Table V. Obsessive-compulsive disorder (OCD): therapeutic strategies. BZ, benzodiazepine; MAOI, monoamine oxidase inhibitor; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricylic antidepressant.

Predominant clinical features	First-line treatment	Partial or no response
• Depressive symptoms, recurrent course wrth bspolar spectrum comorbidity	SSRI	Add mood stabilizer (lithium, gabapenin)
• Highly anxious obsessional subjects	Eventually switch to a different SSRI or SRI (clomipramine or intravenous clomipramine)	Add BZ (clonazepam)
• Prevalent symmetry and atypical obsession or high level of anxiety to treatment		Add MAOI or SNRI and eventually neuroleptic
• Severe hoarding symptoms	(Potentiation with buspirone, clonazepam, tryptophan, pindolol)	Add different typical/atypical neuroleptic (pimozide, haloperidol, risperidone, olanzapine)
• Tics, psychotic symptoms		Add different typical/atypical neuroleptic (pimozide, haloperidol, risperidone, olanzapine)