The pharmacological treatment of obsessive-compulsive disorder

pharmacological treatment of obsessive-compulsive disorder

In the pharmacological treatment of obsessive-compulsive disorder, selective serotonin reuptake inhibitors are the backbone. During the 1980s, tricyclic antidepressant clomipramine was the common first-line agent, but the side-effect restricted its use. In 1989, Goodman and his team of researchers revealed that Fluvoxamine was also an effective drug. Ever since, various blinded, placebo-controlled research has confirmed the effectiveness of SSRI monotherapy in the treatment of OCD. Due to the reason that there are different proves of efficacy and typically non-threatening side effect status, SSRIs are preferred by physicians as the first-line pharmacological selection for OCD treatment (Pittenger & Bloch, 2014, July 24). The first SSRI to exhibit effectiveness was Fluvoxamine, and although today is still perceived as the desired drug for OCD, there is still no proof of disparity in benefits among SSRIs. The decision of the type of SSRI to be used is made based on the drug response, side effects, patient-first choice, and other related considerations.

One disadvantage of using SSRI monotherapy is that OCD symptoms usually respond slowly to the drugs, unlike other depressive disorders when treated using the same agents. It takes roughly 8-12 weeks for SSRI to begin responding to OCD symptoms. Other people with obsessive-compulsive disorder experience personal improvement more rapidly. A study evaluating the progress of symptoms improvement showed that, instead of the rate of response at endpoint, the effect of SSRIs in OCD patients starts during the first week of treatment, even if it might take other many weeks before it is statistically and clinically evident in many cases (Pittenger & Bloch, 2014, July 24). As a result, although the response of SSRI in OCD is a bit slower than other related disorders, the assumption that its effect takes place after several weeks of issuance is a mere postulation.

Cognitive-behavioral therapy and SSRI pharmacotherapy are reflected as the first-line cure of obsessive-compulsive disorder. Naturally, combining the two methods of treatment would lead to better results than using either alone. However, contemporary studies claim that this might not be the case always. Pediatric OCD Treatment Study compared sertraline, CBT, and their blend with placebo in over 100 children with the disorder. Placebo was inferior to all active treatments and was tolerated well. Combination treatment showed to be more operative than either sertraline alone or CBT alone. Another study revealed that adding cognitive behavioral therapy (CBT) to stable SSRIs can improve the outcomes. In fully grown-up individuals, the significance of combination treatment is less certain (Pittenger & Bloch, 2014, July 24). A vast study comparing CBT, clomipramine, and their amalgamation treatment to placebo revealed that the benefit of cognitive-behavioral therapy surpassed that of clomipramine and that this sort of treatment had no additional benefits. Other follow-up studies also experimented with the addition of CBT to stable SSRI management, compared to risperidone intensification. Again, CBT was more superior. According to these studies, combination treatment offers no assistance at all. Still, significant limitations to this conclusion must be considered. During these studies, medication was dispensed in a relatively inflexible, manualized manner, which may not reiterate usual pharmacological approaches. Various authorities in clinical practice continue to encourage the use of combination treatment believing that it has potential benefits surpassing other therapies or medication alone. For instance, some patients fail to endure anxiety integral to CBT until SSRI pharmacotherapy is used to moderate the symptoms.

Management strategies for OCD

The obsessive-compulsive disorder is characterized by obsession and unwanted thought, which the victim reacts to by repeating particular physical or mental acts. OCD has a lifetime prevalence of 2.5 percent and is a chronic ailment and a somewhat common disorder. There are many challenges in the management and treatment of this condition. Times and again, OCD is misdiagnosed with other mental disorders and other times made more complex by psychiatric comorbidities. The usual ingredients of managing obsessive-compulsive disorder include detailed evaluation of comorbid patterns and symptoms through structured assessments or supplementation by unstructured clinical interview. The choice of treatment is made based on the severity of the condition and response to treatment. Formulating the plan of treatment starts with the correct diagnosis of the disorder (Janardhan Reddy et. al, 2017). After the diagnosis is established, an elaborate family psychoeducation is very essential and assessment may also be required. Encouraging adherence to treatment is a major aspect of articulating a treatment strategy. From there, the choice of treatment is made and the psychiatrist decide whether the OCD patient will take CBT, SSRIs, or combination of both. Even with the usefulness of clomipramine and SSRIs in many OCD patients, roughly half of those who use first-line medication do not exhibit any or partial symptom improvement. Therefore, a person may consider using secondary psychiatric services to manage his condition. Secondary mental strategies are usually practiced in specialist settings, involving high-dose medication with serotonergic agents. However, the majority of people with obsessive-compulsive disorder get cured within primary care.

