obsessive-compulsive%20disorder
OBSESSIVE-COMPULSIVE DISORDER
Obsessive-compulsive disorder is characterized by the presence of either obsessions or compulsions, but more commonly by both symptoms that can cause marked impairment or distress.
Obsession is a recurrent, persistent, intrusive, unwanted thought, image or urge that cause distressing emotions (eg anxiety and disgust).
Compulsion is a repetitive behavior or mental act that the person feels driven to perform, in order to lessen the distress caused by the obsession.
Anxiety is the central feature of obsessive-compulsive disorder.

Obsessive-compulsive%20disorder Management

Multidisciplinary Review

Multidisciplinary Team

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

Recommendations after Multidisciplinary Review

  • Combination therapy with cognitive-behavioral therapy andselective 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 and 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 and selective serotonin reuptake inhibitor, and Clomipramine alone
    • Additional cognitive-behavioral therapy
    • Additional antipsychotic to a selective serotonin reuptake inhibitor or Clomipramine
    • Combine Clomipramine and Citalopram

Monitoring

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

Follow Up

  • Follow-up visit is done a few days to 2 weeks after the initiation of therapy
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Psychiatry - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Audrey Abella, 6 days ago
A pilot telemedicine initiative may be an alternative for facilitating delivery of intravenous iron (IVI) for individuals requiring iron supplementation.