• Q. Average number of years between onset and treatment of OCD?
OCD
Ans. 17 years.
Outline of OCD treatment
• Q. What is basic treatment for OCD, speaking generally?
Outline of treatment
Ans. Basically:
• SSRI/clomipramine and behavioral therapy
FDA approved for OCD
• Q. FDA has approved?
FDA
Ans. FDA has approved:
• Clomipramine
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline
Dosing
• Q. Typical doses of OCD with an SSRI?
OCD
Ans. Typically, dosing is higher than with MDD.
OCD
• Q. Onset of effectiveness in OCD when using an SSRI – when it is effective?
OCD
Ans. Should see improvement in 6 to 12 weeks.
OCD
• Q. If the SSRI is successful and then discontinued, what is likely to happen?
OCD
Ans. Symptoms will return in two months.
Typical results
• Q. Typical results with an SSRI?
OCD
Ans. About ½ have 1/3 improvement
OCD augmentation
• If partial response to an SSRI, what meds can you add that may make for further improvement?
Augmentation
Ans.
• Atypical antipsychotic
• Buspirone
• Clomipramine
• Clonazepam
• Lithium
• Venlafaxine
• Valproate
Treatment of PANDAS
• Q. What is treatment?
PANDAS
• 1] plasmopheresis to clear antibodies
• AND
• 2] prophylactic antibiotics
Behavioral therapy for OCD
• Q. Behavioral therapies, three most common?
Behavioral therapy
Ans. Three most common:
• 1. Exposure and response prevention
• 2. Imaginal flooding
• 3. Thought stopping
Exposure and response prevention
• Q. What is exposure and response prevention?
OCD
Ans. Exposure and response prevention consist of asking the pt to endure, in a graduated manner, the anxiety of a specific obsession the pt fears – and refrain from the associated compulsion.
OCD
• Q. What is imaginal flooding?
OCD
Ans. Imaginal flooding consists of having the pt provoked by the obsessions by continually repeating the thought to where the thought no longer provokes fearfulness.
OCD
Q. What is thought stopping?
OCD
Ans. Thought stopping consists of having a technique to stop the pt compulsive thought, e.g., the pt keeps needing to repeat a short prayer and one has the pt shout when that happens, or make a loud noise or snapping a rubber band on the wrist to where it stings.
OCD
• Q. Behavioral therapy helps what % of OCD pts?
OCD
Ans. 3/5
OCD
• Q. Usefulness of relaxation techniques in OCD?
OCD
Ans. Relaxation techniques have not been shown to be helpful
OCD
• Q. Pt only has obsessions, not compulsions. In addition to techniques already mentioned, what psychotherapy technique might be tried?
OCD
Ans. The pt can try not resisting, “just let them pass through.” Also can audio tape and the pt can listen to the tape until no loner upsetting.
OCD
• Q. Typical length of time of behavioral therapy sessions?
OCD
• 90 minutes – and homework
OCD
• Q. Typically, how many sessions?
OCD
• 13 to 20 sessions
Families
• Q. What should you tell families of OCD pts as to how they should relate to the pt?