A clear summary of what is known about a highly prevalent and debilitating disorder that affects nearly as many people as does asthma. Expert authors review the biological basis for the disorder and describe both pharmacological and psychological approaches to treatment.

InhaltsangabeList of Contributors xii Introduction xvii SECTION 1 ASSESSMENT AND TREATMENT 1 Assessment 3 Jose M. Menchon Introduction 3 Detecting OCD 5 Screening in clinical interview 7 Structured interviews 8 Clinical assessment of obsessive-compulsive symptoms 9 Yalebrown obsessivecompulsive scale 10 Dimensional yale-brown obsessive-compulsive scale (DY-BOCS) 11 Leyton obsessional inventory (LOI) 12 Maudsley obsessional-compulsive inventory (MOCI) 13 Padua inventory (PI) 13 Obsessive compulsive inventory (OCI) 14 Insight 14 Rating insight 15 Assessment of the risk of suicide 17 Differential diagnosis, comorbidities and related disorders 18 Organic brain disorders 19 Schizophrenia 20 Depression 20 Hypochondriasis 20 Phobias 21 Tourette disorder and tic disorders 21 Obsessivecompulsive personality disorder (OCPD) 21 Body dysmorphic disorder (BDD) 21 Hoarding 22 Other disorders 22 Conclusions 22 References 23 2 Pharmacotherapy of obsessive-compulsive disorder 31 Eric H. Decloedt and Dan J. Stein Introduction 31 Placebocontrolled studies of clomipramine 32 Placebocontrolled studies of fluvoxamine 32 Placebocontrolled studies of fluoxetine 33 Placebocontrolled studies of paroxetine 34 Placebocontrolled studies of sertraline 34 Placebocontrolled studies of citalopram/escitalopram 34 Placebocontrolled studies of venlafaxine 35 Improving early response in OCD 35 Special populations: children 36 Clomipramine 36 Fluvoxamine 36 Fluoxetine 36 Paroxetine 37 Sertraline 37 Citalopram 38 Metaanalyses 38 Tolerability of clomipramine and serotonin reuptake inhibitors 40 Optimal dose of treatment 41 Duration of treatment 42 Refractory OCD 43 Increased dose of SSRI 43 Augmentation of SSRI treatment with antipsychotics 44 Other drugs 45 Alternative modes of administration of SSRIs 46 Combining SRIs 46 Switching SSRIs 46 Adding psychotherapy 47 Future therapeutic options 47 Conclusion 48 References 48 3 Cognitive behavioural therapy in obsessive-compulsive disorder: state of the art 58 Martin E. Franklin, Addie Goss and John S. March Theoretical models 58 Treatment 60 Exposure plus response prevention (ERP) 60 Cognitive therapies 63 ERP plus medication 63 OCD protocols 64 Assessment 64 Adult ERP protocol 65 Paediatric ERP protocol 67 Dissemination 67 Future research 69 Summary 69 References 70 4 Electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation in OCD 75 Rianne M. Blom, Martijn Figee, Nienke Vulink and Damiaan Denys Introduction 75 Electroconvulsive therapy 75 Transcranial magnetic stimulation 76 Mechanism of action 77 Efficacy of rTMS in OCD 77 Side effects and safety 84 Conclusion and future directions 85 Lesioning 85 Deep brain stimulation 86 Efficacy of DBS in OCD 86 Mechanism of action of DBS in OCD 92 Side effects of DBS in OCD 92 Followup treatment 94 Conclusions: DBS 94 Conclusion 94 Acknowledgements 95 References 95 5 Approaches to treatment resistance 99 Stefano Pallanti, Giacomo Grassi and Andrea Cantisani Terminological problems and operational definitions 100 Pharmacological strategies in resistant OCD 103 Switching 103 Infusion therapy 104 Cognitive behavioural therapy 105 Serotoninergic agents 106 Dopaminergic agents 108 Glutamatergic agents 113 Opioids 115 Physical therapies 115 Electroconvulsive therapy (ECT) 115 Repetitive transcranial magnetic stimulation (rTMS) 116 Deep brain stimulation (DBS) 116 Family intervention 117 Conclusions and future perspectives 117 References 118 SECTION 2 CLINICAL SPOTLIGHTS 6 Subtypes and spectrum issues 135 Eric Hollander, Steven Poskar and Adriel Gerard The obsessive-compulsive spectrum 135 Introduction 135 Cl

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