Treatment of Obsessive Compulsive Disorder (Treatment of OCD)

Treatment of Obsessive Compulsive Disorder (OCD treatment)

Obsessive-compulsive disorder (OCD) is a common psychiatric illness with lifetime prevalence of 1-3%. It is the fourth-most common psychiatric illness and a leading cause of disability. OCD is associated with significant impairment in functioning, quality of life and disability. If untreated, OCD is a chronic illness with a waxing and waning of symptoms. The hallmarks of OCD are presence of obsessions and compulsions. Obsessions are repetitive, unwanted, intrusive thoughts, images or urges that are mostly ego-dystonic and cause severe distress or anxiety. Compulsions (or rituals) are repetitive behaviours or mental acts that are performed in response to an obsession to reduce anxiety/distress or prevent a dreaded consequence. Obsessions and compulsions are time-consuming, distressing and are often resisted unsuccessfully.

OCD is often comorbid with other psychiatric disorders. It is important to assess all patients with OCD for associated psychiatric comorbidity since they may have an effect on treatment outcomes if left untreated. Depression and anxiety disorders are present in over half of patients seeking treatment for OCD.

Meta-analyses of RCTs show that selective serotonin reuptake inhibitors (SSRIs) are significantly more effective than placebo in the treatment of OCD. SSRIs are associated with many adverse effects but are usually well tolerated. The only other medication which has shown to be consistently effective in OCD is the serotoninergic tricyclic antidepressant clomipramine. Clomipramine has been found to be significantly more effective than placebo in multiple RCTs and meta-analysis of RCTs. Network meta-analysis comparing the efficacy of clomipramine vs. SSRIs failed to find any efficacy advantage over SSRIs. Most head-to-head comparison trials have not found any significant difference between the efficacy of clomipramine and SSRIs.

Meta-analyses comparing the different SSRIs and direct head-to-head comparisons have not shown superiority of anyone SSRI over the other. It is generally recommended that OCD be treated with a higher dose of SSRI than that used in depression.

Guidelines recommend continuation of SSRIs / clomipramine for at least 1-2 years after achieving remission. Clinical experience dictates that discontinuation of medication beyond that period may be associated with increased chance of relapse. Hence discontinuation of medications should be carefully considered based on individual patient factors including severity and duration of illness, past history of relapse on discontinuation, residual symptoms, comorbidities etc. Most patients may require continued pharmacotherapy to prevent relapses. Medications are generally recommended to be continued at the same dose that resulted in improvement, unless the dosage is not tolerated.

Around 20% of patients do not respond to available pharmacological and psychological treatments. Neuromodulatory and neurosurgical treatments targeting the cortico-striato- thalamo-cortical (CSTC) circuits have been tried in resistant patients.

[dr.jhulandassharma]

So illuminating presentation! I am hugely benefitted by the presentation. It’s very clear and simple to be perceived by any medical professionals. My sincere thanks to you. Prof. Jhulan Das Sharma. Paediatrician, Chittagong, Bangladesh.

[dast]

Thank you Professor for the great explorative session with confidence boosting session.

[seethajetti]

very clear and nice explanation thank you so much

[prajwalgadade]

Thanks sir
Very very benefial information illustrated by you thanks sir
Hats up

[OOBfF-_O]

Low dose amisulpride is best or memantine is overall best ? 🙏

[rsuramuthu]

Thank you Dr. Your program is very useful. My daughter(15) has been diagnosed with OCD and doing rituals thinkimg that something bad will happen if she doesn't do. Now she is taking sertraline-150mg, Divalproex-500mg, Olanzapine 5mg. Duloxetine-30. The problemp continued persisting. Now after increasing duloxetin -40mg, she started becoming courageous. She has started stopping some of the rituals on her own. If sertranline is given @ 5PM, only then she sleeps @ 10PM.

Maybe this you may not accept also: I've the same problem in my childhood. That was because: Having born and brought up by bramin family, I myslf had corelated two totally irrelevent things, I was not courageous enough to overcome. (I didn't know that it is OCD). I wanted to come of it, So itentionally I violated each and every mis-believes taught to me. Then became alright.

My suggestion is : what if professionals like you conducting awareness program about 'All the superstious beliefs were manually created to control people on their own. Though You may say the other reasons like heidity etc., I strongly believe that at least 20 % the childre will have one or some other form of problems with the fed superstitios beliefs

[ipsitaroy]

Sir my general physician has told me that I have OCD but my psychiatrist told me that I don't have OCD I have gad ...who is correct? Whom I should believe?

[JosepvPv]

Very very valuable information.May GOD bless you all.A lot of thanks from my heart.

[anushkadiya]

sir, I'm taking medicines from a govt psychiatrist, rml hospital
I'm not taking therapy, is it necessary to take therapy ..
or medicine will work

[muhammadfahimkhan]

sit i took clomipramine and fluoxetine at different doses for 5 years suggested by the psychiatrist...but he don't let me know about how much more i have to take it...in between i started 4 fdc due to tb and leave those ssri's and nsri ...what should i do now sir ...

is ocd curable ..?

[moorthiraj]

Very very inspiring sir
Need much more topics in future like this 💐

[aishajan]

Thank you, you are excellent in teaching

[junaidanjum]

Excellent explanation about ocd thank you sir

[ajaybodh]

Good information sir
🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻
Thank you 🙏🏻

[pcb-zone]

Sir is there any treatment for rabies phobia and ocd?

[Shadab-Beg]

Sir ocd me serotonin ka low hona or CSTC circuit ka dysfunctional hona do alag alag karan hai ya fir serotonin ki kami ki bajah se hi CSTC circuit dysfunctional ho jata hai ???
Plz answer kre sir

[harerammandal]

Sir after quitting OCD meds I am experiencing symptoms like insomnia, blurry vision, brain fog, depression is this discontinuation syndrome and what it's solution

[rajshekhar]

Dr how to treat patients when in denial for medicine, my mom is, 60 and suffering from ocd from 25 yrs. Kindly suggest something please sir

[harerammandal]

Hello dr I was on OCD meds for 3 months but after quiting meds i cant sleep all night i feel depressed my mind stopped working I can't think anything clearly I can't not study can OCD meds cause such type of brain damage

[SUDIPGHOSH-twsm]

Sir mera bhai ocd patient.
2018 she chol rakhe but abhi thik hua nehi.
Fluvator
Paxidep cr
Flunil
Cyclotin
Veniz
All are taken in 5 year..
But not improve .
What to do sir??
Nihamans jana paregha ki?