In-patient/residential treatment for obsessive-compulsive disorder

Around a third of patients with obsessive-compulsive disorder (OCD) do not respond to first-line treatments, including out-patient cognitive behavior therapy (CBT) and serotonin reuptake inhibitors. In-patient/residential treatment is indicated in this population, especially in those with severe illness causing marked sociooccupational dysfunction or when out-patient CBT is not accessible. It is often delivered as a multimodal intervention where intensive and closely supervised CBT is combined with other interventions including medication management, management of comorbidities, family therapy, rehabilitation, etc. Around 50% to 70% of patients respond to treatment, with improvement maintained over long-term follow-up. Although resource-intensive, it addresses different aspects of the illness and has been shown to be beneficial in treatment-resistant populations. A trial of in-patient/residential CBT may be attempted before recommending invasive neurosurgical interventions in treatment-refractory OCD.