Obsessive Compulsive Disorder

Fluoxetine REF: Kaplan 9^th ed p — 622

OCD

Treatment of choice: behaviour therapy Drug of choice: SSRI

2nd drug of choice: comipramine

Fluoxetine and Clomipramine are the drugs preferred and Cognitive Behavioural Therapy is the treatment modality of choice. SSRIs help the condition by increasing the seratonin levels.

Fluoxetine and Clomipramine are used as medication options in OCD.

However Cognitive Behaviour Therapy is the psychological traetment for OCD.

This involves a technique called exposure and response prevention.

Two approaches which are indicated in the treatment of OCD are use of SSRIs and Cognitive behavioral therapy.

Drugs which are approved for the treatment of OCD are clomipramine, fluoxetine, fluvoxamine and sertaline.

Reference:
Current Diagnosis and Treatment : Psychiatry 2nd edition chapter 18.

Obsessive compulsive disorder is an anxiety disorder, characterised by recurrent obsessions or compulsions which cause marked distress and functional impairment.

In this, patients have insight about the illness but are unable to resist their actions.

This is ego dystonic.

Ego syntonic traits are seen in patients with personality disorders.

Something that goes with the ego is called ego syntonic and something that goes against the ego is called ego dystonic.

Reference:
Current Diagnosis & Treatment: Psychiatry, 2e chapter 21

Thought disorders can be of 2 types:

a) Disorders of thought form or stream e.g. Thought block, formal thought disorder in Schizophrenia, disorganised thinking, derailment in thinking etc
b) Disorders of thought content e.g. Delusions, obsessions and compulsions etc

Hallucinations are not thought disorders. They are perceptual abnormalities. Hallucinations can however lead to secondary delusions. 

A i.e. Fluoxitine

A. i.e. Panic attack B. i.e. OCD; C. i.e. Personality disorder

B i.e. Egosyntonic

B i.e. Undoing; A i.e. Repression > E i.e. Displacement

• OCD was thought to result from a regression from the oedipal phase to anal psychosexual phase of development, with its characteristic

preoccupation with aggression or cleanliness (anal phase)

ambivalence i.e., coexistence of love & murderous hate towards the same person/ object and sometimes simultaneously , which leaves patient in paralyzing doubt and indecision, evident as doing of undoing pattern of behaviour

–        magical thinking

• Freud, surmised that unconscious impulses of sexual & aggressive nature result in OCD. These impulses 1/ t extreme anxiety, which can be reduced by the action of defence mechanisms of repression & reaction formationQ. He described isolation, undoing & reaction formationQ as three major defence mechanisms of OCD.

D. i.e. Combination of behaviour & drug therapy

A. i.e. Serotonin receptor

D i.e. Diazepam

D i.e. MAO inhibitor

Ans:D.)All

Selective serotonin reuptake inhibitors (SSRIs) are US-FDA approved drugs of first choice (line) for major Depression, Obscessive – compulsive disorder (OCD), Premenstrual dysphoric disorder, Post traumatic stress disorder (PTSD), Panic disorder, Eating disorder (bulimia nervosa), and Social phobia (social anxiety disorder)Q. Mn-SSRI for “DOPES” is 1^st choice.

SSRIs are also used in generalized anxiety disorder, treatment of premature ejaculation (paroxetiene is most useful), body dysmorphic disorders, compulsive buying, & kleptomania.

Psychotherapy (group, supportive) remains the treatment of choice for adjustment disordersQ. And medications are used only to treat specific symptoms for brief periods. Patients with severe anxiety bordering on panic can benefit from anxiolytics (diazepam); those in withdrawn or inhibited states may benefit from short course of psychostimulant drugs; those with signs of decompensation or impending psychosis may be helped by antipsychotic drugs; whereas, SSRIs are useful in treating symptoms of traumatic grief. There is recent trend of increased antidepressant use, however, to augment psychotherupy in adjustment disorder rather than serving as the primary modality. All SSRIs (except fluvoxamine) are US-FDA approved for treatment of major depression. Fluvoxemine is only used for treatment of OCD in US (b/o commercial reasons not d/t therapeutic profile as it is used for major depression in other countries). In US, citalopram is used only in major depression; escitalopram in major depression & GAD; paroxetine is only not used in bulimia nervosa; and setraline is not used in bulimia & GAD. Fluoxetine is not used in GAD, PTSD and social anxiety but is approved for treatment of bipolar depression (with olanzapine).

Ans. is ‘a’ i.e., Fluoxetine

SSRIs are drug of choice for ‑

o OCD                                 o Panic disorder                   o Premenstural dysphoric disorder                  o Eating disorders

o Depression                       o Social phobia                    o Post traumatic stress disorder

Ans. A i.e. Basal ganglia

Ans. OCD