Practice guideline for the treatment of patients with obsessive-compulsive disorder
Practice guideline for the treatment of patients with obsessive-compulsive disorder
American Psychiatric Association - Medical Specialty Society
Summary,
GUIDELINE OBJECTIVE(S)
To provide recommendations for the treatment of patients with obsessive-compulsive disorder
TARGET POPULATION
Adult patients with obsessive-compulsive disorder
INTERVENTIONS AND PRACTICES CONSIDERED
Evaluation/Management
Psychiatric evaluation and management including the following:
1. Establish a therapeutic alliance by tailoring communication and allowing extra time and repetition
2. Assess the patient's symptoms using the Diagnostic and Statistical Manual of Mental Disorders, Text Revision IV (DSM-IV-TR)
3. Consider rating severity of symptoms and co-occurring conditions using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), documenting hours with compulsive behavior, or recording actively avoided items/areas
4. Evaluate and enhance the safety of the patient and others (e.g., assess potential for self-injury, suicide, and aggressive behavior)
5. Perform complete psychiatric and medical assessment
6. Establish treatment goals
7. Establish appropriate setting for treatment
8. Enhance treatment adherence
Treatment
1. Consideration of patient's motivation and ability to comply with pharmacotherapy and psychotherapy in developing treatment plan
2. Pharmacotherapy
* Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, paroxetine, sertraline
* Clomipramine
* Other anti-depressants, including venlafaxine, mirtazapine
* Other medications, including antipsychotics, morphine sulfate, buspirone, pindolol, riluzole, D-amphetamines, tramadol, monoamine oxidase inhibitors (MAOIs), ondansetron
3. Psychotherapy
* Cognitive behavioral therapy (CBT), including exposure and response prevention (ERP)
* Psychodynamic psychotherapy
* Motivational interviewing
4. Combination therapy
5. Other therapies, including transcranial magnetic stimulation (TMS), deep brain stimulation, intensive residential treatment, partial hospitalization, ablative neurosurgery
6. Implement a treatment plan including appropriate dosing of pharmacotherapy, strategies to manage side effects, scheduling of cognitive-behavioral therapy, changing treatments, and sequential treatments therapy
7. Discontinuing active treatment
MAJOR OUTCOMES CONSIDERED
* Symptoms of obsessive-compulsive disorder
* Resistance to treatment
* Response and remission rates
* Degree of functioning vs. disability
* Quality of life
