OCD

Question 1

What medication are approved for OCD?

Answer 1

Fluvoxamine and clomipramine

Question 2

Which medications have the most data as augmenting agents in OCD?

Answer 2

Risperidone and aripiprazole

Question 3

Can fluvoxamine and come up for me and be combined?

Answer 3

Yes

Clomipramine is converted to its active metabolite desmethylclomipramine(DMC) by CYP450 1A2 And fluvoxamine is an inhibitor of 1A2

DMC acts as a norepinephrine blocker rather than a serotonin reuptake Inhibitor

Fluvoxamine Blocking the conversion of Clomipramine to DMC results in increased serotonin reuptake inhibition and this may be helpful for the patient’s obsessive compulsive symptoms

Plasma levels of clomipramine and DMC should be monitored

Question 4

Dosage of SSRIs and clomipramine in OCD versus depression

Answer 4

OCD doses are generally higher than doses to treat depression and may even be higher than the maximum recommended dose

Question 5

How long should a medication trial be for medication used to treat OCD?

Answer 5

At least 12 weeks

Question 6

What is the treatment of choice for trichotillomania?

Answer 6

Habit reversal therapy

There is limited evidence to support the efficacy of medication’s for Trichotillomania; however some medication to me indirectly help in the presence of comorbid disorders such as anxiety or mood disorders

Studies with NAC (n-acetyl cysteine), anti-convulsants, antipsychotics, and naltrexone are ongoing and if yielded some positive results in case reports and small studies

SSRIs are commonly used however evidence for their efficacy is mixed

Stimulant medication‘s are helpful in the context of Trichotillomania with ADHD

Question 7

Habit reversal therapy for Trichotillomania

Answer 7

Self Monitoring: patient keeps records of hair pulling

Awareness training: patient increases awareness of hair pulling behaviors and situations that trigger hair pulling behaviors

Stimulus control: patient takes measures to interfere with hair pulling, for example wearing gloves

Competing response intervention: patient engages in a physically incompatible behavior for a fixed period of time or until the urge to pull hair goes away for example sitting on hands