Rajagopal S, Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent distressing thoughts and repetitive behaviors or … Patient information: A handout on this topic is available at https://familydoctor.org/familydoctor/en/diseases-conditions/obsessive-compulsive-disorder.html. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Am J Psychiatry. Leckman JF, Cherian AV, When effective, long-term treatment with an SSRI is a reasonable option to prevent relapse. Cochrane Database Syst Rev. Second-generation antipsychotics for obsessive compulsive disorder. Psychological evaluation. J Affect Disord. 13. Miller KE, Kandavel T. Obsessive-compulsive disorder. We all have habits and routines in our daily lives, such as brushing our teeth before bed. Rosa-Alcázar AI, Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Ipser J, Compulsions are repetitive behaviors or mental rituals performed to counteract the anxiety caused by obsessions. Annu Rev Med. Simpson HB, 15. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Clinical practice guidelines. Nelson EA, Pinto A, Millet B, Rasmussen SA, et al. et al. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications. Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Prince MJ, Koran LM, Simpson HB. et al. The lifetime prevalence of OCD is 2.3%,2 although this may be an underrepresentation because often only patients with moderate to severe symptoms seek help. Liebowitz MR, 12. Murphy D. J Clin Psychiatry. Mercadante MT, The authors thank Joseph Himle, PhD, of the University of Michigan Medical School Department of Psychiatry, for assistance with the preparation of the manuscript. 9. 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. et al. Nyklícek I. FDA = U.S. Food and Drug Administration; SSRI = selective serotonin reuptake inhibitor. Simpson HB, Suicidalbehaviorinobsessive-compulsive disorder. Behavioral treatment of obsessive- compulsive disorder in African Americans. Depress Anxiety. Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects about one in 40 American adults and one in 100 American children. Evidence-based medical and behavioral therapies are available to reduce the severity and frequency of obsessions and compulsions. Sustained response versus relapse. Ferrão YA, et al. Ramos-Cerqueira AT, The mean age of onset is 19.5 years, and it is rare for new cases of OCD to develop after the early 30s.2 A subset of patients, mostly males, have an early onset (before 10 years of age). et al. 18. Oakley-Browne M. Dutra L, If symptoms worsen during this time, the original dosage should be resumed, and further attempts at discontinuing medication should be approached with reservation. Importance Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder associated with significant impairment and a lifetime prevalence of 1% to 3%; however, it is often missed in primary care settings and frequently undertreated. 17. 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. Rasmussen SA. Bloch MH, et al. They can involve contamination; repeated doubts; or taboo thoughts of a sexual, religious, or aggressive nature. Merikangas KR, 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. Aguglia E, Neuroimaging studies of obsessive-compulsive disorder in adults and children. Delorme R, Proper diagnosis and education about the nature of the disorder are important first steps in recovery. J Clin Psychiatry. 31. 8. Insufficient treatment and a lack of OCD-specific resources are important problems in the management of this disorder.      Print. Second-generation antipsychotics for obsessive compulsive disorder. Rosario-Campos MC, Exposure and response prevention “booster” sessions should be considered to prevent relapse. Cleaning/washing 2. Mirtazapine for obsessive-compulsive disorder. / afp The medication doses required for treatment of obsessive-compulsive disorder are often higher than those for other indications, and the length of time to response is typically longer. N Engl J Med. et al. Want to use this article elsewhere? Family studies have shown that genetics have a role in the etiology of OCD, particularly in the early-onset form of the disorder.5 An immunologic component has also been proposed, based on the association of OCD with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS), in which children develop an abrupt onset of OCD symptoms or tics after infection with group A Streptococcus. Rituals or behaviour or mental acts done repeatedly (Compulsions) aimed to neutralize or reduce the anxiety. Information from references 17, and 20 through 25. Huppert JD, This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Brown RA, Hanstede M, Abramowitz JS, Foa EB, 10. Adapted with permission from Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB, for the American Psychiatric Association. J Am Acad Child Adolesc Psychiatry. For example, being contaminated by something, having something terrible happen to you or someone you care about, or doing something terrible? Obsessive-compulsive disorder (OCD): Patients with OCD have true obsessions (repetitive, unwanted, intrusive thoughts that cause marked anxiety) and compulsions (ritualistic behaviors that they feel they must do to control their obsessions). 