Abstract
Effective first-line treatments including cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors help a majority of children and adults with obsessive-compulsive disorder (OCD). However, a substantial proportion of adults and children with OCD do not respond to first-line treatments or have a substantial amount of residual OCD symptoms despite treatment. Many individuals with treatment-refractory OCD can suffer a lifetime of distress, impairment, and decreased functioning related to this condition. This chapter defines treatment-refractory OCD and then discusses the evaluation and available treatments for children with refractory OCD symptoms. Pharmacological treatments discussed include dosing of selective serotonin reuptake inhibitor (SSRI) pharmacotherapy, clomipramine, antipsychotic augmentation, and glutamate-modulating agents. The use of cognitive-behavioral therapy in treatment-refractory OCD, as well as intensive treatment programs for pediatric OCD, is discussed.
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