The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S14) ◽  
pp. 37-46 ◽  
Author(s):  
Borwin Bandelow
Keyword(s):  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
History Of ◽  
Higher Doses

AbstractSelective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.

Anxiety, Obsessive-Compulsive, and Stress Disorders

2014 ◽  
Author(s):  
Franklin R. Schneier ◽  
Hilary B. Vidair ◽  
Leslie R. Vogel ◽  
Philip R. Muskin
Keyword(s):  
Anxiety Disorder ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Stress Disorders ◽  
Panic Attacks ◽  
Social Situations ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Patients with generalized anxiety disorder experience anxiety related to multiple areas, such as work, finances, and illness. Discrete, unexpected panic attacks and anticipatory anxiety characterize patients with panic disorder. Patients with social anxiety disorder have fear of embarrassment in social situations. Patients with obsessive-compulsive disorder are preoccupied with and distressed by inappropriate thoughts, urges, and images. The four cardinal features of posttraumatic stress disorder are intrusive reexperiencing of the initial trauma, avoidance, persistent negative alterations in cognitions and mood, and alterations in arousal and activity. One element common to patients suffering from most of the anxiety disorders is an elevated sensitivity to threat, which appears to involve brain systems identified to mediate “fear” responses, including the amygdala. The selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line pharmacotherapy treatment for obsessive-compulsive disorder and most of the anxiety and stress disorders. Cognitive-behavioral therapy for anxiety, obsessive-compulsive, and stress disorders is an empirically validated time-limited treatment.

Cognitive-Behavioral Therapy and Integrated Approaches in the Treatment of Obsessive-Compulsive Disorder

CNS Spectrums ◽  
1999 ◽  
Vol 4 (S3) ◽  
pp. 35-40 ◽  
Author(s):  
Fritz Hohagen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavior Therapy ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Mental Condition ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD) has long been considered a treatment-refractory mental condition. Neither pharmacologic nor psychodynamic therapy has been proven to treat OCD effectively. Yet the prognosis for OCD has changed dramatically in recent years with the introduction of behavior therapy and the use of selective serotonin reuptake inhibitors (SSRIs). Many studies have shown that behavior therapy, especially exposure with response prevention, and SSRIs reduce obsessive-compulsive symptoms significantly. Still, many unanswered questions—including the role of cognitive therapy in the treatment of OCD, exposure therapy vs multimodal behavioral therapy, individual versus group therapy, outcome predictors in adults, adolescents, and children, and the role of combination treatment using an SSRI and cognitive-behavioral therapy—remain. This article will explore these issues as well as suggest directions for further research into OCD.

scholarly journals Agomelatine Augmentation of Escitalopram Therapy in Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Domenico De Berardis ◽  
Nicola Serroni ◽  
Stefano Marini ◽  
Giovanni Martinotti ◽  
Francesca Ferri ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Chronic Condition ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Young Female ◽  
Treatment Resistant ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Augmentation Strategies

Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy.

scholarly journals Drug treatment of obsessive-compulsive disorder

2010 ◽  
Vol 12 (2) ◽  
pp. 187-197 ◽  
Keyword(s):  
Drug Treatment ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Options ◽  
Future Research ◽  
Considerable Proportion ◽  
Preliminary Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Rational Drug

Knowledge of pharmacotherapeutic treatment options in obsessive-compulsive disorder (OCD) has grown considerably over the past 40 years. Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRls) and clomipramine, are the established pharmacologic first-line treatment of OCD. Medium to large dosages and acute treatment for at least 3 months are recommended until efficacy is assessed. In case of significant improvement, maintenance treatment is necessary, Unfortunately, about half of the patients do not respond sufficiently to oral serotonergic antidepressants; augmentation with atypical antipsychotics is an established second-line drug treatment strategy. Alternatives include intravenous serotonergic antidepressants and combination with or switch to cognitive behavioral psychotherapy. Remarkably, a considerable proportion of OCD patients still do not receive rational drug treatment. Novel research approaches, such as preliminary treatment studies with glutamatergic substances, and trials with further drugs, as well as needed aspects of future research, are reviewed.