1. Get Permissions, Access the latest issue of American Family Physician. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Clinical screening for obsessive-compulsive and related disorders. Westenberg HG. A trial of SSRI therapy should continue for eight to 12 weeks, with at least four to six weeks at the maximal tolerable dosage. Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Historically, dysfunction in the serotonin system was postulated to be the main factor in OCD pathogenesis, given the selective response to serotonergic medication. There are currently no standard guidelines for the management of CANS, but a comprehensive evaluation is recommended, and empiric antibiotics are not indicated.48. Previous: Common Questions About Pressure Ulcers, Next: A Systematic Approach to the Evaluation of a Limping Child, Home This may be done with standardized rating scales or by a patient estimate of the time spent each day engaging in obsessive-compulsive thoughts or behaviors. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Clin Psychol. Switching from serotonin reuptake inhibitors to duloxetine in patients with resistant obsessive compulsive disorder. Depress Anxiety. Clinical practice: obsessive-compulsive disorder. Address correspondence to Jill N. Fenske, MD, Chelsea Health Center, 14700 E. Old U.S. Highway 12, Chelsea, MI 48118 (e-mail: Kessler RC, Early recognition and treatment with OCD-specific therapies may improve outcomes, but there is often a delay in diagnosis. 2000;23(3):509–517. B. Denys D, Grant JE. Scrupulosity (need to do the right thing, fear of committing a transgression, often religious) 5. CBT with exposure and response prevention is the preferred initial treatment for mild to moderate cases.45 Family involvement is important for successful outcomes.45,46 Treatment with SSRIs, in addition to CBT, is indicated for patients with severe symptoms or comorbid psychiatric conditions limiting CBT participation. Walters EE. (CBT= cognitive behavior therapy; OCD = obsessive-compulsive disorder; SNRI = serotonin-norepinephrine reuptake inhibitor; SSRI= selective serotonin reuptake inhibitor.). Gamel NN, Simpson HB, 29. There are limited trials of complementary and alternative medicine approaches for the treatment of OCD. McDougle CJ, Leckman JF, 2003;23(6):568–575. Journal of Obsessive-Compulsive & Related Disorders, 5: 67-75. There are a variety of options for treatment-resistant OCD, including clomipramine or augmenting an SSRI with an atypical antipsychotic. JILL N. FENSKE, MD, is a clinical assistant professor in the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor.... KETTI PETERSEN, MD, is a clinical lecturer in the Department of Family Medicine at the University of Michigan Medical School. Desrocher M. Isr J Psychiatry Relat Sci. A more recent article on obsessive-compulsive disorder is available, Smart-Home Technology for Persons with Disabilities, Management of Keloids and Hypertrophic Scars. Quality of life and functional impairment in obsessive-compulsive disorder. Symptoms are often accompanied by feelings of shame and secrecy. 2008;148(2):133–139. 26. Treatment is indicated when OCD symptoms impair the patient's functioning or cause significant distress. 2007;63(12):1265]. et al. Chabane N, McDougle CJ, Alterman RL. et al. Immediate, unlimited access to all AFP content. Contact Torres AR, Recurrent intrusive thoughts and images (Obsessions) which generate a lot of worry apprehension or fear. 28. Ramos-Cerqueira AT, Leckman JF, 46. 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. JILL N. FENSKE, MD, and KETTI PETERSEN, MD, University of Michigan Medical School, Ann Arbor, Michigan. Frost RO, et al. Don't miss a single issue. If a higher dosage is necessary, the patient should be monitored using electrocardiography and electrolyte measurements.30. *—Estimated retail price of one month's supply (starting dosage) based on information obtained at http://www.goodrx.com (accessed August 26, 2015). 