Obsessive- Compulsive Disorder

(TREATMENT)

Pharmacological Treatment

CBT

Partial Hospital and Inpatient Treatment

Family education

Single Drug Treatment

25-40% Reduction in 40-50%

The choice of medication for OCD should be

Influenced by the presence of coexisting

panic disorder, psychotic or schizotypal

features , depression or Tourette disorder

The most studied medication in treatment of OCD are potent serotonin reuptake inhibitors(SRIs),which also affect other neurotransmitter system.

Fluoxetine (Prozac) 20–60

Agitation ,insomnia , anorexia ,dizziness ,

Xerostomia ,increased anxiety , disturbing

akathisia , suicidal ideation and aggression

Sertraline (Zoloft) 50–200

Insomnia, nausea, agitation and tremor

Fluvoxamine (Luvox) 50–200

Nausea , lethargy and insomnia

Paroxetine (Paxil) 20–60

Citalopram (Celexa) 20–60

Escitalopram (Lexapro) 5–20

Clomipramine (Anafranil) 50–2 Dizziness , blurred vision ,postural

hypotension , tachycardia ,sedation ,and constipation

Memantine glutamate antagonist

It can be readily seen that between 40 and 50% of individuals with OCD without associated diagnosis may not respond to adequate trials of SRIs

The response to one SRI agent dose not predict the response to another

Side effects from one agent do not predict side effect on another

The maximum dose that a patient can tolerate or the maximum allowable dose for no less than 12 weeks

It is important to offer adequate dose for a sufficient period of at least two and possibly three agents before moving on to augmentation strategies

Augmentaion with:

antipsychotic

lithium , t3

Buspirone ,L-tryptophan

SRI+ clomipramine

Clonazepam

Evaluate their symptoms Family in crisis symptoms are completely out of

everyone’s control the family’s capacity to support the

patient is thoroughly depleted Symptoms are dangerous Ongoing sever impairment following a

course of adequate treatment

Cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) . According to the American Academy of Child and Adolescent Psychiatry CBT or CBT with concurrent pharmacotherapy using an SSRI is considered the first-line treatment for pediatric OCD.

The first step of treatment is psychoeducation about OCD and E/RP.

child's age, cognitive functioning, and insight into the nature of his or her OCD is paramount in determining the direction of treatment, as introduction of cognitive components of therapy depends on the child's developmental level and insight.