Obsessive- Compulsive Disorder ( TREATMENT )
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Obsessive- Compulsive Disorder(TREATMENT)
Pharmacological TreatmentCBTPartial Hospital and Inpatient TreatmentFamily education
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.
Fluoxetine (Prozac) 2060 Agitation ,insomnia , anorexia ,dizziness , Xerostomia ,increased anxiety , disturbing akathisia , suicidal ideation and aggression Sertraline (Zoloft) 50200Insomnia, nausea, agitation and tremor
Fluvoxamine (Luvox) 50200 Nausea , lethargy and insomnia Paroxetine (Paxil) 2060 Citalopram (Celexa) 2060 Escitalopram (Lexapro) 520
Clomipramine (Anafranil) 502 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 anotherSide effects from one agent do not predict side effect on anotherThe maximum dose that a patient can tolerate or the maximum allowable dose for no less than 12 weeks
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 , t3Buspirone ,L-tryptophanSRI+ clomipramine Clonazepam
Evaluate their symptomsFamily in crisis symptoms are completely out of everyones control the familys capacity to support the patient is thoroughly depleted Symptoms are dangerousOngoing sever impairment following a course of adequate treatment
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.
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.