Transtorno obsessivo-compulsivo resistente: conceito e estratégias de tratamento

Abstract

<abstract language="eng">Despite the fact that majority of OCD patients responds to conventional treatments, about 40% remain symptomatic after appropriate trials with serotonin uptake inhibitors (SRIs) or behavioral therapy. A patient is considered treatment-resistant after failing to respond to three pharmacological trials with SRIs as well as to behavior therapy. When all somatic strategies have been tried, including augmentation with other medications, and the patient remains symptomatic, he or she is considered treatment refractory. The concepts of resistance and refractoriness are briefly revised, and the current augmentation strategies, as well as non-pharmacological approaches such as neurosurgery and transcranial magnetic stimulation, are addressed in this paper. Finally, issues of predictive response factors, pharmacogenetics, and the pathophysiology of resistant cases are suggested as targets for further researches

Resistência e refratariedade no transtorno obsessivo-compulsivo

“…Although conducted in a correct and appropriate manner, these studies did not assess the possibility of response to other treatments, even pharmacological or psychotherapeutic alternative treatments. 4 Rauch and Jenike, in 1994, established the difference between "resistant" and "refractory" patients. They defined as "resistant" those who participate in a trial with any first-line therapy and do not have a satisfactory response, while the "refractory" patients are those who do not respond appropriately to several treatments administered in an adequate manner.…”

Estudo de associação de genes candidatos no transtorno obsessivo-compulsivo: investigação dos loci SLC6A4, HTR1B, HTR2A, SLC6A3, COMT e SLC6A2

“…Atualmente, alternativas farmacológicas têm sido empregadas no tratamento do TOC, incluindo agentes noradrenérgicos, inibidores da monoamina oxidase, opióides, lítio, oxitocina, entre outros (Shavitt et al, 2001).…”