378. Achieving remission in OCD: challenges and opportunities

Abstract

Abstract Background Despite the availability of evidence-based pharmacological and psychotherapeutic treatments for obsessive–compulsive disorder (OCD), achieving full remission remains a major clinical challenge. A substantial proportion of patients show only partial response, with persistent symptoms, functional impairment, and reduced quality of life. This has shifted the therapeutic focus from symptomatic improvement to remission as the primary and clinically meaningful outcome. Aims & Objectives This symposium aims to examine key clinical and neurobiological factors that influence the achievement of remission in OCD. Objectives include: (i) clarifying the concept and clinical relevance of remission; (ii) identifying treatment-related variables that determine remission likelihood, particularly early pharmacological decisions; and (iii) highlighting the role of secondary obsessive–compulsive syndromes and neuroscience-informed classifications in guiding personalized interventions. Method The symposium integrates evidence from clinical trials, treatment guidelines, retrospective clinical studies, systematic literature reviews, and illustrative case material. Emphasis is placed on individualized pharmacological strategies, including dose optimization and augmentation, as well as on neuroscience-based approaches that link symptom dimensions to underlying pathophysiological mechanisms. Data from studies investigating autoimmune markers, cerebrospinal fluid alterations, genetic syndromes, and focal brain lesions associated with obsessive–compulsive symptoms are reviewed. Results Emerging evidence indicates that remission is more likely when pharmacological treatments are initiated at adequate doses, maintained for sufficient duration, and tailored to individual symptom profiles. Suboptimal early dosing and delayed optimization appear to be major contributors to partial response. Furthermore, recognition of secondary obsessive–compulsive syndromes reveals distinct clinical and biological features that may require Discussion & Conclusions A remission-oriented approach to OCD requires integration of optimized early pharmacological interventions, personalized augmentation strategies, and careful assessment for secondary causes. Incorporating neuroscience-based classifications and biological markers into clinical decision-making may enhance the precision of treatment selection and improve long-term outcomes. This framework supports a shift toward personalized, mechanism-informed care aimed at achieving sustained remission rather than partial symptom control.