Cheatography
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Obsession VS Compulsion
Obsession |
Compulsion |
Fear of contamination |
Washing or cleaning rituals |
Recurrent worries about doing things incorrectly/incompletely |
Checking excessively, performing actions in a particular order |
Need for symmetry |
Ordering, arranging, straightening |
Unwanted thoughts about being immoral |
Asking forgiveness, praying, reassurance seeking |
Concerns about throwing away something valuable |
Hoarding |
Obsession is the fear, Compulsion is the response
Goals of Treatment
Short-Term |
Reduction in frequency and severity of obsessive thoughts; Reduction in time spent performing compulsive acts; improved psychosocial and occupational functioning; improved psychosocial and occupational functions |
Long-Term |
Remission |
Pharm | FIRST LINE
Citalopram |
Escitalopram |
Fluoxetine |
⇦ FDA APPROVED |
Fluvoxamine |
⇦ FDA APPROVED |
Paroxetine |
⇦ FDA APPROVED |
Sertraline |
⇦ FDA APPROVED |
SSRI maximum doses in OCD are typically higher than max doses in anxiety and depression
Duration of Therapy
Continue Tx for at least 1 to 2 years |
• 0 to 3 months: monitor Q wk to QOW |
• 3 to 6 months: monitor Q month |
• 6 to 24 months: monitor Q 1 to 2 months |
Lifelong treatment recommended when: |
• ≥ 2 severe relapses or ≥ 3 mild relapses |
• Unable to achieve remission |
Discontinuation or treatment |
• Evaluate risks vs benefit |
• taper slowly |
• encourage non-pharmacologic tx |
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DSM 5 Diagnostic Criterion
Presence of obsessions, compulsions, or both |
Must be time consuming (> 1 hour) OR Cause clinically significant distress in any area of life |
Not attributed to a medical diagnosis or substance induced |
Not better explained by another mental disorder |
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
Most commonly used scale |
40 point, 10-item clinician rated scale |
Measures overall severity of obsessions and compulsions |
Response: ≥ 25% reduction in score |
Remission: score ≤ 8 |
Treatment Considerations
Appropriate when:
• an insufficient response to monotherapy (either drug or CBT)
• Patient prefers short duration
• Comorbid psychiatric conditions with no response to pharmacotherapy alone
Pharm | SECOND LINE
CLOMIPRAMINE |
TCA with strong 5-HT reuptake inhibition |
Active metabolite inhibits NE reuptake |
Studies showed it was more effective than SSRIs, but use is limited due to ADRs |
True medication trial is at least 12 weeks at maintenance dosage |
Note: In PTSD, 8 to 12 weeks was a true medication trial
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