Introduction

Obsessive-compulsive disorder (OCD) is a common, chronic, and disabling disorder marked by obsessions and/or compulsions that are egodystonic and cause significant distress to the patients and their families. During the last two decades, there has been a resurgence of studies into various aspects of OCD, including epidemiological, pathophysiological, and pharmacological investigations. Moreover, algorithms for the management of these patients have been proposed. The progress in our understanding of OCD is an example of the investment in studies on selective treatments, advanced methodologies of imaging studies (both before and after treatment), and the neurological aspects of OCD and OCD-related conditions, all of which reflect the development of psychiatry in recent years.

Up to the early 1980s, OCD was considered a treatment-refractory chronic condition of psychological origin. Dynamic psychotherapy was of little benefit and several pharmacological treatments were attempted without much success.(1) Since then, several researchers have reported that the prevalence of OCD is around 2 per cent in the general population.(23) In addition, numerous studies have reported on the efficacy of various serotonin reuptake inhibitors, and consequently an understanding of the biological basis of OCD has begun to unfold.

The observation that clomipramine, a tricyclic antidepressant with a serotonergic profile, is effective in treating symptoms of OCD (4,5) has increased interest in the relationship between serotonin and OCD. Substantial evidence currently suggests that OCD is almost unique among psychiatric disorders, as only serotonergic medications appear to be effective in this disorder.(6) For example, non-serotonergic drugs, such as desipramine, a potent antidepressant and antipanic agent, are entirely ineffective in OCD.(78. and9) This specific response to serotonergic drugs has paved the way for further research on the role of serotonin in the pathogenesis of OCD in particular, and in OCD-related disorders in general.

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