People living with this disorder should be monitored for suicide risk and comorbidities. During their lifetime, approximately 90 percent of OCD patients meet standards to be involved in at least one other psychiatric diagnosis. Anxiety disorders are the most prevalent comorbid diagnoses, including social phobia, panic disorder, posttraumatic stress disorder, and specific phobias. There are other distinguished comorbidities, including impulsive control disorders, mood disorders, substance use disorders, and major depressive disorder. The odds of suicide for an individual with OCD are high. According to a recent community survey, around 63% of OCD patients have experienced suicidal thoughts, while another 26 percent have attempted to commit suicide (Janardhan Reddy et al., 2017). Comorbidity with substance use, depression, and mood disorders increases the odds of suicidal behavior. During the treatment of the obsessive-compulsive disorder, it is crucial to evaluate all OCD patients for related psychiatric comorbidity as they can affect the treatment outcomes if untreated.

Impact of OCD on quality of life

The severe impacts of obsessive-compulsive disorders are so severe that they can wreak havoc on a person’s life. The compulsions and obsession can consume many hours in an individual’s day, thus interfering with social activities and family life. These effects can also spread to how a person performs at work or school. OCD patients face various detrimental impacts due to their mental disorder. Some of them include the thoughts of being crazy. With obsessive thoughts intruding the mind time and again, joined with resilient compulsions to perform certain rituals and behaviors, a person begins to think he might be crazy, especially if they don’t know their condition (Fenske, & Petersen, 2015). Also, OCD affects an individual’s self-esteem and may result in depression. If a person lives with the disorder for an extended period without seeking medical attention, he/she suffers the risk of going out of control. These feelings contribute to degraded self-perception and depression. Obsessive-compulsive disorder may cause social isolation.

For people living with this condition, performing their rituals is the primary plan. The period wasted doing these compulsive actions is exhausting; therefore, the person feels exhausted and pressured to socialize with others, causing loneliness and isolation. Social isolation becomes devastating when the person stays at home to avoid public situations that may trigger compulsive behaviors. Anger is another common effect of obsessive-compulsive disorder. From the person suffering from the condition to family members accommodating him, they all feel angry towards this unpleasant mental condition. Other family members hold the ill person responsible for the situation as if they chose to be such. Anger is one of the most adverse impacts of this condition because blame is placed on the patient. Resentment follows, and some close people avoid the OCD sufferer due to fear of embarrassment. The urge to hide OCD gives birth to the bitterness. OCD, too, has a physical impact. If the condition remains unchecked for an extended period, it may have adverse effects on the health of the person. People suffering from OCD go through absurd pressures as they feel an intense compulsion to perform their mental rituals and in a proper manner. Due to these pressures and exhaustion resulting from compulsive behaviors, the person may develop ulcers or any other heart disease. For instance, people who perform washing rituals like washing fifty times each day, they may develop severe skin infections and lesions.

Conclusion

In conclusion, obsessive-compulsive disorder is a particularly heterogeneous condition that can be difficult to manage. Modification of challenging responses and exposure to feared stimuli are the basis of any operational, empirically driven treatment for the disorder. The CBT and SSRIs are the first-line therapeutic options. Cognitive-behavioral therapy can be tried alone in the treatment of mild to moderately sick people. In severe conditions, a combination of both CBT and SSRIs is recommended. If OCRDs are left untreated, they may become chronic, leading to psychosocial impairment and substantial distress. However, treatment can alleviate the symptoms and improve the quality of life.

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