S-38-01

Neuropsychological deficits in OCD as a correlate of a neurobiological dysfunction: Do these deficits change by successful cognitive behavioral treatment?

U. Voderholzer, A. K. Kuelz. University of Freiburg, Freiburg, Germany

Objective: There is evidence for neuropsychological deficits in OCD patients which are commonly interpreted as cognitive correlates of an underlying fronto-striatal dysfunction. Whereas recent neuroimaging studies suggest reversibility of observed functional brain abnormalities, it is less clear whether neuropsychological impairment can likewise be modified by successful cognitive behavioral treatment (CBT).

Methods: 21 unmedicated inpatients with OCD and 39 carefully matched healthy controls were assessed using a comprehensive neuropsychological test battery and psychometric questionnaires. All patients underwent CBT, 7 patients were additionally treated with selective serotonin reuptake inhibitors (SSRI). After the end of treatment, the test battery was applied again. Also the controls were tested again after an interval of 3 months.

Results: At baseline, patients showed significantly lower performance compared with controls on tasks of nonverbal memory and fluency as well as speed of information processing and flexible, self-guided behavior. After CBT, there were no differences between groups on any neuropsychological parameter. A significant group x time interaction was found for the organization score of the Rey Figure, for verbal creativity and for speed-related tasks of set shifting with patients improving to a significantly larger extent. There was no significant association between severity and duration of illness or additional medication intake during CBT and cognitive functioning.

Conclusion: Results suggest that certain neuropsychological deficits in OCD patients are state-related and can be improved by CBT.

S-38-02

Brain imaging findings in patients with obsessive-compulsive disorder and their impact on cognitive behavioral therapy

A. Kordon, F. Hohagen. Lübeck, Germany

S-38-03

Pharmacotherapy of treatment resistant OCD: A summary of recent findings

D. Denys, UMC Utrecht Dept. of Psychiatry, Utrecht, Netherlands

Objective: Obsessive-compulsive disorder (OCD) is a common and severe, but still under-recognized psychiatric disorder. Although serotonin reuptake inhibitors (SRIs) currently are the most effective pharmacological treatment for OCD, up to 40 to 60% of OCD patients do not respond to treatment. Even after a switch to a second SRI-treatment, 30 to 40% of OCD patients fail to respond. In case of refractoriness to SRIs, addition with antipsychotics might lead to symptom improvement. It is intriguing why antipsychotics in monotherapy lack efficacy in OCD, while they are capable to induce de novo OCD symptoms in psychotic disorders, and are efficacious in addition to SRIs in some subtypes of OCD.

Methods: Results of efficacy of addition trials will be reviewed, and the possible neurobiological mechanisms of action of antipsychotic addition to SRIs will be discussed.

Results: Risperidone, olanzapine, and quetiapine were shown to be effective as add-on to SRIs in a number of studies. Changes in extracellular dopamine levels may account for the clinical efficacy of addition strategies with atypical antipsychotics in treatment-refractory OCD.

Conclusion: Addition of antipsychotics to SRIs is a safe and effective treatment option for patients with SRI-refractory OCD.

S-38-04

Cognitive treatment of OCD: Current developments

P. Salkovskis. London, United Kingdom