Management of obsessive-compulsive disorder
PHARMACOLOGICAL THERAPY:
- OCD pharmacological and behavioral treatment considered better approaches .
- The standard approach are start treatment with An SSRI or Clomipramine , and then move forward to other pharmacological therapies if serotonin specific drugs are not effective .
SSRI –
- Fluoxetine, Fluvoxamine , Paroxetine , Citalopram – all are approved by FDA for OCD treatment .
- Common side effect – sleep disturbances , nausea , diarrhea , headache , restlessness , anorgasmia . Most of this side effect are transient .
- Best clinical outcome occur when SSRI are combined by CBT .
- Clomipramine (tricyclic anti-depressant) – 1st drug approved by FDA for OCD treatment , side effects includes : G.I disturbances , orthostatic hypotension , sedation , anticholinergic side effects included dry mouth and constipation . As with SSRI best outcome is with combined behavioral therapy .
Other pharmacotherapy which used for first augmentation in case of resistance cases –
- Valporate
- Lithium
- Carbamazepine
- Other drugs which could be tried – Venelafaxine , pindolol , MAOI phenelzine , buspirone , 5-hydroxytryptamine , l-tryptophan , clonazepam .
- Atypical anti-psychotic such as Risperidol , helped in some cases .
BEHAVIOUR THERAPY:
- Pharmacotherapy and behavioral therapy has long lasting effect .
- The principle of the therapy is –
- Exposure and response prevention
- Desensitization and thoughts stopping
- Flooding
- Aversive conditioning .
- Psychotherapy with concentrating in Cognitive behavioral therapy , and insight oriented therapy , also can be combined by supportive therapy .
- In psychoanalytic terms, obsessive compulsive disorder is fixed at Anal stage
FAMILY THERAPY:
- Building alliance with the family members , and helping reduce marital discord resulting from the disorder .
OTHER THERAPIES:
- For extreme cases that treatment resistant and chronically debilitating – ELECTROCONVULSIVE THERAPY (ECT) and psychosurgery are the consideration .
Psychosurgery
- Cingulotomy which is successfully treating 25-30 percent of unresponsive cases .
- Subcaudate tractotmy (capsulotomy) also has been used for that purpose .
- Non ablative surgical techniques involving indwelling electrodes in various basal ganglia (deep brain stimulation ) are under investigation forpatient who is suffering from Tourettes disorder and OCD .
- Seizures development due to Psychosurgery , mostly can be eliminated by phenytoin .
Exam Question
- Drug of choice for OCD is Fluoxetine
- Clomipramine is used for treatment of OCD
- In psychoanalytic terms, obsessive compulsive disorder is fixed at Anal stage
- Treatment of choice for OCD is Combination of behavior and drug therapy
- In OCD treatment is based on Serotonergic receptor
- Exposure & response prevention ,Psychoanalytic psychotherapy, Clomipramine are the treatment modalities of OCD
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