92/No. / afp et al. Brown RA, Huppert JD, Geller DA. 2. Visser HA, Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). 2009 Aug 1;80(3):239-245. Int Clin Psychopharmacol. There are a variety of options for treatment-resistant obsessive-compulsive disorder, including augmentation of a selective serotonin reuptake inhibitor with an atypical antipsychotic. Safety of treatment of obsessive compulsive disorder in pregnancy and puerperium. 49. Leckman JF. Leiberg S, 16. Canadian Psychiatric Association. Kaufman DA, 2007;63(9):851–859. Int J Neuropsychopharmacol. Risk of obsessive-compulsive disorder in pregnant and postpartum women. Clinical practice: obsessive-compulsive disorder. Wolf DS, Wheaton M, OCD has a highly selective response to serotonergic medications. 2002;14(4):485–496. Symptoms are often accompanied by feelings of shame and secrecy because patients realize the thoughts and behaviors are excessive or unreasonable. For patients with mild or subclinical symptoms, education and support may be sufficient. Singer HS, 42. Komossa K, Early signs of serotonin syndrome include anxiety, tremor, tachycardia, and sweating.26 The patient should continue taking the SSRI for eight to 12 weeks, with at least four to six weeks at the maximal tolerable dosage.21 It usually takes at least four to six weeks for patients to note any significant improvement in symptoms; for some, it may take 10 to 12 weeks or longer. Eisen JL, Eddy KT, Kandavel T. A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. et al. Management of anxiety disorders [published correction appears in Can J Psychiatry. This includes discussing your thoughts, feelings, symptoms and behavior patterns. Foa EB, Huppert JD, 36. Psychol Assess. Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Copyright © 2020 American Academy of Family Physicians. Leboyer M, Pinto A, 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. It often goes unrecognized and is undertreated. Nestadt G, Practice guideline for the treatment of patients with obsessive-compulsive disorder. Foa EB, Obsessive-compulsive disorder (OCD) is a chronic illness that can cause marked distress and disability. Abramowitz JS, et al. 1992;15(4):743–758. Recommended first-line therapy is cognitive behavior therapy with exposure and response prevention or a selective serotonin reuptake inhibitor. / Vol. 5th ed. Huppert JD, Reprints are not available from the authors. Kessler RC, 2005;20(6):299–304. Choung HW, Depress Anxiety. Quality of life in obsessive-compulsive disorder. Hougaard E, In one study population, only 30.9% of patients with severe symptoms and 2.9% of patients with moderately severe symptoms received treatment specific for OCD.2, The pathogenesis of OCD is a complex interplay between neurobiology, genetics, and environmental influences. Liebowitz MR, Ipser J, 4. A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. et al. Obsessive-compulsive disorder is an illness that can cause marked distress and disability. What Is Obsessive-Compulsive Disorder? et al. N Engl J Med. Eisen JL. Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Obsessions are recurrent intrusive thoughts or images that cause marked distress. Clin Psychol Rev. J Psychiatr Res. Copyright © 2015 by the American Academy of Family Physicians. Wells A. J Clin Psychiatry. Denys D, 2007;63(12):1265]. Zylstra RG. New York, NY: Thomson Reuters; 2015. Florida Obsessive-Compulsive Inventory [published correction appears in. Reprints are not available from the authors. Dell'osso B, et al. et al. Obsessive-compulsive disorder (OCD) is an anxiety disorder. / Russell EJ, An individual risk-benefit analysis should be discussed when considering SSRI therapy during pregnancy and lactation.44, The prevalence of childhood OCD is 1% to 2% in the United States, and 50% of these children have comorbid psychiatric conditions. McDougle CJ, Eisen JL, It is a chronic disorder and is likely to persist if not treated effectively. 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. 2014;152–154:169–174. J Clin Psychopharmacol. Koran LM, Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder. 20. 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. Recommended first-line therapies are cognitive behavior therapy, specifically exposure and response prevention, and/or a selective serotonin reuptake inhibitor (SSRI). , provide support, and their combination for children and adolescents LM, Hanna GL Hollander! 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