Skip to main content
Springer Nature Link
Log in

Therapieresistente Zwangsstörungen

Treatment-resistant obsessive-compulsive disorders

  • Leitthema
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Zwangsstörungen werden hauptsächlich mit störungsspezifischer kognitiver Verhaltenstherapie mittels Expositionen und Reaktionsmanagement und/oder mit selektiven Serotoninwiederaufnahmehemmern behandelt. Eine relevante Patientensubgruppe profitiert hiervon jedoch nicht ausreichend.

Ziel der Arbeit

Diese Arbeit gibt eine Übersicht über therapieresistente Zwangsstörungen.

Material und Methoden

Diese narrative Übersicht beschäftigt sich mit der Definition, den Ursachen sowie der diagnostischen und therapeutischen Vorgehensweise bei therapieresistenten Zwangsstörungen.

Ergebnisse

Von einer Therapieresistenz kann ausgegangen werden bei einer fehlenden klinisch relevanten Verbesserung unter Therapie im Sinne einer Reduktion von < 25 % auf der Yale-Brown Obsessive Compulsive Scale und einem Score von 4 auf Clinical Global Impression – Improvement Scale („keine Veränderung“). Die für eine Therapieresistenz geforderte Anzahl an nicht erfolgreichen Therapieversuchen ist unterschiedlich definiert. Ursächliche Faktoren beinhalten eine falsche Diagnosestellung, einen hohen Schweregrad, komorbide Störungen, Substanzkonsum, spezielle Symptomkonstellationen, organische Ursachen, Umgebungsfaktoren und erschwerende Faktoren in der Psychotherapie und Pharmakotherapie. Vorschläge zum diagnostischen und therapeutischen Vorgehen basierend auf der deutschen S3-Leitlinie Zwangsstörungen wurden zusammengestellt.

Diskussion

Für Patienten mit Therapieresistenz auf die Erstlinienbehandlung liegen nützliche diagnostische und therapeutische Ansätze (psychotherapeutisch, psychopharmakologisch oder mit Neurostimulationsverfahren) vor.

Abstract

Background

Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach.

Objective

This article provides an overview of treatment-resistant OCD.

Material and methods

In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed.

Results

Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented.

Conclusion

For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. AACAP (2012) Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 51(1):98–113. https://doi.org/10.1016/j.jaac.2011.09.019

    Article  Google Scholar 

  2. Carmi L, Tendler A, Bystritsky A et al (2019) Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry 176(11):931–938. https://doi.org/10.1176/appi.ajp.2019.18101180

    Article  PubMed  Google Scholar 

  3. Denys D, Graat I, Mocking R et al (2020) Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients. Am J Psychiatry 177(3):265–271. https://doi.org/10.1176/appi.ajp.2019.19060656

    Article  PubMed  Google Scholar 

  4. Denys D, van der Wee N, van Megen HJ, Westenberg HG (2003) A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. J Clin Psychopharmacol 23(6):568–575. https://doi.org/10.1097/01.jcp.0000095342.32154.54

    Article  CAS  PubMed  Google Scholar 

  5. DGPPN (2022) AWMF S3-Leitlinie Zwangsstörungen. https://register.awmf.org/de/leitlinien/detail/038-017. Zugegriffen: 30. Okt. 2023

  6. Endres D, Mertens L, Berger B et al (2022a) Autoimmune obsessive-compulsive disorder with novel anti-basal ganglia antibodies. Psychother Psychosom 91(3):214–216. https://doi.org/10.1159/000522136

    Article  PubMed  Google Scholar 

  7. Endres D, Pollak TA, Bechter K et al (2022b) Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype? Transl Psychiatry 12(1):5. https://doi.org/10.1038/s41398-021-01700-4

    Article  PubMed  PubMed Central  Google Scholar 

  8. Endres D, Domschke K, Schiele MA (2022c) Neurobiology of obsessive-compulsive disorder. Nervenarzt 93(7):670–677. https://doi.org/10.1007/s00115-022-01331-0

    Article  PubMed  Google Scholar 

  9. Evey KJ, Steinman SA (2023) A systematic review of the use of acceptance and commitment therapy to treat adult obsessive-compulsive disorder. Behav Ther 54(6):1006–1019. https://doi.org/10.1016/j.beth.2022.02.009

