OCD

Question 1

Pharmacotherapy for OCD

Answer 1

First line: Paroxetine, Fluvoxamine, Fluoxetine, Sertraline, Escitalopram
Second line: Clomipramine, Venlafaxine XR, Citalopram, Mirtazapine
Third line: IV Citalopram, IV Clomipramine, Duloxetine, Tramdol, MAOIs

Adjunctive:
First line - Aripiprazole, Risperidone
Second line: Memantine, Quetiapine, Topiramate

Question 2

Treatment for refractory OCD?

Answer 2

Psychosurgery - Cingultomy or Anterior Capsulotomy
DBS
rtMS

Question 3

Prognostic indicators for poor outcomes in OCD

Answer 3

early age of onset
yielding to compulsions
bizarre compulsions
hospitalizations
comorbid depression
lack of insight

Question 4

Neuroimaging - OCD

Answer 4

OCD supposedly involves dysfunction in a neuronal loop between the orbital frontal cortex and the cingulate gyrus, striatum (caudate nucleus and putamen), globus pallidus, thalamus .
Increased metabolism of corbito cingulate region

Question 5

Compulsions in OCD

Answer 5

The most common compulsion is checking, which is followed by washing, symmetry, the need to ask or confess, and counting.

Question 6

Favorable prognostic indicators - OCD

Answer 6

presence of a stressor

episodic nature of illness