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- OCD - Outcome studies
- OCD - Treatment protocols
- OCD - Treatment considerations
- OCD - Evidenced based treatment
- OCD - Theory based treatment
- OCD - Team working considerations
- OCD - Followup
OCD can be treated with Behavioral therapy (BT), Cognitive therapy (CT), or a combination of both known as Cognitive-Behavorial therapy (CBT), as well as with a variety of medications. Psychotherapy can also help in some cases, while not one of the leading treatments. According to the Expert Consensus Guidelines for the Treatment of Obsessive-Compulsive Disorder (Journal of Clinical Psychiatry, 1995, Vol. 54, supplement 4), the treatment of choice for most OCD is behavior therapy or cognitive behavior therapy. Medications can help make the treatment go faster and easier, but most experts regard BT/CBT as clearly the best choice. Medications generally do not produce as much symptom control as BT/CBT, and symptoms invariably return if the medication is ever stopped.
The specific technique used in BT/CBT is called Exposure and Ritual Prevention (also known as Exposure and Response Prevention) or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure." The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the (formerly) anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking.
Pharmacologic treatments include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil, Aropax), sertraline (Zoloft), fluoxetine (Prozac), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, the serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety that OCD patients suffer from. SSRIs seem to be the most effective drug treatments for OCD because they work well with chronic anxiety. SSRIs help about 60% of OCD patients, but relapses are common once the medication is no longer taken (Barlow & Durand, 2006). Other medications like gabapentin (Neurontin), lamotrigine (Lamictal), and the newer atypical antipsychotics olanzapine (Zyprexa) and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. Symptoms tend to return, however, once the drugs are discontinued.
Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the addictive property of these drugs likely stands as an obstacle to their sanctioned approval for OCD treatment. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not encouraged, again because of their addictive qualities.
Studies have also been done that show nutrition deficiencies may also be a probable cause for OCD and other mental disorders. Certain vitamin and mineral supplements may aid in such disorders and provide the nutrients necessary for proper mental functioning.
Some individuals who experience OCD can find relief from attending 12-step support group meetings. These meetings, often under the auspices of Obsessive Compulsive Anonymous (OCA), are patterned after the system originated by Alcoholics Anonymous (AA). Meetings are customarily restricted to those who, to the best of their judgement or through a clinical diagnosis, have OCD. It is not unusual to find some attendees who may not have experienced relief through behavioral therapy or medication, but profess that "working the steps" alone has helped alleviate their symptoms.
For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure (Barlow & Durand, 2006).