Obsessive-Compulsive Disorder: Diagnosis and Management

Am Fam Physician. 2015 Nov 15;92(10):896-903.

Abstract

Obsessive-compulsive disorder (OCD) is a chronic illness that can cause marked distress and disability. It is a complex disorder with a variety of manifestations and symptom dimensions, some of which are underrecognized. Early recognition and treatment with OCD-specific therapies may improve outcomes, but there is often a delay in diagnosis. Patients can experience significant improvement with treatment, and some may achieve remission. Recommended first-line therapies are cognitive behavior therapy, specifically exposure and response prevention, and/or a selective serotonin reuptake inhibitor (SSRI). Patients with OCD require higher SSRI dosages than for other indications, and the treatment response time is typically longer. When effective, long-term treatment with an SSRI is a reasonable option to prevent relapse. Patients with severe symptoms or lack of response to first-line therapies should be referred to a psychiatrist. There are a variety of options for treatment-resistant OCD, including clomipramine or augmenting an SSRI with an atypical antipsychotic. Patients with OCD should be closely monitored for psychiatric comorbidities and suicidal ideation.

Publication types

  • Patient Education Handout

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / therapeutic use*
  • Chronic Disease / drug therapy*
  • Cognitive Behavioral Therapy*
  • Drug Therapy, Combination
  • Education, Medical, Continuing
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obsessive-Compulsive Disorder / diagnosis*
  • Obsessive-Compulsive Disorder / drug therapy*
  • Practice Guidelines as Topic*
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Treatment Outcome
  • Young Adult

Substances

  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors