Week 8- Medicine Management Advice For Obsessive Compulsive Disorder(OCD), Social Anxiety(Social Phobia)and Panic Disorder

Question 1

what drugs can be used to reduce the symptoms but not cure OCD?

Answer 1

SSRI can get the patient under control

Question 2

what is OCD?

Answer 2

• Obsessions: thoughts, impulses, ideas which are recurrent and persistent e.g. fear of contamination
• Compulsions: repetitive behaviours/ actions preformed in response to an obsession e.g. hand washing/ counting/ checking

Question 3

what is the incidence and time of onset of OCD?

Answer 3

Lifetime incidence 2-3%, onset: usually starts in adolescence or
early adulthood.

Question 4

what are first line treatment for OCD? Dose, duration, discontinuation

Answer 4

SSRI or the TCA Clomipramine
The daily dose usually needs to be very high, e.g. -Clomipramine 250–300 mg/d,
-Fluoxetine 60–80mg/d, -Sertraline 100-200mg/d; ↓ tolerability, ↑ efficacy
in resistant OCD doses might have to be a bit higher
- Response: Maximum tolerated dose of an SSRI for three months (over 25%
respond given adequate dose and duration and most of the rest will respond
significantly)
- Relapse prevention: A minimum of 1–2 years (relapse is common on
discontinuation)
- Discontinuation:
- Gradual discontinuation over several months is widely recommended

Question 5

what is social anxiety? % of ppl with it alcohol dependency

Answer 5

• This is excessive anxiety which is evoked by a specific object or a specific situation. It can be accompanied by
panic attacks. It can include agoraphobia (fear of public places or crowds) or social anxiety disorder (social
phobia)
• An important aspect is that around 25% people with alcohol dependence have social anxiety

Question 6

when is benzodiazepines used in OCD?

Answer 6

Up to 25% of people with alcohol dependence have social anxiety and use
alcohol to help manage the symptoms. In such cases SSRI’s and when required
Benzodiazepines may be far less damaging than alcohol misuse and
dependence

Question 7

WHAT IS PANIC DISORDER?

Answer 7

-its an anxiety that builds quickly

Question 8

what are the symptoms of panic disorder?

Answer 8

-Symptoms include shortness of breath, palpitations, chest discomfort, sweating,
nausea, trembling, fear of dying
-self help and CBT (cognitive behavioural therapy) should be encouraged

Question 9

what is the first and second line treatment for panic disorder?

Answer 9

For Moderate to Severe Panic Disorder
• SSRI’s first line- Escitalopram, Sertraline, Citalopram, Paroxetine licensed
• Venlafaxine also licensed
• Second line Imipramine or Clomipramine (unlicensed),If an SSRI is not suitable or there
is no improvement after a 12-week course
• NICE do not recommend Benzodiazepines for Panic Disorder but in practice may be
used for emergency management