Obsessive-compulsive patients

Hoehn-Saric, R., Harris, G.J., Pearlson, G.D., Cox, C.S., Machlin, S.R., and Camargo, E.E. (1991) A fluoxetine-induced frontal lobe syndrome in an obsessive compulsive patient. / Clin Psychiatry 52 131-133. 

Significantly decreased H-labeled imipramine binding sites in platelets from depressed and obsessive-compulsive patients... 

Smeraldi, E., Diaferia, G., Erzegovesi, S., Lucca, A., Bellodi, L., and Moja, E. A., Tryptophan depletion in obsessive-compulsive patients, Biol. Psychiatr., 40, 398,1996. 

When compared with the selective serotonin reuptake inhibitors (SSRIs), mirtazapine may show an earlier onset of action (although data are currently not well established). Mirtazapine has also been found to be efficacious in the treatment of elderly patients with depression. Mirtazapine has been shown to be effective in the treatment of panic disorder, social phobia, and post-traumatic stress disorder. In one study, mirtazapine combined with citalopram in obsessive-compulsive patients induced an earlier response when compared with citalopram plus placebo. It was suggested that antagonism of presynaptic a2-adrenergic receptors does not enhance serotonin neurotransmission directly, but rather disinhibits the norepinephrine activation of serotonergic neurons and thereby increases serotonergic neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. 

Obsessive-compulsive disorders Erythrocytes from patients with obsessive-compulsive disorder have significantly higher calpain activities than normal controls which could not be attributed to differences in memory function46... 

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. 

Extrapolation to other countries is not easy. Canada has a very different health-care system to the USA. A small-scale study involving 466 anxiety disorder patients in Quebec established a clear relationship between the severity of the disorder and utilization of health services (McCusker et al, 1997). Patients with obsessive-compulsive disorder were particularly likely to seek treatment. No information on dmg use was presented. 

Data from Katon WJ. Panic disorder. N Engl J Med 2006 354 2360-2367 Bandelow B, Zohar J, Hollander E, etal. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 2002,3 171-199 Work Group on Panic Disorder. Practice guideline for the treatment of patients with panic disorder. Am J Psychiatry 1998 155(Supp 5) l-34 and EffexorXR[package insert]. Philadelphia, PA Wyeth Pharmaceuticals, Inc., August 2006. 

Hopkins Symptom Checklist. The Hopkins Symptom Checklist (HSCL) is a scale that has been used to measure the presence and intensity of various symptoms in outpatient neurotic patients. It is a 58-item self-rating scale and has generally been replaced by the Self-Report Symptom Inventory (SCL-90). It measures the symptoms during the past week and requires approximately 20 minutes to complete. There are five subtests somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety. 

Self-Report Symptom Inventory. Each of the 90 items in the SCL-90 uses a five-point scale of distress. It was designed as a general measure of symptomatology for use by adult psychiatric outpatients in either a research or clinical setting. It rates either the present or previous week. It requires about 15 minutes for the patient to complete this form and about 5 minutes for a technician to verify identifying information. This test is sensitive to drug effects and may be used with inpatients. Nine subscales are measured somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, and psychoticism. 

Lin, S. K., Su, S. F., and Pan, C. H. (2006) Higher plasma drug concentration in clozapine-treated schizophrenic patients with side effects of obsessive/compulsive symptoms. Ther. Drug Monit. 28, 303-307. 

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. 

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. 

The so-called anxious disorders of Cluster C include avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). Like the Cluster A disorders, these personality disorders are typically unobtrusive and may escape clinical detection for many years. Over time, patients adapt their life styles to these illnesses by decreasing their social contacts in an effort to minimize anxiety. In so doing, they further decrease the likelihood of encountering mental health professionals. 

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. 

Obsessive-Compulsive Personality Disorder (OCPD). Despite the similarity in name, OCD and OCPD are not closely related. Therefore, the medications used to treat OCD are not necessarily helpful for OCPD. As a result, we also cannot offer any specific medication recommendations for the treatment of OCPD. The overall anxious nature of the illness and the likelihood that such patients have comorbid depression or anxiety disorders may, however, guide medication selection. 

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. 

A considerable number of tricyclic antidepressants have been developed in the past, although with slight differences in their pharmacological activities, ah with similar efficacy. They are primarily indicated for the treatment of endogenous depression. However this does not exclude efficacy in patients in whom the depression is associated with organic disease or in patients with reactive depression or depression combined with anxiety. They may also benefit patients during the depressive phase of manic-depressive disorder. For some also efficacy has been claimed in panic states, phobic disorders, and in obsessive-compulsive disorders. 

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