Exposure and response prevention is a key element of CBT that has been proven effective in the treatment of OCD.23 Patients are taught to confront situations that create fear related to their obsessions, and to avoid performing compulsive behaviors in response. Choung HW, ADHD = attention-deficit/hyperactivity disorder; OCD = obsessive-compulsive disorder. Patients with OCD should be closely monitored for psychiatric comorbidities and suicidal ideation. Panic attacks, which represent an extreme form of anxiety, can occur in association … Ramos-Cerqueira AT, van Megen HJ, Mink JW, All rights Reserved. Simpson HB, *— Approved by the U.S. Food and Drug Administration for treatment of obsessive-compulsive disorder. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. London, UK: NICE; 2005. Examples of obsessions are a fear of germs or a fear of being hurt. et al. McDougle CJ, Westenberg HG. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Sustained response versus relapse. Patients with a later age of onset, shorter duration of symptoms, good insight, and response to initial treatment have an increased likelihood of remission.5–7 Early and aggressive treatment of OCD, with a goal of remission, is important for a positive outcome.5 Therefore, it is critical that primary care physicians are equipped to diagnose and treat patients with OCD appropriately. Simpson HB, If OCD is suspected, the use of a few simple screening questions can be helpful (Table 4).16 Standardized diagnostic tools are available, but most are not practical for use in primary care. Children with abrupt onset of obsessive-compulsive symptoms or tics should be evaluated for group A Streptococcus infection, with possible PANDAS. Depress Anxiety. Clinical practice guidelines. Torres AR, Previous: Smart-Home Technology for Persons with Disabilities, Next: Management of Keloids and Hypertrophic Scars, Home 36. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Abrantes AM, Reprints are not available from the authors. 8. There are some brief patient self-report inventories that may be useful; two commonly used tools are the Obsessive-Compulsive Inventory–Revised17 and the Florida Obsessive-Compulsive Inventory18. 26. Abrantes AM, A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. Focseneanu M, Citalopram (Celexa) and escitalopram (Lexapro) are also commonly used, but in 2011, the FDA began recommending dose limitations for citalopram because of concerns about QT prolongation.30 There is insufficient evidence to show that one SSRI is superior,22 and the choice of SSRI should be individualized, taking into account potential drug interactions and tolerability. Foa EB, Doubting one's memory or perception 4. 49. J Child Psychol Psychiatry. et al.      Print. 2003;41(6):681–700. Fineberg NA, Patients with OCD should be monitored for psychiatric comorbidities and suicide risk. Washington, DC: American Psychiatric Association; 2013. van der Wee N, Ferrão YA, A double-blind, placebo-controlled study in patients with and without tics. Counting/repeating actions a certain number of times or until it "feels right" 4. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Clin Psychol Rev. et al. 2013;30(8):763–772. Physicians should maintain a high awareness for the possibility of OCD in patients with general complaints of anxiety or depression. The genetics of obsessive compulsive disorder: a review of the evidence. Aboujaoude EN. Diagnostic and Statistical Manual of Mental Disorders. Want to use this article elsewhere? Mirtazapine for obsessive-compulsive disorder. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2014;371(7):646–653. Coric V, Souza F, Safety of treatment of obsessive compulsive disorder in pregnancy and puerperium. Kurlan R. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Pediatr. Walters EE. 12. 2002;14(4):485–496. Mol Psychiatry. Rosa-Alcázar AI, Koran LM, Simpson HB. Mouren MC, Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. Huppert JD, 45. Get Permissions, Access the latest issue of American Family Physician. Komossa K, SSRI = selective serotonin reuptake inhibitor. Kobak KA, This content is owned by the AAFP. Sign up for the free AFP email table of contents. Storch EA, Frost RO, et al. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. 32. Millet B, et al. Grant JE. Gamel NN, In one community survey, 63% of persons with OCD had experienced suicidal thoughts, and 26% had attempted suicide.18 Comorbidity with depression, posttraumatic stress disorder, substance abuse, or impulse control disorders increases the risk of suicidal behavior.15,16. 14. 2006;67(5):703–711.... 2. Barbui C, 2011;72(1):17–26. This content is owned by the AAFP. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent distressing thoughts and repetitive behaviors or mental rituals performed to reduce anxiety. Once a diagnosis of OCD has been established, it is important to provide education and support. (CBT= cognitive behavior therapy; OCD = obsessive-compulsive disorder; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI= selective serotonin reuptake inhibitor.). Reddy YC. OCD often begin to occur later than tics (average 1–2 years later) •While any OCD symptoms can occur, the most frequent obsessions in people with tic spectrum disorders include those of an aggressive, sexual, and religious nature A more recent article on obsessive-compulsive disorder is available. Altman D, 26. Deep brain stimulation for intractable psychiatric disorders. Heimberg RG, Can J Psychiatry. Hounie AG, Five-year course of obsessive-compulsive disorder. If medical therapy is successful, it should be continued for at least one to two years.21 If the patient chooses to discontinue pharmacotherapy, the dosage should be gradually tapered over several months. Recommended first-line therapy is cognitive behavior therapy with exposure and response prevention or a selective serotonin reuptake inhibitor. Obsessive-Compulsive Disorder: Diagnosis and Management. A recent double-blind study did not support the effectiveness of this treatment, although further study has been recommended.33, Although OCD in childhood can occur in isolation, there is a high rate of comorbidity with mood disorders, tic disorders, attention-deficit/hyperactivity disorder, and developmental abnormalities. Clin Psychol Rev. et al. 21. 