Interactive block 1: Difficult to treat OCD

This interactive case discussion addresses brain stimulation treatment options in a man with severe obsessive-compulsive disorder despite adequate medication and specialist exposure and response prevention. Dr. Iris Dalhuisen guides the initial discussion of rTMS, including protocol selection, treatment adequacy and assessment of non-response. Following an unsuccessful course, Dr. Roel Mocking leads the transition to DBS assessment and shared decision making. Subsequent scenarios address stimulation-related activation and partial clinical improvement. Participants discuss how to assess neuromodulation treatment benefit using symptom severity, adverse effects, daily functioning and patient-defined goals. A neighbour discussion considers the rationale for DBS after rTMS non-response. An optional final scenario addresses sudden deterioration and possible interruption of stimulation. The session connects non-invasive and implanted neuromodulation within an individual treatment pathway and distinguishes established evidence from uncertainty about additional interventions.