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.

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
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