Tuy nhiên, Cox et al. (1993) báo cáo hiệu quả bình đẳng trong một phân tích tổng hợp. Mặc dù thực tế đó Các biện pháp can thiệp sinh học được hiệu quả cho nhiều bệnh nhân OCD, yếu tố psychodynamic Might Be của lợi ích trong sự hiểu biết đáng kể gì kết tủa tăng của chứng rối loạn này | 178 I. IANCU Y. SASSON N. NAKASH M. CHOPRA AND J. ZOHAR are few and are limited by methodological issues. However Cox et al. 1993 reported equal efficacy in a meta-analysis. Despite the fact that biological interventions are more efficacious for OCD patients psychodynamic factors might be of considerable benefit in understanding what precipitates exacerbations of the disorder and in treating various forms of resistance to treatment such as noncompliance to medications or to homework assignments. Symptoms may hold important psychological meanings that make patients reluctant to give them up. Therefore a psychological assessment of the patient s resistance to treatment may improve compliance. In the absence of controlled studies of insight-oriented psychotherapy for OCD the anecdotal reports reporting lasting change do not enable a generalization of its efficacy. Also the efficacy of medications in producing rapid improvement has rendered slow and long-term psychotherapy out of favor. Non-specific approaches such as supportive psychotherapy have a place in OCD and may help patients improve their functioning and adjustment. Management should also include attention to family members through the provision of emotional support reassurance education and advice on how to cope with and respond to the patient. Family therapy may reduce marital discord and build a treatment alliance also to help in the resistance to compulsions. Group therapy is useful for providing a support system for some patients. TREATMENT-RESISTANT OCD Despite the abundance of reports concerning the efficacy of various agents in OCD about 20-30 of patients do not respond at all and another 20-30 display only partial response. Possible reasons for treatment refractoriness in OCD are presented below according to Goodman et al. 1993 . Inadequacy of trial duration too short dose too low impaired absorption increased metabolism noncompliance Coexisting condition limits drug efficacy Incorrect diagnosis .
