A Complex Case of Obsessive-Compulsive Disorder (OCD)
Despite being amongst the commonest psychological problems seen in both adults and children, treatment of OCD is often misunderstood and poorly administered. This is disappointing as, correctly treated, OCD responds well to treatment with either psychological treatment involving graded exposure and response prevention (ERP) or with relatively high doses of drugs acting on the serotonin system. The first-line treatment of OCD is outlined in this chapter. A small percentage of people do not respond to these first-line treatments and, in these cases, there is evidence for either combining drug treatment with ERP or additionally adding in an agent which acts on the dopamine system. More recent work from highly specialist centres have also demonstrated efficacy for using selective serotonin reuptake-inhibiting drugs in above licensed doses for the small percentage of patients who fail to respond to more conventional treatment.
KeywordsObsessive-compulsive disorder OCD Selective serotonin reuptake inhibitors SSRI Graded exposure Exposure response prevention ERP
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- 2.Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry. 2016;3(8):730–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Soomro GM, Altman DG, Rajagopal S, Oakley Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews 2008;1: DOI: https://doi.org/10.1002/14651858.CD001765.pub3.
- 15.Drummond LM. CBT for adults: a practical guide for clinicians. London: Royal College of Psychiatrists; 2014. p. 93–111.Google Scholar
- 16.McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D, Accreditation Task Force of The Canadian Institute for Obsessive Compulsive Disorders. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res. 2015;227(1):104–13.CrossRefPubMedGoogle Scholar
- 19.Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatr. 2005;162(1):151–61.CrossRefPubMedGoogle Scholar
- 20.Simpson HB, Foa EB, Liebowitz MR, Ledley DR, Huppert JD, Cahill S, Vermes D, Schmidt AB, Hembree E, Franklin M, Campeas RA. Randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatr. 2008;165(5):621–30.CrossRefPubMedGoogle Scholar
- 24.Simpson HB, Foa EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, McLean CP, Bender J, Marcus SM, Williams MT, Weaver J. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiat. 2013;70(11):1190–9.CrossRefGoogle Scholar
- 25.Pampaloni I, Sivakumaran T, Hawley CJ, Al Allaq A, Farrow J, Nelson S, Fineberg NA. High-dose selective serotonin reuptake inhibitors in OCD: a systematic retrospective case notes survey. J Psychopharmacol. 2010;24(10):1439–45.Google Scholar
- 26.Vaughan, R, O’Donnell, C and Drummond, L.M. Blood Levels of Treatment Resistant Obsessive-Compulsive Disorder Patients Prescribed Supra-normal Dosages of Sertraline Faculties of Child & Adolescent Psychiatry and General Adult Psychiatry. Annual Conference 2016 06–07 October 2016. The ICC, Birmingham.Google Scholar