OCD quo vadis? The Cape Town consensus statement

Abstract

The perception of Obsessive Compulsive Disorder (OCD), once seen as a rare refractory condition, has changed significantly over the past two decades. Neuroimaging and genetic findings have advanced the understanding of the neurobiology of OCD and new treatment options have improved the outlook for patients.

A consensus group at the International Anxiety Disorders Conference in Cape Town, South Africa in February 2006, felt it was timely and appropriate to revisit OCD, to identify key developments in the field of OCD and to examine how they might be translated into clinical practice.

The group reviewed the currently available data on symptomatology, diagnosis, assessment, psychobiology and treatment of OCD in order to provide an up-to-data summary of the literature and recommendations for the treating physician. Special attention was paid to the current controversies about the relationship of OCD to OCD spectrum disorders, and the subtyping of OCD. An important issue was also of whether OCD should be considered as a distinct disorder, separate from the anxiety disorders. Based on the available evidence, it was proposed to remove OCD from the anxiety disorders and place it within a separate category of OCDs. To do justice to the complex and heterogeneous presentation of OCDs it was also proposed to utilize a combination of categorical and dimensional approaches in the diagnostic process. The consensus was that this would enable not only the tailoring of treatment, but would also be helpful to studies on the neurobiology and endophenotyping of OCD.

Key issues in the neurobiology OCD, including the role of serotonin and dopamine, the cortico-striatal circuits and genetic factors, were addressed with respect to their relationship to special populations, such as treatment resistant patients, tic disorders and "schizo-obsessive' patients, and the response to various treatments.