires an integrated approach, as it is unusual for patients to respond fully to either cognitive-behavior therapy (CBT) or medications. A combination of behavioral and pharmacological approaches provides the maximum benefit for most patients. Obsessive-compulsive disorder is a chronic condition, and long-term therapy is often required, although lower medication doses may suffice during the latter stages of treatment (Ravizza et al., 1998). Discontinuation studies have shown that 80 percent of cases have relapsed by 2-year follow-up (Dolberg et al., 1996), although the rate is somewhat lower among patients receiving concomitant CBT (Stanley and Turner, 1995). When discontinuation is attempted, tapering should be gradual, usually over several weeks. Long-term or lifetime drug maintenance is suggested after 2 to 4 relapses.

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