Functional neuroimaging points to increased metabolic activity of prefrontal cortex in OCD.
Neuropsychological tests reveal that impaired performance connected with frontal lobe function is present in OCD, on the Wisconsin Card Sorting Test (WCST) especially when complicated with psychosis loaded by negative symptoms.
Frontal lobe pathology is a part of both schizophrenia and OCD, but the underlying neural circuits may involve different structures and different neurotransmitters. A circuit responsible for cognitive dysmetria is thought to effect schizophrenia, while in OCD, it is believed that basal ganglia play a prominent role. A dopaminergic deficit in frontal cortex may underlie hypofrontality in schizophrenia, while serotonergic disturbance is believed the most significant cause of OCD, which has immediate therapeutic implications.
SSRIs in mega doses compared with depression, including clomipramine, fluvoxamine 300mg, fluoxetine 40mg, sertraline 200mg, and paroxetine 40mg, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive- compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents.
-gradual dosage titration is needed to avoid insomnia and restlessness or potential exacerbation of anxiety early in treatment
Adding another agent that alters other neurotransmitter systems or different serotonin receptors. It is known that dopamine and serotonin have complex structural interactions in the brain,and combinations of a dopamine antagonist and an SRI have been reported to be effective in the treatment of obsessive- compulsive disorder.
- Atypical antipsychotics with serotonergic action.