    Article  PubMed  Google Scholar 

  10. Foa EB, Simpson HB, Rosenfield D et al (2015) Six-month outcomes from a randomized trial augmenting serotonin reuptake inhibitors with exposure and response prevention or risperidone in adults with obsessive-compulsive disorder. J Clin Psychiatry 76(4):440–446. https://doi.org/10.4088/JCP.14m09044

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gadot R, Najera R, Hirani S et al (2022) Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp-2021-328738

    Article  PubMed  Google Scholar 

  12. Göbel T, Maier A, Schlump A et al (2023) Obsessive-compulsive symptoms and 15q11.2q13.1 duplication syndrome. Eur Neuropsychopharmacol 78:67–69. https://doi.org/10.1016/j.euroneuro.2023.09.009

    Article  CAS  PubMed  Google Scholar 

  13. Grabe HJ, Meyer C, Hapke U et al (2000) Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. Eur Arch Psychiatry Clin Neurosci 250(5):262–268. https://doi.org/10.1007/s004060070017

    Article  CAS  PubMed  Google Scholar 

  14. Guzick AG, McCabe RE, Storch EA (2021) A review of motivational interviewing in cognitive behavioral therapy for obsessive-compulsive disorder. J Cogn Psychother 35(2):116–132. https://doi.org/10.1891/JCPSY-D-20-00027

    Article  PubMed  Google Scholar 

  15. Hirschtritt ME, Bloch MH, Mathews CA (2017) Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA 317(13):1358–1367. https://doi.org/10.1001/jama.2017.2200

    Article  PubMed  Google Scholar 

  16. Howes OD, Thase ME, Pillinger T (2022) Treatment resistance in psychiatry: state of the art and new directions. Mol Psychiatry 27(1):58–72. https://doi.org/10.1038/s41380-021-01200-3

    Article  PubMed  Google Scholar 

  17. Jacobi F, Höfler M, Strehle J et al (2014) Mental disorders in the general population : study on the health of adults in Germany and the additional module mental health (DEGS1–MH). Nervenarzt 85(1):77–87. https://doi.org/10.1007/s00115-013-3961-y

    Article  CAS  PubMed  Google Scholar 

  18. Jelinek L, Balzar A, Moritz S et al (2022) Therapists’ thought-action fusion beliefs predict utilization of exposure in obsessive-compulsive disorder. Behav Ther 53(1):23–33. https://doi.org/10.1016/j.beth.2021.05.004

    Article  PubMed  Google Scholar 

  19. Külz AK, Lumpp A, Herbst N et al (2010) Welche Funktionen erfüllen Zwangssymptome? – Ergebnisse einer Analyse im stationären Setting. Verhaltenstherapie 20(2):101–108. https://doi.org/10.1159/000295428

    Article  Google Scholar 

  20. Mack S, Jacobi F, Gerschler A et al (2014) Self-reported utilization of mental health services in the adult German population−evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH). Int J Methods Psychiatr Res 23(3):289–303. https://doi.org/10.1002/mpr.1438

    Article  PubMed  PubMed Central  Google Scholar 

  21. Marazziti D, Golia F, Consoli G et al (2008) Effectiveness of long-term augmentation with citalopram to clomipramine in treatment-resistant OCD patients. CNS Spectr 13(11):971–976. https://doi.org/10.1017/s1092852900014024

    Article  PubMed  Google Scholar 

  22. Mataix-Cols D, Fernández de la Cruz L, Nordsletten AE et al (2016) Towards an international expert consensus for defining treatment response, remission, recovery and relapse in obsessive-compulsive disorder. World Psychiatry 15(1):80–81. https://doi.org/10.1002/wps.20299

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mataix-Cols D, Jenike MA (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry. https://doi.org/10.1176/ajp.156.9.1409

    Article  PubMed  Google Scholar 

  24. Moritz S, Külz A, Voderholzer U et al (2019) Phobie à deux and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive-compulsive disorder. Cogn Behav Ther 48(2):162–176. https://doi.org/10.1080/16506073.2018.1494750

    Article  PubMed  Google Scholar 

  25. Ninan PT, Koran LM, Kiev A et al (2006) High-dose sertraline strategy for nonresponders to acute treatment for obsessive-compulsive disorder: a multicenter double-blind trial. J Clin Psychiatry 67(1):15–22. https://doi.org/10.4088/jcp.v67n0103

    Article  CAS  PubMed  Google Scholar 

  26. Pallanti S, Hollander E, Bienstock C et al (2002) Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol 5(2):181–191. https://doi.org/10.1017/S1461145702002900

