Repeating, counting, and touching to prevent harm

2021 ◽  
pp. 137-142
Author(s):  
Ivana Viani
Keyword(s):  
Gold Standard ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Repetitive Behaviors ◽  
Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Impairment In Functioning ◽  
Clinically Significant ◽  
Mental Acts

Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning. Obsessions are recurrent and persistent intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress. Examples of obsessions include worrying about germs, the feeling things need to be “just right,” worrying about bad things happening, and disturbing thoughts or images about hurting others. Compulsions are repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. Examples of compulsions include washing, checking, tapping, ordering, and repeating. Young children may not be able to articulate the aims of these repetitive behaviors or mental acts. Selective serotonin reuptake inhibitors (SSRIs) are the first-line class of medications used to treat OCD in children and adolescents. Exposure and response prevention (ERP) therapy is the gold standard psychotherapy treatment for OCD.

Obsessive–Compulsive Disorder

2014 ◽  
Vol 27 (2) ◽  
pp. 116-130 ◽  
Author(s):  
Gyula Bokor ◽  
Peter D. Anderson
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Package Insert ◽  
Repetitive Behaviors ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Mental Acts ◽  
The Brain

Obsessive–compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico–striato–thalamo–cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

A teenager who spends hours scrutinizing her skin

2021 ◽  
pp. 129-136
Author(s):  
Kevin M. Hill
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Body Dysmorphic Disorder ◽  
Behavioral Therapy ◽  
Repetitive Behaviors ◽  
Obsessive Compulsive ◽  
Trial Duration ◽  
Reasonable Approach ◽  
High Doses ◽  
Mental Acts ◽  
Excessive Grooming

Body dysmorphic disorder (BDD) is an obsessive-compulsive and related disorder characterized by a preoccupation with a perceived defect or flaw in physical appearance that is not observable or appears slight to others. Individuals with BDD engage in repetitive behaviors or mental acts in response to appearance concerns such as comparing, excessive grooming, skin picking, mirror checking, or reassurance seeking. Females are much more likely to be affected and the disorder typically begins in adolescence. Many patients do not divulge their symptoms to medical providers unless specifically asked. The first-line medication class for BDD is selective serotonin reuptake inhibitors (SSRIs). Patients with BDD tend to require relatively high doses of SSRIs, and a relatively longer trial duration of 12 to 16 weeks is required to determine response. Research on the most effective psychotherapeutic treatments remains limited; however, cognitive behavioral therapy (CBT) may be a reasonable approach.

Quetiapine Augmentation of Selective Serotonin Reuptake Inhibitors in Treatment-Resistant Obsessive-Compulsive Disorder: A Six-Month Follow-Up Case Series

CNS Spectrums ◽  
2006 ◽  
Vol 11 (11) ◽  
pp. 879-883 ◽  
Author(s):  
Bernardo Dell'Osso ◽  
Emanuela Mundo ◽  
A. Carlo Altamura
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Case Series ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

ABSTRACTObsessive-compulsive disorder (OCD) is a relatively common, often chronic and disabling disorder with high rates of partial and/or absent response to standard, recommended treatments, such as selective serotonin reuptake inhibitors (SSRIs) and psychotherapy. This article presents the cases of four patients suffering from OCD and comorbid mood or anxiety disorders, who were treated with SSRIs at adequate doses for at least 12 weeks, showing a partial response. Quetiapine treatment was added to SSRIs at a dose of 25 mg/day and titrated up to 200 mg/day. Patients were followed up for 6 months. After 12 weeks, all the patients were classified as “much improved” on the Clinical Global Impression–Improvement scale and showed a Yale-Brown Obsessive-Compulsive Scale score reduction ≥35%. After 6 months of follow-up, all the patients maintained the same level of improvement. Although quetiapine augmentation to SSRIs has shown mixed results in published controlled trials in the acute treatment (12 weeks) of patients with treatment-resistant OCD, this case series indicates that patients who benefit from this pharmacologic regimen in the acute phase tend to maintain such an improvement. Larger follow-up studies are warranted to confirm our findings.

Fear Over Facts: When Fellow Clinicians Become a Barrier to Dissemination of Exposure and Response Prevention for Obsessive-Compulsive Disorder—A Clinical Response to Licensing Board Investigation of Exposure and Response Prevention

2020 ◽  
Vol 34 (3) ◽  
pp. 179-184
Author(s):  
Laura M. Lokers
Keyword(s):  
Effective Treatment ◽  
Obsessive Compulsive Disorder ◽  
Gold Standard ◽  
Standard Treatment ◽  
Response Prevention ◽  
Accurate Assessment ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Level Student

In 2018, a graduate level student filed a complaint regarding the use of exposure-based therapy for persons with obsessive-compulsive disorder (OCD) experiencing violent obsessions. In the investigation, the licensing board expressed concern about safety of us of exposure and response prevention (ERP) with children and in public venues. The licensing board also struggled with accurate assessment of a clinician's efficacy in following the gold-standard treatment for OCD. Despite extensive research demonstrating ERP is a safe, effective treatment for OCD, stigma against exposure based treatments remain strong, even among clinicians. This commentary article discusses the specific licensing investigation and implications for change throughout the field of psychotherapy.

Sign in / Sign up

Export Citation Format

Share Document