Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by repetitive inappropriate thoughts (obsessions) and behaviors to get rid of obsessions (compulsions). Although selective serotonin reuptake inhibitors (SSRIs) are the first-choice treatment for OCD, response rates to SSRI treatment vary between symptom dimensions. In this study, to find a therapeutic target for SSRI-resilient OCD symptoms, we evaluated treatment responses of quinpirole sensitization-induced OCD-related behaviors. Chronic SSRI administration rescued the cognitive inflexibility and the hyperactivity in the lateral orbitofrontal cortex (lOFC), while repetitive behavior was not improved by SSRI. D2 receptor signaling in the central striatum (CS) was involved in SSRI-resistant repetitive behavior. An adenosine A2A antagonist, istradefylline rescued abnormal excitatory synaptic function in the CS indirect pathway medium spiny neurons of sensitized mice and also alleviated both of the QNP-induced OCD-related behaviors with only short-term administration. These results provide a new insight into therapeutic strategies for SSRI-resistant OCD symptoms and indicate the potential of A2A antagonists as a rapid-acting anti-OCD drug.

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