Michael Quach, MD
Board Certified Psychiatrist
Integrative Psychiatry for Men

OCD

The prevalence of OCD (Obsessive-Compulsive Disorder) is 2.5%.  The onset of OCD usually begins in adolescence or early adulthood.  Notably, the suicide risk is elevated; about 50% of OCD patients have suicidal thoughts. 

OCD is highly co-morbid with anxiety disorders, major depressive disorder, substance use disorders (especially alcohol or sedatives), Tourette’s disorder, and anorexia nervosa.

Common obsessions include contamination, pathological doubt, somatic, need for symmetry, aggressive, and sexual.  Common compulsions include checking, washing, counting, confessing, symmetry, and hoarding.

The mainstay of OCD treatment is CBT (Cognitive Behavioral Therapy) which comprises of exposure response prevention and cognitive therapy.  Supportive techniques such as psychoeducation and family therapy are also used to address secondary gain.

Effective medications include SSRIs such as Prozac, Paxil, Zoloft and Fluvox.  Other medications include Clomipramine, Pindolol, Risperdal, Zyprexa, Effexor, Remeron, Buspar, and Lithium.  Some of these agents are not currently FDA approved for the treatment of OCD. 

In treatment resistant cases, Topamax, Inositol, IVIG, ECT, DBS, TMS and even neurosurgery (anterior cingulotomy) can be considered.


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