New Pharmacotherapeutic Approaches to Obsessive-Compulsive Disorder

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S3) ◽  
pp. 13-23 ◽  
Author(s):  
Martijn Figee ◽  
Damiaan Denys
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Response To Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Recent Developments ◽  
Patients At Risk ◽  
Treatment Refractory ◽  
Norepinephrine Reuptake

AbstractThis article summarizes results of all pharmacotherapy trials for obsessive-compulsive disorder (OCD) published from 2006 to 2008 as well as studies on markers for predicting response to treatment and neurobiological changes induced by pharmacotherapy. Results show that recent developments in the treatment of OCD have been modest and primarily involve evidence for the efficacy of escitalopram and other selective serotonin reuptake inhibitors (SSRIs); augmentation with antipsychotics in treatment-refractory patients and combination treatment with D-cycloserine and cognitive-behavioral therapy has also been effective. The efficacy of serotonin-norepinephrine reuptake inhibitors remains inconclusive. Studies on markers of clinical response have shown inconsistent results, however, duration and severity of OCD and the presence of comorbidities can often identify patients at risk for nonresponse. Lastly, successful treatment with an SSRI results in both serotonergic and dopaminergic changes, but more research is necessary in order to define the biological characteristics of responders and nonresponders.

scholarly journals Thermocoagulation as a Surgical Approach for the Treatment of Obsessive-Compulsive Disorder in Refractory Patients: Systematic Review

2021 ◽  
Author(s):  
Lucas Praxedes Chaves ◽  
Álef Ribeiro Souza ◽  
Ledismar José da Silva ◽  
Laura de Lima Crivellaro ◽  
Marina Ferreira da Silva
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Therapeutic Option ◽  
High Morbidity ◽  
Obsessive Compulsive ◽  
Noninvasive Treatment ◽  
Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitive-behavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highly-refractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

Overcoming barriers in cognitive-behavioral therapy for youth anxiety and obsessive-compulsive disorder: Addressing parent behaviors

2021 ◽  
Vol 85 (3) ◽  
pp. 231-253
Author(s):  
Erika A. Chiappini ◽  
Carisa Parrish ◽  
Elizabeth Reynolds ◽  
Joseph F. McGuire
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Parent Behaviors ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Therapeutic Outcomes ◽  
Common Parent

Exposure-based cognitive-behavioral therapy (CBT) is a well-established treatment for anxiety disorders and obsessive-compulsive disorder (OCD) in youth. Although a majority of youth respond to CBT, a substantial portion remain symptomatic and/or experience a return of symptoms after completing a course of treatment. This highlights the need for further improvements to this evidence-based treatment. Given that parent behaviors can negatively influence treatment, addressing parental behaviors in CBT serves as a novel and promising treatment target to improve youth's therapeutic outcomes. The authors review three common parent behaviors that influence anxiety and treatment outcomes: family accommodation, parent anxious behaviors, and management of disruptive behaviors. The authors then discuss each behavior, its effect on anxiety/OCD and treatment, and how to address the behavior within the context of CBT. In doing so, therapeutic learning can be optimized to improve CBT outcomes for youth with anxiety disorders and/or OCD.

scholarly journals On the Pharmacotherapy of Obsessive—Compulsive Disorder: Is a Consensus Possible?

2000 ◽  
Vol 45 (3) ◽  
pp. 257-262 ◽  
Author(s):  
Christo Todorov ◽  
Mark H Freeston ◽  
Francois Borgeat
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Research Evidence ◽  
Serotonin Reuptake Inhibitors ◽  
Expert Consensus ◽  
Consensus Guidelines ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Objective: To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive–compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials. Method: The literature on the pharmacotherapy of OCD was critically examined. Results: The available research evidence is not conclusive but suggests that clomipramine possesses greater antiobsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs. Conclusion: Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

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