Transcript TREATMENT
Obsessive- Compulsive Disorder )TREATMENT( Pharmacological Treatment CBT Partial Hospital and Inpatient Treatment Family education Single Drug Treatment 25-40% Reduction in 40-50% The choice of medication for OCD should be Influenced by the presence of coexisting panic disorder, psychotic or schizotypal features , depression or Tourette disorder The most studied medication in treatment of OCD are potent serotonin reuptake inhibitors(SRIs),which also affect other neurotransmitter system. Fluoxetine (Prozac) 20–60 Agitation ,insomnia , anorexia ,dizziness , Xerostomia ,increased anxiety , disturbing akathisia , suicidal ideation and aggression Sertraline (Zoloft) 50–200 Insomnia, nausea, agitation and tremor Fluvoxamine (Luvox) 50–200 Nausea , lethargy and insomnia Paroxetine (Paxil) 20–60 Citalopram (Celexa) 20–60 Escitalopram (Lexapro) 5–20 Clomipramine (Anafranil) 50–2 Dizziness , blurred vision ,postural hypotension , tachycardia ,sedation ,and constipation Memantine glutamate antagonist It can be readily seen that between 40 and 50% of individuals with OCD without associated diagnosis may not respond to adequate trials of SRIs The response to one SRI agent dose not predict the response to another Side effects from one agent do not predict side effect on another The maximum dose that a patient can tolerate or the maximum allowable dose for no less than 12 weeks It is important to offer adequate dose for a sufficient period of at least two and possibly three agents before moving on to augmentation strategies Augmentaion with: antipsychotic lithium , t3 Buspirone ,L-tryptophan SRI+ clomipramine Clonazepam Evaluate their symptoms Family in crisis symptoms are completely out of everyone’s control the family’s capacity to support the patient is thoroughly depleted Symptoms are dangerous Ongoing sever impairment following a course of adequate treatment Cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) . According to the American Academy of Child and Adolescent Psychiatry CBT or CBT with concurrent pharmacotherapy using an SSRI is considered the first-line treatment for pediatric OCD. The first step of treatment is psychoeducation about OCD and E/RP. child's age, cognitive functioning, and insight into the nature of his or her OCD is paramount in determining the direction of treatment, as introduction of cognitive components of therapy depends on the child's developmental level and insight.