Download TREATMENT

Obsessive- Compulsive Disorder
)TREATMENT(
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Pharmacological Treatment
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CBT
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Partial Hospital and Inpatient Treatment
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Family education
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Single Drug Treatment
25-40% Reduction in 40-50%
The choice of medication for OCD should be
Influenced by the presence of coexisting
panic disorder, psychotic or schizotypal
features , depression or Tourette disorder
The most studied medication in treatment of
OCD are potent serotonin reuptake
inhibitors(SRIs),which also affect other
neurotransmitter system.
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Fluoxetine (Prozac) 20–60
Agitation ,insomnia , anorexia ,dizziness ,
Xerostomia ,increased anxiety , disturbing
akathisia , suicidal ideation and aggression
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Sertraline (Zoloft) 50–200
Insomnia, nausea, agitation and tremor
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Fluvoxamine (Luvox) 50–200
Nausea , lethargy and insomnia
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Paroxetine (Paxil) 20–60
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Citalopram (Celexa) 20–60
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Escitalopram (Lexapro) 5–20
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Clomipramine (Anafranil) 50–2
Dizziness , blurred vision ,postural
hypotension , tachycardia ,sedation ,and
constipation
Memantine
glutamate antagonist
It can be readily seen that between 40 and 50%
of individuals with OCD without associated
diagnosis may not respond to adequate trials
of SRIs
The response to one SRI agent dose not
predict the response to another
Side effects from one agent do not predict side
effect on another
The maximum dose that a patient can tolerate
or the maximum allowable dose for no less
than 12 weeks
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It is important to offer adequate dose for a
sufficient period of at least two and possibly
three agents before moving on to
augmentation strategies
Augmentaion with:
antipsychotic
lithium , t3
Buspirone ,L-tryptophan
SRI+ clomipramine
Clonazepam
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Evaluate their symptoms
Family in crisis
symptoms are completely out of everyone’s
control
the family’s capacity to support the patient
is thoroughly depleted
Symptoms are dangerous
Ongoing sever impairment following a course
of adequate treatment
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Cognitive-behavioral therapy (CBT) with
exposure and response prevention (E/RP) .
According to the American Academy of Child
and Adolescent Psychiatry CBT or CBT with
concurrent pharmacotherapy using an SSRI is
considered the first-line treatment for
pediatric OCD.
The first step of treatment is
psychoeducation about OCD and E/RP.
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child's age, cognitive functioning, and insight
into the nature of his or her OCD is
paramount in determining the direction of
treatment, as introduction of cognitive
components of therapy depends on the
child's developmental level and insight.