OBJECTIVES To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). METHODS The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). RESULTS We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. CONCLUSION SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

中文翻译：

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巴西强迫症谱系障碍研究联合会成人强迫症治疗指南。第一部分：药物治疗。

目的 总结基于证据的药物治疗，并为成年强迫症 (OCD) 患者的临床干预提供指导。方法 美国精神病学协会 (APA) 强迫症治疗指南 (2013) 更新了一项系统评价，评估药物治疗成人强迫症的疗效，包括选择性 5-羟色胺再摄取抑制剂 (SSRIs)、氯米帕明、5-羟色胺和去甲肾上腺素再摄取的单一疗法抑制剂 (SNRIs)，以及氯米帕明、抗精神病药和谷氨酸调节剂的增强策略。我们在五个数据库中搜索了 2013-2020 年发表的文献，考虑了研究的设计、主要结果测量、出版类型和语言。使用经过验证的工具对选定文章的质量进行了评估。治疗建议根据美国心脏病学会和美国心脏协会 (ACC/AHA) 制定的证据水平进行分类。结果 我们检查了 57 项新研究以更新 2013 年 APA 指南。高质量的证据支持 SSRIs 作为 OCD 的一线药物治疗。此外，用抗精神病药物（利培酮、阿立哌唑）增加 SSRI 是对 SSRI 耐药的 OCD 最循证的药理学干预措施。结论 SSRIs，在 8-12 周的最高推荐或耐受剂量下，仍然是成人 OCD 的一线治疗。SSRI 耐药强迫症的最佳增强策略包括低剂量利培酮或阿立哌唑。药物治疗被认为无效或可能有害，