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Obsession
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Compulsion
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Fear of contamination
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Washing or cleaning rituals
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Recurrent worries about doing things incorrectly/incompletely
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Checking excessively, performing actions in a particular order
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Need for symmetry
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Ordering, arranging, straightening
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Unwanted thoughts about being immoral
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Asking forgiveness, praying, reassurance seeking
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Concerns about throwing away something valuable
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Hoarding
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Short-Term
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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
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Long-Term
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Remission
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Citalopram
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Escitalopram
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Fluoxetine
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⇦ FDA APPROVED
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Fluvoxamine
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⇦ FDA APPROVED
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Paroxetine
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⇦ FDA APPROVED
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Sertraline
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⇦ FDA APPROVED
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Continue Tx for at least 1 to 2 years
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• 0 to 3 months: monitor Q wk to QOW
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• 3 to 6 months: monitor Q month
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• 6 to 24 months: monitor Q 1 to 2 months
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Lifelong treatment recommended when:
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• ≥ 2 severe relapses or ≥ 3 mild relapses
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• Unable to achieve remission
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Discontinuation or treatment
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• Evaluate risks vs benefit
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• taper slowly
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• encourage non-pharmacologic tx
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Presence of obsessions, compulsions, or both
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Must be time consuming (> 1 hour) OR Cause clinically significant distress in any area of life
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Not attributed to a medical diagnosis or substance induced
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Not better explained by another mental disorder
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Most commonly used scale
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40 point, 10-item clinician rated scale
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Measures overall severity of obsessions and compulsions
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Response: ≥ 25% reduction in score
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Remission: score ≤ 8
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Pharmacotherapy ± CBT
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CLOMIPRAMINE
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TCA with strong 5-HT reuptake inhibition
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Active metabolite inhibits NE reuptake
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Studies showed it was more effective than SSRIs, but use is limited due to ADRs
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True medication trial is at least 12 weeks at maintenance dosage
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