A 24-year-old woman with OCD has failed adequate trials of two different SSRIs at maximum doses. What is the recommended next pharmacological strategy according to evidence-based guidelines?

• A Switch to a benzodiazepine as primary anxiolytic treatment
• B Add valproate for mood stabilisation and anti-obsessional effect
• C Add a low-dose antipsychotic such as risperidone or aripiprazole to the current SRI ✓
• D Initiate MAO inhibitor as third-line monotherapy

Explanation

For OCD refractory to adequate SRI monotherapy, antipsychotic augmentation with a second-generation antipsychotic — primarily risperidone or aripiprazole — has the strongest evidence base and is the recommended next step. This strategy is hypothesised to act via dopaminergic modulation complementing serotonergic SRI effects. Approximately 30–40% of SRI-resistant patients respond to augmentation. Benzodiazepines are not effective for OCD's core features. MAO inhibitors have insufficient evidence in OCD.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.