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Book Forum: Obsessive-Compulsive Disorder   |    
Obsessive Compulsive Disorder: A Practical Guide
STEFANO PALLANTI, M.D., Ph.D.
Am J Psychiatry 2003;160:809-809. doi:10.1176/appi.ajp.160.4.809
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Edited by Naomi Fineberg, M.A. (Cantab), M.B.B.S., M.R.C.Psych., Donatella Marazziti, M.D., and Dan J. Stein, B.Sc. (Med), M.B.Ch.B., F.R.C.P.C. London, Martin Dunitz, 2001, 228 pp., $39.95.

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Written by clinicians specifically for clinicians, Obsessive Compulsive Disorder: A Practical Guide includes contributions from recognized experts in the field of obsessive-compulsive disorder (OCD). The guide provides accurate, comprehensive reviews of recent studies in different aspects of the disorder, together with practical suggestions.

The introduction illustrates the phenomenon of OCD from a 21st-century perspective, taking account of prevalence, course, and prognosis. This is followed by a chapter on assessment, which distinguishes between diagnostic and rating instruments. From a purely clinical point of view, Goldsmith, Shapira, and Goodman remind us that face-to-face interviews are necessary to establish a relationship between patient and practitioner, and they recall the distinctions among obsession, depressive ruminations, and anxious worries.

The third chapter focuses on the complex topic of the OCD spectrum or, rather, spectra, including the Jarry and Vaccarino OCD-eating spectrum, Eric Hollander’s more famous compulsive-impulsive spectrum, and related proposals from McElroy, Phillips, and Bienvenu. Tic-related subtypes are also considered. The illustrations of recent findings on dysfunction of the serotonergic and dopaminergic systems in this chapter are very useful because this is the level at which clinical practitioners will apply the different hypotheses to build the pharmacological treatment.

From my own point of view, the chapter by Stein, Fineberg, and Harvey on unusual OCD symptoms is one of the most useful. These symptoms include somatic, sensory, stereotypic, impulsive, interpersonal (such as jealousy and compulsive sexual behaviors), and problematic symptoms. In fact, typical forms of OCD are uncommon, like all "typical" things (e.g., presenting "typical Italian" in terms of pizza, mandolins, and "O Sole Mio"). The authors examine the mixed range of people with OCD disturbances who are referred to a physician for treatment.

Lorrin Koran’s professional research competence and personal sensibility shine through clearly in his chapter on quality of life in OCD. Not only does he suggest how and why it is important to evaluate quality of life in OCD patients, but he also offers critical advice for future research on the topic.

David Pauls reviews the genetics of OCD with explanations and suggestions for future research. James Lucey focuses on neuroanatomy, reviewing neuroimaging studies, and Donatella Marazziti provides a chapter on integrated pathophysiology in which research data provide the empirical basis for established hypotheses.

In Zohar and Fineberg’s chapter on practical pharmacotherapy, the focus returns once again to OCD clinics, with a look at some of the most common questions that arise: What is the most effective drug dosage for OCD? Is treatment effective over time? and What is the best dose for long-term treatment?

In their chapter on psychotherapy in OCD, Brooks and Hohagen also present some predictors for exposure/prevention therapy and a multimodal approach. In the chapter on treatment-refractory OCD, McDougle and Walsh tell us about some potentially effective strategies for resistant cases: intravenous clomipramine; the addition of clonazepam, haloperidol, or risperidone; and inositol monotherapy. They list a dozen other promising treatments that may warrant controlled study.

Flament and Cohen, two fine experts in child and adolescent psychiatry, summarize all that is currently known about OCD in children and adolescents and that specifically should be considered in the treatment of these age groups. In the next chapter, Stein, Fineburg, and Seedat provide a practical guide to integrated treatment, and in the final chapter Frederick Toates, who has already made other major contributions in this area, reports patients’ perspectives on OCD. This is another fundamental point of view that can never be neglected in a book written by clinicians for clinicians.

The editors and contributors of Obsessive Compulsive Disorder: A Practical Guide are to be thanked for this simple but complete guide. Even if you do not have time to read all the extensive literature on OCD published in the last 10 years, you should at least read this guide. It will tell you everything that clinicians need to know about a disorder that is being seen more and more frequently.

Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.

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