Obsessive-compulsive disorder OCD

TCAs primarily work by blocking the reuptake of norepinephrine, although they block serotonin reuptake as well. The lone exception is clomipramine (Anafranil), which preferentially blocks serotonin reuptake. It is this unique characteristic that makes clomipramine the only TCA that effectively treats obsessive-compulsive disorder (OCD). 

Obsessive-Compulsive Disorder (OCD). In theory, distingnishing the obsessions and compnlsive ritnals of OCD from the delusions and behavioral peculiarities of schizophrenia shonld be straightforward. Usually, the OCD patient is aware of the excessive natnre of his/her obsessions and wishes to be rid of them. The delusional patient with schizophrenia is nnaware that these false beliefs are not based in reality and clings to them tenacionsly. However, a few OCD patients lose the insight that their obsessions are excessive. At this point, the distinction between obsession and delnsion often becomes blnrred. 

Freud coined the term anxiety neurosis approximately 100 years ago, and all forms of anxiety would be subsumed under that collective diagnostic entity for decades to come. In 1980, based on an emerging literature DSM-111 classified anxiety disorders into several discrete syndromes including panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). 

Panic disorder is characterized by the occurrence of panic attacks that occur spontaneously and lead to persistent worry about subsequent attacks and/or behavioral changes intended to minimize the likelihood of further attacks. Sporadic panic attacks are not limited, however, to those with syndromal panic disorder as they do occur occasionally in normal individuals and in those with other syndromal psychiatric disorders. The hallmark of panic disorder is that the panic attacks occur without warning in an unpredictable variety of settings, whereas panic attacks associated with other disorders typically occur in response to a predictable stimulus. For example, a person with acrophobia might experience a panic attack when on a glass elevator. A patient with obsessive-compulsive disorder (OCD) with contamination fears may have a panic attack when confronted with the sight of refuse, and a combat veteran with post-traumatic stress disorder (PTSD) may experience a panic attack when a helicopter flies overhead or an automobile backfires. 

Obsessive-Compulsive Disorder (OCD). Like those with social phobia, patients with OCD can also experience a panic attack when confronted by the object of their fear. Again, the distinction from panic disorder lies in discriminating such stimulus-induced panic attacks from spontaneous panic attacks. 

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. 

Obsessive-Compulsive Disorder (OCD). Certainly the name suggests that OCD and OCPD are closely related. This is actually somewhat misleading. With OCD, the obsessions are intrusive and distressful (i.e., ego dystonic) thoughts that lead the patient to develop rituals (i.e., compulsions) to alleviate the resultant anxiety. With OCPD, we use the term obsession in a somewhat different way. The OCPD patient is not necessarily prone to obsessions in the form of intrusive thoughts instead, they display a perfectionistic preoccupation with detail that characterizes their obsessionality. Furthermore, this obsessionality is ego-syntonic. Patients with OCPD purposefully harbor these obsessions in an effort to exert control over themselves and their environment. 

Clomipramine Only for treatment of Obsessive-Compulsive Disorder (OCD). 

Citalopram, escitalopram, and paroxetine are not approved for use in pediatric patients. Fluoxetine is approved for use in pediatric patients with MDD and obsessive-compulsive disorder (OCD). Sertraline is not approved for use in pediatric patients except for patients with OCD. Fluvoxamine is not approved for use in pediatric patients except for patients with OCD. 

Obsessive-compulsive disorder (OCD) Fluoxetine fluvoxamine paroxetine (immediate-release), sertraline. 

In recent years many of these primary care cases that would formerly have been seen as anxiety disorders have been portrayed as anxious-depressives and have led to treatment with antidepressants, in particular the more recent serotonin reuptake inhibitors. As part of this rebranding a variety of states such as panic disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder have appeared, along with more traditional disorders such as obsessive compulsive disorder (OCD). Many of these diagnoses are likely to lead to prescriptions of an SSRI although the evidence for benefit from SSRIs is poor except for OCD. 

The efficacy of benzodiazepines in most anxiety disorders has been proved through extensive clinical experience and controlled trials (Faravelli et al. 2003), although it is important to note that they are not effective at treatingpost-traumatic stress disorder or comorbid depression, and there is less evidence to support their use in obsessive-compulsive disorder (OCD). Their anxiolytic effects have an immediate onset and in contrast to many other drugs, they do not cause a worsening of anxiety when therapy is initiated. 

Obsessive-compulsive disorder (OCD) PO 50 mg at bedtime may increase by 50 mg every 4 7 days. Dosages greater than 100 mg/day given in 2 divided doses. Maximum 300 mg/day. 

Although genetic influences on the dynamics of drug response have been studied in a wide range of disorders, most of the studies have been carried out in only the past few years. Disorders and behaviors studied include Alzheimer s disease, schizophrenia, depression, suicide, anxiety, obsessive-compulsive disorder (OCD), substance abuse, smoking, and alcoholism. Across these disorders, however, there has been a focus on only a handful of neuroeffector systems. These include apolipoprotein and the cholinergic system (in Alzhei-... 

The past decade has seen a renewed emphasis on the range of neurological and psychiatric symptoms seen in TS patients. Symptoms associated with obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) have received the most attention. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

One of the clinician s most important tasks is thus to identify the principal sources of distress and impairment and to prioritize the targets for pharmacological intervention. Although tic reduction may be the first priority in some cases, in other cases it may be a child s ADHD, depression, or compulsions that may have the first claim on the clinician s interventional efforts. Even when the tics are not themselves the initial target of treatment, the TS-related nature of the child s depression, ADHD, or obsessive-compulsive disorder (OCD) may have important implications for the choice of agents, therapeutic response, or possible side effects. 

Bogetto, F, Bellino, S., Vaschetto, P., and Ziero, S. (2000) Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD) a 12-week open trial. Psychiatry Res 96 91-98. 

It is uncertain how pregnancy may affect the natural history of obsessive-compulsive disorder (OCD). Some... 

Children with obsessive-compulsive disorder (OCD) have high rates of comorbid mood disorders, ODD, ADHD, CD, psychosis, and tic disorders (Geller et al., 1996). If untreated, these children may act on violent or sexual thoughts. 

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