By Dr.Stephen Antony, MD (Psychiatry)
The lifetime prevalence of OCD is approximately 2.5%. There is no sex difference in prevalence, but the age of onset is usually earlier in males.
OCD usually begins in adolescence or early adulthood, but it may occasionally begin in childhood. The onset is usually gradual and most patients have a chronic disease course with waxing and waning of symptoms in relation to life stressors.
Fifteen percent of patients have a chronic debilitating course with marked impairment in social and occupational functioning. Up to 50% of patients with Tourette’s disorder have coexisting OCD; however, only 5% of OCD patients have Tourette’s disorder
Treatment of Obsessive-Compulsive Disorder:
OCD Medication:
Pharmacotherapy is almost always the treatment of choice in OCD. Though the preferred choice of treatment without medications is indeed Linden method of treatment.
Most of the patients with OCD respond well to anti-depressants. SSRIs (Antidepressants) are considered the first line of treatment for OCD. The most commonly used OCD Medication are Clomipramine, sertraline, paroxetine fluoxetine, citalopram, escitalopram and fluvoxamine.
Standard antidepressant doses of clomipramine are usually effective, but higher doses of SSRIs are usually required, such as fluoxetine (Prozac) 60-80 mg, paroxetine (Paxil) 40-60 mg, or sertraline (Zoloft) 200 mg.
OCD patients respond well to medication, however the medicine shows its effects only after 4-6 weeks. Usually a trial of SSRI therapy is continued for atleast 8 to 12 weeks, with at least 4-6 weeks at the maximal tolerable dosage to check for response.
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Augmentation of SSRI therapy with a typical antipsychotic agents is effective in some patients with treatment-resistant OCD.
Monoamine oxidase inhibitors (MAOs) should be considered as a last option if none of the SSRIs are effective in treatment of OCD.
SSRIs should be taken for at least 1-2 years and should be tapered and discontinued under the supervision of a psychiatrist. No drug should be discontinued abruptly, the brain cannot tolerate abrupt stoppage of medication and there may be rebound symptoms of OCD and depression at a higher intensity.
Therapeutic methods:
Therapeutic methods can also be used to treat OCD.
Behavioral therapy is commonly used to decrease compulsions. First, patients are exposed to the situations that produce obsessions and anxiety, and then they are trained and encouraged to resist performing the rituals that usually help control the anxiety. Over time and with practice, OCD symptoms gradually decrease and go away.
Behavior therapy, such as cognitive-behavioral therapy, thought stopping, desensitization or flooding, may also be effective. A combination of behavioral therapy and medication is most effective. Behavior therapy can also act as a relapse prevention strategy.
It is rare for treatment to completely eliminate the symptoms of OCD, but significant clinical improvement in symptoms can occur, and the patient’s functioning can be drastically enhanced if the appropriate treatment methods are used.
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