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Asian J Psychiatr. 2019 Nov 9;47:101878. doi: 10.1016/j.ajp.2019.101878. [Epub ahead of print]

Clinical remission of a treatment-refractory individual with severe repetitive rituals and rumination.

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The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang City, 453002, Henan Province, PR China.
The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang City, 453002, Henan Province, PR China; Workstation of Henan Province for Psychiatry Experts, Kaifeng City, 475003, Henan Province, PR China. Electronic address:



Obsessive-compulsive disorder (OCD) is a severe chronic mental disorder and tends to be refractory to pharmacotherapy or psychotherapy. For treatment-refractory patients, neurosurgical interventions are options. 64 % of OCD patients who undergo neurosurgery still have greater than 16 in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) after a long-term follow-up. Here, we reported a patient living with long-term OCD (20 years) who was refractory to pharmacotherapy, mindfulness-based psychotherapy, and neurosurgery that injured his bilateral anterior cingulates (AC) and caudate nucleus.


The patient accepted a novel psychotherapy named cognitive-coping therapy (CCT) and completed Y-BOCS, Hamilton depression rating scale, the Hamilton anxiety rating scale, social and occupational function assessment, and resting-state function magnetic resonance imaging scans (rs-fMRI) before and after 4-week CCT.


His Y-BOCS score was reduced from 25 to 4. His depression score and anxiety score were reduced from 19 to 3 and from 12 to 3, respectively. The global assessment of functioning score increased from 32 to 88.


The remission of the patient suggested that CCT could be an alternative intervention for treatment-refractory OCD and those with severe OCD could be cured in short-term.


Cognitive-coping therapy; Neurosurgery; Obsessive-compulsive disorder; Pharmacotherapy; Treatment


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