SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
is a general consensus that fronto-striato-thalamo-cortical dysfunction is the neuronal basis of obsessive-compulsive disorder. The
differential response of OCD to clomipramine and SSRIs, compared to other antidepressants, has led to the primacy of the serotonin (5HT)
hypothesis of OCD. Currently serotonin has also been implicated in the pathophysiology of other OC spectrum disorders. However, several
lines of research suggest that the dopamine system, with which 5HT interacts, may play a major role in the expression of OC symptoms.
Recent genetic and neurochemical studies also implicate glutamate in the pathophysiology of OCD. The recognition of PANDAS (Pediatric
autoimmune neuropsychiatric disorders associated with streptococcal infection) has increased the interest in the possibility of an
immune-mediated pathophysiology of obsessive-compulsive disorder. In this presentation, these recent advances in biological models
of OCD will be discussed.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S46-7
Psychopharmacological and somatic interventions for OCD
Kandasamy Arun
Assistant professor, Department of Psychiatry, SRM Medical College & Research Center, Kattankulathur, 603203, India
E-mail: arunnimhans05@gmail.com
OCD was initially thought to be unresponsive to treatment but subsequently, a range of effective treatments has been developed on the
basis of two approaches, pharmacological and psychosocial. Pharmacological agents such as Selective Serotonin Reuptake Inhibitors
(SSRIs) and clomipramine have changed the face of OCD management. Around 50–60 % of patients showed remission after treatment. In
treatment resistant cases, augmenting agents like clonazepam, risperidone and buspirone are used. Intravenous clomipramine is another
option. Other strategies which are currently under study include riluzole and other drugs which act on the glutaminergic system, opioid
agonists and inositol augmentation. Immunomodulatory therapies have also been studied especially in PANDAS. Development of newer
somatic methods of treatment like repetitive trans-cranial stimulation (rTMS) and Deep Brain Stimulation (DBS) are promising in targeting
the fronto-striato-pallido-thalamo-cortical circuits for treatment resistant OCD. Although controversial, stereotactic and gamma knife
assisted neurosurgical procedures such as cingulotomy and anterior capsulotomy are also possible treatments for resistant cases.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S47
Psycho-social interventions for OCD
Manickam Thirunavukarasu
Professor & Head, Department of Psychiatry, SRM MC & RC, Kattankulathur, 603203, India
E-mail: arasueshwar@gmail.com
We will review recent advances in the psychological treatments for obsessive compulsive disorder. In the early 20th century, psychological
treatment for OCD consisted largely of psychodynamic psychotherapy. The general consensus of that era was that OCD was an
unmanageable condition with a poor prognosis. Starting from the 1950s, laboratory studies on extinction of conditioned responses
followed by clinical research led to the formulation of Exposure and Response Prevention (ERP) for OCD.We have developed a model
combining ERP and CBT. This behavioral approach currently is the first-line intervention for adult obsessive-compulsive disorder. Recently
predominantly cognitive approaches have been evaluated to overcome the shortcomings of ERP. Methodologically rigorous controlled
trials have suggested that the benefits from CBT exceed those from placebo and attention-control conditions and have similar or greater
efficacy than serotonergic monotherapy. The clinical predictors for response to CBT include symptom severity, symptom subtype, severe
depression, the presence of comorbid personality disorders, family dysfunction and the therapeutic alliance. Combination treatment with
pharmacotherapy has generally revealed promising results. Nevertheless, more studies are still needed in certain areas. We will explain in
detail how we practice in our patients and the results.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S47
S47