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 .
  1. Best clinical outcome occur when SSRI are combined by CBT .
  2. 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 
  1. Valporate
  2. Lithium
  3. Carbamazepinev Other drugs which could be tried – Venelafaxine , pindolol , MAOI phenelzine , buspirone , 5-hydroxytryptamine , l-tryptophan , clonazepam .
  4. 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 –
  1. Exposure and response prevention
  2. Desensitization and thoughts stopping
  3. Flooding
  4. 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 t
  • e 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
  1. Cingulotomy which is successfully treating 25-30 percent of unresponsive cases 
  2. . 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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