Multidisciplinary Team

• With expertise in obsessive-compulsive disorder & referred to when treatment options fail to produce adequate response
• Supports & collaborates with those professionals already involved in the patient’s care

Recommendations after Multidisciplinary Review

• Combination therapy with cognitive-behavioral therapy & selective serotonin reuptake inhibitors for patients with inadequate response to selective serotonin reuptake inhibitors alone within 12 weeks or cognitive-behavioral therapy of >10 therapist hours per patient
• Another selective serotonin reuptake inhibitors or Clomipramine should be offered for patients with inadequate response to combined treatment of selective serotonin reuptake inhibitors & cognitive-behavioral therapy, no response to selective serotonin reuptake inhibitor alone, or have not engaged with cognitive-behavioral therapy
• Clomipramine should be considered after an adequate trial of at least one selective serotonin reuptake inhibitor which has been ineffective or poorly tolerated, patient prefers Clomipramine, or has good response previously to Clomipramine
• Other options if there are no response after a full trial of at least 1 selective serotonin reuptake inhibitor alone, combination therapy with cognitive-behavioral therapy & selective serotonin reuptake inhibitor, & Clomipramine alone
  
  • Additional cognitive-behavioral therapy
  • Additional antipsychotic to a selective serotonin reuptake inhibitor or Clomipramine
  • Combine Clomipramine & Citalopram

• Frequency of visits will depend on the severity of the symptoms, complexities of co-occurring conditions, presence of suicidal ideation, & side effects
• Psychotherapy should be done as often as necessary

• Follow-up visit is done a few days to 2 weeks after the initiation of therapy