Ferrão Ygor Arzeno, Diniz Juliana Belo, Lopes Antônio Carlos, Shavitt Roseli Gedanke, Greenberg Benjamin, Miguel Euripedes
Consórcio Brasileiro de Pesquisa em Transtorno Obsessivo-Compulsivo, Brazil.
Braz J Psychiatry. 2007 Oct;29 Suppl 2:S66-76. doi: 10.1590/s1516-44462006005000059.
Despite the existence of effective therapeutic alternatives for obsessive-compulsive disorder, a significant number of patients does not achieve or does not maintain remission after adequate treatment. The relief of these patients' suffering with the available treatments is a clinical challenge related to many unanswered questions. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness, to describe the intrinsic and extrinsic factors of obsessive-compulsive disorder's phenomenology that might influence treatment response to conventional treatment, and to present a fluxogram of therapeutic alternatives for resistant or refractory obsessive compulsive disorder patients.
The literature evinces that intrinsic and/or extrinsic phenomenological aspects of obsessive-compulsive disorder may collaborate to the fact that, at least 30% of obsessive-compulsive disorder patients do not respond to conventional treatment. Several therapeutic or augmentation alternatives, psychopharmacological, biological or even psychotherapeutical exist, but more studies are necessary to evince the correct way to symptom remission.
尽管存在治疗强迫症的有效替代方法，但仍有相当数量的患者在充分治疗后未实现缓解或无法维持缓解状态。用现有治疗方法减轻这些患者的痛苦是一项临床挑战，涉及许多尚未解答的问题。本文献综述的目的是评估当前治疗抵抗和难治性的概念，描述强迫症现象学中可能影响对传统治疗反应的内在和外在因素，并为难治性或抵抗性强迫症患者呈现治疗替代方案流程图。
文献表明，强迫症的内在和/或外在现象学方面可能导致至少30%的强迫症患者对传统治疗无反应。存在多种治疗或增效替代方法，包括心理药理学、生物学甚至心理治疗方法，但仍需要更多研究来明确实现症状缓解的正确方法。
