NEW ORLEANS — Up to 30% of patients with obsessive-compulsive disorder (OCD) are not helped at all or are inadequately helped by current pharmacotherapies, according to Jon Grant, MD, JD, MPH, professor of psychiatry and behavioral neuroscience at the University of Chicago, in his presentation at the 2017 US Psych Congress.
“Most people tend to think of OCD as an innocuous, silly problem based on television,” Dr. Grant said, “but it is an incredibly serious mental health problem.”
OCD is characterized by recurrent distressing ideas and recurring behaviors designed to reduce the anxiety caused by the obsessions. While onset occurs earlier in boys than in girls, OCD affects both genders equally. Additionally, the age of onset appears to be bimodal, occurring either during childhood (mean age 10 years) or during adolescence or young adulthood (mean age 21 years).
Dr. Grant highlighted the importance of screening and diagnosis, emphasizing that patients with OCD should be assessed regarding their conviction that their obsessive beliefs are accurate.
Without treatment, remission rates for OCD are low (approximately 20%), but higher response and remission rates are reported with appropriate treatment, with early diagnosis and treatment leading to improved outcomes.
The US Food and Drug Administration (FDA) has approved the serotonin reuptake inhibitor clomipramine, as well as the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline for the treatment of OCD.
According to head-to-head comparisons, all SSRIs are equally effective. Dr. Grant also acknowledged that while some patients are uncomfortable with the fact that medication doses for OCD are higher than they are for depression, those higher doses are crucial for symptomatic improvement.
Nonpharmacologic treatments are also effective options for OCD. Cognitive-behavioral therapy (CBT) attempts to reduce patient anxiety by implementing experiments that will force the patient to confront fallacies in their thinking about cause and effect.
Another treatment option for OCD is exposure and response prevention therapy (ERP), which consists of repeated, prolonged exposures to fear-eliciting stimuli or situations with instructions for the patient to refrain from his or her compulsive behaviors.
The purpose of this practice is to allow the patient to experience a reduction in the fear response and to learn that the anxiety will reduce naturally if he or she does not make efforts to avoid it. As many as 60% to 85% of patients report substantial symptom reduction with ERP; the large amount of empirical data supporting ERP over CBT make it a first-line treatment for OCD.
Grant J. Obsessive-compulsive disorder: treatment with psychotherapy and pharmacotherapy. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.