2. It causes unwanted thoughts (obsessions) and repetitive behaviors (compulsions). 37. 2007;63(9):851–859. et al. CBT with or without medication is superior to medication alone for treatment of childhood OCD.47, Abrupt onset of obsessive-compulsive symptoms in children may raise concern for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). et al. The epidemiology and clinical features of obsessive compulsive disorder. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Even when compulsions are not easily observable, patients with OCD usually have mental rituals. Brown RA, Hanna GL, Coric V, Eddy KT, 2008;28(8):1310–1325. Westenberg HG. Kandavel T, 11. If medical therapy is successful, it should be continued for at least one to two years, if not indefinitely.17,22 Relapse prevention with continuous SSRI therapy is a reasonable treatment goal.33 If the patient chooses to discontinue pharmacotherapy, the dosage should be gradually tapered over several months, and the original dosage resumed if symptoms worsen. 2010;22(2):223–232. Also searched were the Cochrane database, Database of Abstracts of Reviews of Effects, BMJ Clinical Evidence, National Guideline Clearinghouse database, and Essential Evidence Plus. 1. 3. In one longitudinal study, more than 90 percent of patients with OCD met the criteria for at least one other axis I diagnosis in their lifetime.3 The most common comorbid diagnosis is major depressive disorder, which affects two thirds of persons with OCD at some point in life.3 Panic disorder, social phobia, specific phobias, and substance abuse are also common. Treatment is indicated when OCD symptoms impair the patient's functioning or cause significant distress. Altamura AC. Boisseau CL, Proper diagnosis and education about the nature of the disorder are important first steps in recovery. Adams SM, Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. Most visits included psychotropic medications (84%), most commonly a serotonin reuptake inhibitor (69%) and less commonly included any psychotherapy (39%). / Journals With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. Leckman JF, 2004;19(4):225–233. 2009;26(1):39–45. Bebbington PE, et al. It is helpful to quantify the severity of symptoms and impairment before and during treatment for OCD. 30. Foa EB. Lasalle-Ricci VH, Rather, it is a pervasive pattern of behaviors emphasizing organization, perfectionism, and a sense of control.10  If true OCD is suspected, the use of a few simple screening questions can be helpful (Table 4).12 Standardized diagnostic tools are available, but most are not practical for use in primary care. 1. Aguglia E, Canadian Psychiatric Association. for the American Psychiatric Association. Obsessive-compulsive disorder. 2014;371(7):649. Abramovitch A, Mol Psychiatry. Early-onset obsessive-compulsive disorder: a subgroup with a specific clinical and familial pattern? Suicidal behavior in obsessive-compulsive disorder. The Obsessive-Compulsive Inventory: development and validation of a short version. Cochrane Database Syst Rev. If symptoms worsen during this time, the original dosage should be resumed, and further attempts at discontinuing medication should be approached with reservation. Epperson CN. Desrocher M. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml. The trial of therapy should continue for eight to 12 weeks, with at least four to six weeks at the maximal tolerable dosage.17 It usually takes at least four to six weeks for patients to note any significant improvement in symptoms; it may take 10 weeks or longer for some. et al. Fineberg NA, Storch EA, Leckman JF. Am J Med Genet C Semin Med Genet. 2006;51(10):623]. Diagnostic and Statistical Manual of Mental Disorders. Heninger GR, Ipser J, Rasmussen SA. Behavioral treatment of obsessive- compulsive disorder in African Americans. The Obsessive-Compulsive Inventory. N Engl J Med. The epidemiology and clinical features of obsessive compulsive disorder. Behav Cogn Psychother. Mercadante MT, https://familydoctor.org/familydoctor/en/diseases-conditions/obsessive-compulsive-disorder.html, http://www.caleblack.com/psy5960_files/OCI-R.pdf, http://www.ocdscales.org/index.php?page=scales, http://ericwexlermd.com/MB_PDFs/OCD/YBOCSII.pdf, https://www.nice.org.uk/guidance/cg31/evidence/cg31-obsessive-compulsive-disorder-ocd-and-body-dysmorphic-disorder-bdd-evidence-update2, http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd-watch.pdf, http://www.fda.gov/drugs/drugsafety/ucm297391.htm, A Systematic Approach to the Evaluation of a Limping Child. Increase engagement with cognitive behavior therapy, sertraline, and the behaviors to get rid the! Meta-Analyses, randomized controlled trials, and some may achieve remission studies of disorder... And is likely to persist if not treated effectively, significant improvement with CBT.. A pilot study of patients with OCD, as measured by the Y-BOCS the... 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