Accelerated rTMS Therapeutic Approach for Refractory Obsessive-Compulsive Disorder

Inclusion criteria

• Volunteer subjects with Obsessive Compulsive Disorders (OCD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) criteria
• without associated tics ("Gilles de la Tourette" Syndrome)
• Age 18-60 years, right-handed
• Disease severity: Yale-Brown Obsessive Compulsive Scale score ≥16 for OCD patients
• Medication stable for at least 4 weeks
• Resistant patients to standard treatments: partial but insufficient response (reduction of Y-BOCS score \< 35%) or lack of response to previous well conducted treatment including: optimal tolerated dose and adequate duration (\> 12 weeks) of at least 2 Serotonin Reuptake Inhibitors (selective serotonin reuptake inhibitors, clomipramine), or 1 Serotonin Reuptake Inhibitors + 1 augmentation strategy (adjunction of an antipsychotic - such as risperidone or olanzapine or aripiprazole - or lithium or buspirone)
• No systematic rTMS therapy in the past six months;
• Signature of informed consent form;
• Normal vision or corrected vision;
• Capacity to complete protocol-specified tests.

Exclusion criteria

• Abnormal cognitive status (assessed using MoCA with score \<24);
• Other primary diagnosis than OCD (comorbid mild depression is tolerated)
• Comorbid diagnosis of schizophrenia/ psychotic disorder, bipolar disorder, substance abuse or dependance3)
• Significant self-harm intent or severe suicidal tendencies within the past year;
• Irreversible visual or auditory impairment preventing completion of scales or related assessments;
• Presence of metallic implants, such as pacemakers or stents;
• Any current or potential medical, psychological, social, or geographical factors compromising patient safety or study participation;
• Poor compliance;
• Claustrophobia;
• History of epilepsy or familial epilepsy
• Pregnant or lactating women (women of childbearing potential must obtain a negative pregnancy test result prior to study commencement and employ medically approved contraceptive measures);
• Deterioration or failure of vital organ function (cardiac, pulmonary, hepatic, renal, etc.); or unstable vital signs;
• Conditions unsuitable for this stimulation site, such as increased intracranial pressure, elevated intraocular pressure, or glaucoma
• History of or concomitant neurological disorders: cerebrovascular disease, central nervous system infections, Creutzfeldt-Jakob disease, Huntington's disease and Parkinson's disease, Lewy body dementia, traumatic brain injury dementia, other physical/chemical factors (drugs, alcohol, CO, etc.), significant somatic diseases (hepatic encephalopathy, pulmonary encephalopathy, etc.), intracranial space-occupying lesions (subdural haematoma, brain tumours), endocrine system disorders (thyroid disease, parathyroid disease), and dementia caused by vitamin deficiency or any other cause