almost 10% of people have subclinical OCD symptoms, while 2% of people have the disabling disorder which impacts their life
it is in the top 10 disabling medical conditions, although most suffer in silence, rarely seeking help as they are either embarrassed or perceive that their symptoms will be seen as trivial
treatment requires patience but significant benefits are achievable
clinical features
may present in a variety of symptoms such as:
excessive cleaning and fear of contamination
need to have order or symmetry
excessive doubt and need to re-check
unacceptably intrusive aggressive, sexual or religious thoughts
psychological interventions
cognitive behaviour therapy
systematic desensitisation to reduce their fears may be useful
drug treatments
drug Rx may be indicated if they are unable or unwilling to have psychological therapy and they have severe symptoms
SSRI/SNRI antidepressants are generally the 1st line Rx and most will have some improvement with up to 50% achieving remission
some patients respond to standard doses, but most need higher doses (eg. escitalopram 10-40mg/d and double this for citalopram) 1)
given the higher than usual doses, watch for serotonin syndrome and warn of concomitant use of other drugs such as St Johns Wort and tramadol, and also watch for prolonged QTc
doses are generally increased every 2 weeks pending response and toleration and should be trialed for at least 12 weeks before concluding it has failed
successful Rx should be continued as 50% will relapse within 12wks of cessation
cessation should be done by gradual withdrawal over several months with close guidance
if 2 trials of these fail then clomipramine may be tried