Obsessive compulsive disorder management

Antidepressant drugs are used to manage depressive episodes such as major depression or depression accompanied by anxiety. These drugs may be used in conjunction with psychotherapy in severe depression. The SSRIs also are used to treat obsessive-compulsive disorders. The uses of individual antidepressants are given in the Summary Drug Table Antidepressants. Treatment is usually continued for 9 months after recovery from the first major depressive episode. If the patient, at a later date, experiences another major depressive episode, treatment is continued for 5 years, and with a third episode, treatment is continued indefinitely. 

Rasmussen SA, Eisen JL, Pato MT (1993). Current issues in the pharmacologic management of obsessive compulsive disorder. J Clin Psychiatry 54 (suppl. 6), 4—9. 

Appropriate management of AN also requires the early detection and treatment of any comorbid psychiatric disorders. The most common comorbid conditions associated with AN are major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and substance use disorders. At the time of presentation, over 50% of AN patients also fulfill criteria for MDD however, accurate diagnosis of depression in these patients is complicated by the fact that prolonged starvation often produces a mood disturbance and neurovegetative symptoms identical to MDD. If MDD appears to be comorbid with AN at the time of presentation, there is debate as to whether it is more prudent to withhold treatment of the depression until weight restoration has been initiated. If the depression persists despite refeeding, then treatment of the depression is likely warranted. 

Rasmussen, S.A., and Eisen, J.L. (1998) Epidemiology and clinical features of obsessive compulsive disorders. In Jenike, M.A., Baer, L., and Minichiello, W.E. eds. Obsessive Compulsive Disorders— Practical Management, 3rd ed. Boston Mosby, pp. 12-43. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

Jenike MA Drug treatment of obsessive-compulsive disorder, in Obsessive Compulsive Disorders Theory and Management, 2nd Edition. Edited by Jenike MJ, Baer L, Minichiello WE. Littleton, MA, PSG Publishing, 1990, pp 249-282 Jenike MA, Baer L An open trial of Buspirone in OCD. Am J Psychiatry 145 1285-1286, 1988... 

Maletzky B, McFarland B, Burt A Refractory obsessive-compulsive disorder and ECT. Convulsive Therapy 10 1 34-42, 1994 Malgaroh A FTP expression hanging like a yo-yo Semin Cell Biol 5 231-241, 1994 Mahzia AL, Bridges PK The management of treatment-resistant affective disorder clinical perspectives. J Psychopharmacol 6 145-155, 1992... 

Jenike MA, Rauch SL. Managing the patient with treatment resistant obsessive-compulsive disorder current strategies. J Clin Psychiatry 1994 55[Suppl 3] 11-17. 

Sertraline hydrochloride is used in the management of depression, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder. 

Levin Z, Hwang MY, Rotrosen J. The relationship between clozapine and obsessive-compulsive disorder. Compr Psychiatry 1996 37 74. Oshika T. Ocular adverse effects of neuropsychiatric agents Incidence and management. Drug Saf 1995 12 256-263. 

FIGURE 70-2. Algorithm for management of obsessive-compulsive disorder in adults. A. Overall approach to treatment. B. Pharmacotherapeutic approach to treatment. CBT, cognitive behavioral therapy SSRI, selective serotonin reuptake inhibitor. (Derived from Expert Consensus Panel for Obsessive-Compulsive Disorder and American Pharmaceutical Association. )... 

The ability of several drugs to inhibit the reuptake of CNS amine neurotransmitters is shown in the table (number of arrows -i indicates the intensity of inhibitory actions). Which one of the drugs is most likely to have therapeutic effectiveness in the management of both obsessive-compulsive disorders (OCD) and major depressive disorders ... 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

A) Alprazolam is effective in the management of obsessive-compulsive disorders Clonazepam has effectiveness in patients who suffer from phobic anxiety states Diazepam is used for chronic management of bipolar affective disorder in patients who are unable to tolerate lithium Intravenous buspirone is usefiil in status epilepticus... 

Other clinical uses Tricyclic drugs are also used in the treatment of bipolar affective disorders, acute panic attacks, phobic disorders (compare with alprazolam Chapter 22), enuresis, and chronic pain states. Clomipramine and the selective serotonin reuptake inhibitors, including fiuvoxamine, are effective in obsessive-compulsive disorders. SSRls are also effective in patients who suffer from panic attacks, social phobias, bulimia, and premenstrual syndrome (PMS) and may also be useful in the treatment of alcohol dependence. Bupropion is used for management of patients attempting to withdraw from nicotine dependence. 

Chlordiazepoxide Diazepam Midazolam Phenobarbital 54. Benzodiazepines are LEAST effective in (A) Alcohol withdrawal syndromes Balanced anesthesia regimens Initial management of phencyclidine overdose Obsessive-compulsive disorders Social phobias... 

Veale, D., Freeston, M., Krebs, G., Heyman, I. and Salkovskis, P (2009) Risk assessment and management in obsessive-compulsive disorder. Advances in Psychiatric Treatment, 15 (5), 332-343. 

FIG. 13-3. Strategy for the management of obsessive-compulsive and related disorders. 

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