![]() They should also be warned that response to treatment may be slow and the full effect of their medication may only become evident after 12 weeks. Patients prescribed higher doses should be informed of this and monitored carefully in consultation with a psychiatrist. 12, 13 Doses used in trials are listed in the Table. Some patients respond to standard doses of SSRIs, however most will need higher doses. 7 Unlike other anxiety disorders, OCD tends not to respond to benzodiazepines. Although clomipramine can be effective for some patients, it is usually used after two failed trials of an SSRI due to problems with the tolerability of clomipramine. Trials have not convincingly proven the superiority of clomipramine over SSRIs. Response rates are similar between drugs 10 so the choice of which one to prescribe is usually determined by the doctor’s familiarity with an SSRI or by the need to reduce the risk of drug interactions. Treatment usually commences with an SSRI (see Table). Some studies indicate that 50% of people will achieve remission when treated with a selective serotonin reuptake inhibitor (SSRI). 8 Most patients will have some alleviation of their symptoms. The evidence for drug treatment is robust (see Table). The cost of psychological counselling is also a commonly reported problem. 7 It may be difficult to find a psychologist with adequate experience of OCD or waiting lists may be long. Pharmacological interventions are recommended when patients are unable to face the prospect of heightening their anxiety in exposure and response prevention, when they have severe symptoms and when they are unable to access an appropriately trained psychologist. 6 This may be particularly useful for those in rural and remote areas. In clinical trials, both therapist-guided and self-guided programs were effective. Internet-based treatment programs * based on cognitive behavioural therapy can also be beneficial. Exposure should be conducted in a graded manner with exposure to less anxiety-provoking stimuli in the initial stages. The patient is then taught to manage their anxiety without using washing or cleaning compulsions (response prevention). For example, a person with contamination obsessions is asked to touch something that they deem contaminated (exposure) and would normally avoid. 5Įxposure and response prevention therapy involves exposing patients to their fears and preventing their response (or their compulsion). Of the many psychological treatments that are available, exposure and response prevention has the most evidence for its effectiveness. They will therefore often request psychological strategies to assist them to resist and cope with their symptoms. Patients often fear adverse effects associated with drug treatment, or the risk of drug dependency. ![]() The personality disorder does not always accompany OCD. It is often confused with obsessive compulsive personality disorder (anankastic personality disorder) in which perfectionism, orderliness and rigidity is an ego-syntonic or non-distressing aspect of personality. ![]() ![]() unacceptable aggressive, sexual or religious intrusive thoughts.the need to have objects symmetrical or in order.OCD is difficult to screen for as it can present with a variety of symptoms, including: They might also believe there is no effective treatment. 3 They are often embarrassed by their symptoms and may fear that their symptoms will be seen as trivial. Patients tend to disclose their symptoms to their GP after many years of suffering in silence. It is ranked as one of the top 10 most disabling medical conditions. The repetitive behaviours, distress and indecisiveness can lead to obsessional slowness and avoidance. In most cases, patients see their symptoms as senseless or unreasonable, but they have difficulty resisting them. ![]() OCD is characterised by recurrent and intrusive thoughts, images or impulses (obsessions) that are distressing, accompanied by repetitive behaviours or compulsions. It occurs in approximately 2% of the population and 6–8% of people have subclinical symptoms. Obsessive compulsive disorder (OCD) is a common and disabling condition. ![]()
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