OCD

Question 1

Dx Criteria for OCD

Answer 1

Obsessions and Compulsions >1h/day or cause impairment/distress
Pt must have insight into the fact it’s excessive
Not explained by drug or other medical condition

Question 2

Risk factors for OCD

Answer 2

Females
Childhood/adolescence - onset
Anxiety comorbidities
Family history

Question 3

OCD Rating Scale

Answer 3

Y-BOCS
10 item quiz
Max - 40 severe

Question 4

Adult Mild-Moderate OCD

Answer 4

CBT monotherapy

SSRI or clomipramine monotherapy

Question 5

Adult Severe OCD

Answer 5

CBT AND SSRI or clomipramine

Question 6

Adult First Line pharmacotherapy

Answer 6

SSRI > clomipramine
Equal efficacy and better side effect profile
Dose probably higher than p. insert max
Start slow (avoid rebound anxiety)
4-6 - good trial

Question 7

Adult Second Line

Answer 7

Remeron or effexor

Switch SSRIs

Question 8

Adult Successful Treatment

Answer 8

Lasts 1-2 years then reassess and try to taper

Question 9

OCD and Pregnancy

Answer 9

CBT only

NO paxil/clomipramine

Question 10

OCD and elderly

Answer 10

Start lower and go slower

NO paxil/clomipramine

Question 11

Child Mild/Mod OCD

Answer 11

1st - CBT only

2nd - CBT + SSRI

Question 12

Child Mod/Severe OCD

Answer 12

1st - SSRI + CBT

2nd - Augmentation

Question 13

Med Considerations in Kids

Answer 13

Low and super slow
Can take up to 12 weeks (slower taper)
SUICIDE
6-12 months at dose then taper

Question 14

Kid Failure Augmentation

Answer 14

Must have failed 2 SSRIs
SSRI + clomip (watch out with fluvox)
SSRI + risperidone