open access

Vol 4, No 4 (2007)
Review paper
Published online: 2007-10-31
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Diagnosis and therapy of obsessive-compulsive disorder

Jolanta Rabe-Jabłońska
Psychiatria 2007;4(4):160-174.

open access

Vol 4, No 4 (2007)
Prace poglądowe - nadesłane
Published online: 2007-10-31

Abstract

OCD is a disorder, which etiology is not clear, probably both psychological and biological. Significant meaning have functional disorders of basal ganglia, frontal lobe and thalamus and disorders of serotoninergic, noradrenergic and dopaminergic transmission. OCD, which demands therapy is regarding 2-3% of general population. The diagnosis of OCD is not based on neuroimaging studies or neuropsychological data mostly on the clinical picture, significant disorders of functioning and severe discomfort of patient. OCD therapy in children and adolescents as well as mild OCD in adults starts from CBT. If results are poor and in adults with severe OCD, significant disordered functioning we start with pharmacotherapy and CBT. Frequency of CBT (1/day-1/month) and number of sessions (10-30) are depended from age, severity of OCD symptoms, patient’s discomfort, and results of therapy. After significant improvement of mental state, CBT ought be continued for 3–6 months. Drugs approved by FDA for treatment of OCD: clomipramine, SSRI: fluoxetine, fluovoxamine, sertraline, and paroxetine are used in higher doses than in depression (in doses close to the upper limit of therapeutic range) and during 8-12 weeks to assessment of results pharmacotherapy. Suggested time of maintenance therapy is 1, 2 years and longer. If effects of pharmacotherapy are only partial, we can use augmentation, but data regarding this problem are not from RTC studies, and the effects of this therapy are not clear. In the most of standards of OCD treatment if three consecutive adequate treatments are ineeficient, we can diagnose refractory OCD. In patients with refractory OCD we can used combined pharmacotherapy: 2-3 drugs used for treatment OCD, but we must remember about possibility of occurrence of serotonine syndrome.

Abstract

OCD is a disorder, which etiology is not clear, probably both psychological and biological. Significant meaning have functional disorders of basal ganglia, frontal lobe and thalamus and disorders of serotoninergic, noradrenergic and dopaminergic transmission. OCD, which demands therapy is regarding 2-3% of general population. The diagnosis of OCD is not based on neuroimaging studies or neuropsychological data mostly on the clinical picture, significant disorders of functioning and severe discomfort of patient. OCD therapy in children and adolescents as well as mild OCD in adults starts from CBT. If results are poor and in adults with severe OCD, significant disordered functioning we start with pharmacotherapy and CBT. Frequency of CBT (1/day-1/month) and number of sessions (10-30) are depended from age, severity of OCD symptoms, patient’s discomfort, and results of therapy. After significant improvement of mental state, CBT ought be continued for 3–6 months. Drugs approved by FDA for treatment of OCD: clomipramine, SSRI: fluoxetine, fluovoxamine, sertraline, and paroxetine are used in higher doses than in depression (in doses close to the upper limit of therapeutic range) and during 8-12 weeks to assessment of results pharmacotherapy. Suggested time of maintenance therapy is 1, 2 years and longer. If effects of pharmacotherapy are only partial, we can use augmentation, but data regarding this problem are not from RTC studies, and the effects of this therapy are not clear. In the most of standards of OCD treatment if three consecutive adequate treatments are ineeficient, we can diagnose refractory OCD. In patients with refractory OCD we can used combined pharmacotherapy: 2-3 drugs used for treatment OCD, but we must remember about possibility of occurrence of serotonine syndrome.
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Keywords

obsessive-compulsive disorders; diagnosis; therapy

About this article
Title

Diagnosis and therapy of obsessive-compulsive disorder

Journal

Psychiatria (Psychiatry)

Issue

Vol 4, No 4 (2007)

Article type

Review paper

Pages

160-174

Published online

2007-10-31

Bibliographic record

Psychiatria 2007;4(4):160-174.

Keywords

obsessive-compulsive disorders
diagnosis
therapy

Authors

Jolanta Rabe-Jabłońska

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