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ocd

obsessive compulsive disorder (OCD)

introduction

  • 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
  • it is DIFFERENT to obsessive compulsive personality disorder (anankastic PD) and the PD does not always accompany OCD
  • 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
  • OCD does NOT respond to benzodiazepines
1)
Aust. Prescriber Aug 2015
ocd.txt · Last modified: 2015/10/04 23:51 (external edit)