    Article  PubMed  Google Scholar 

  27. Runge K, Reisert M, Feige B et al (2023) Deep clinical phenotyping of patients with obsessive-compulsive disorder: an approach towards detection of organic causes and first results. Transl Psychiatry 13(1):83. https://doi.org/10.1038/s41398-023-02368-8

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2010) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 15(1):53–63. https://doi.org/10.1038/mp.2008.94

    Article  CAS  PubMed  Google Scholar 

  29. Schirmbeck F, Zink M (2022) Obsessive-compulsive symptoms in psychotic disorders: pathogenesis and treatment. Nervenarzt 93(7):688–694. https://doi.org/10.1007/s00115-022-01332-z

    Article  PubMed  Google Scholar 

  30. Shakeri J, Farnia V, Karimi AR et al (2016) The prevalence and clinical features of amphetamine-induced obsessive compulsive disorder. Drug Alcohol Depend 160:157–162. https://doi.org/10.1016/j.drugalcdep.2015.12.034

    Article  CAS  PubMed  Google Scholar 

  31. Simpson HB, Foa EB, Liebowitz MR et al (2013) Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry 70(11):1190–1199. https://doi.org/10.1001/jamapsychiatry.2013.1932

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Skapinakis P, Caldwell DM, Hollingworth W et al (2016) Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 3(8):730–739. https://doi.org/10.1016/S2215-0366(16)30069-4

    Article  PubMed  PubMed Central  Google Scholar 

  33. Stein DJ, Costa DLC, Lochner C et al (2019) Obsessive-compulsive disorder. Nat Rev Dis Primers 5(1):52. https://doi.org/10.1038/s41572-019-0102-3

    Article  PubMed  PubMed Central  Google Scholar 

  34. Steuber ER, McGuire JF (2023) A meta-analysis of transcranial magnetic stimulation in obsessive-compulsive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. https://doi.org/10.1016/j.bpsc.2023.06.003

    Article  PubMed  Google Scholar 

  35. Swedo SE, Leonard HL, Garvey M et al (1998) Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 155(2):264–271. https://doi.org/10.1176/ajp.155.2.264

    Article  CAS  PubMed  Google Scholar 

  36. Voderholzer U, Favreau M, Rubart A et al (2022) Treatment of obsessive-compulsive disorders: recommendations of the revised S3 guidelines on obsessive-compulsive disorders. Nervenarzt 93(7):678–687. https://doi.org/10.1007/s00115-022-01336-9

    Article  PubMed  Google Scholar 

  37. Wang G, Si T, Imperato JS et al (2021) Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive-compulsive disorder: a real-world evidence analysis from the United States. Int J Clin Pract 75(10):e14522. https://doi.org/10.1111/ijcp.14522

    Article  CAS  PubMed  Google Scholar 

  38. Zhou DD, Zhou XX, Li Y et al (2019) Augmentation agents to serotonin reuptake inhibitors for treatment-resistant obsessive-compulsive disorder: A network meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 90:277–287. https://doi.org/10.1016/j.pnpbp.2018.12.009

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland

    Dominique Endres, Katharina Domschke & Ulrich Voderholzer

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Lena Jelinek

  3. Schön Klinik Roseneck, Prien am Chiemsee, Deutschland

    Ulrich Voderholzer

  4. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum, Ludwig-Maximilians-Universität München, München, Deutschland

    Ulrich Voderholzer

  5. Deutsches Zentrum für Psychische Gesundheit (DZPG), Standort Berlin, Berlin, Deutschland

    Katharina Domschke

Authors
  1. Dominique Endres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lena Jelinek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharina Domschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich Voderholzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominique Endres.

Ethics declarations

Interessenkonflikt

D. Endres, L. Jelinek und U. Voderholzer geben an, dass kein Interessenkonflikt besteht. K. Domschke: Innerhalb der letzten drei Jahre: Mitglied ‚Steering Committee Neurosciences‘ und Referentenhonorare, Janssen-Cilag.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Hinweis

Zur besseren Lesbarkeit wurde auf die gleichzeitige Verwendung der Sprachformen weiblich, männlich und divers verzichtet. Sämtliche Personenbezeichnungen gelten gleichermaßen für alle Geschlechter.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Endres, D., Jelinek, L., Domschke, K. et al. Therapieresistente Zwangsstörungen. Nervenarzt 95, 432–439 (2024). https://doi.org/10.1007/s00115-024-01629-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-024-01629-1

Schlüsselwörter

Keywords

Search

Navigation