The following modes of therapy may be useful for treatment of Obsessive Compulsive Disorder EXCEPT
(D) Electroconvulsive therapy # Treatment of OCD:> Psychotherapy: Psychoanalytic-Psychotherapy is used in certain selected patients, who are psychologically oriented. Supportive psychotherapy is an important adjunct to other modes of treatment. Supportive psychotherapy is also needed by the family members.> Behaviour Therapy & Cognitive Behaviour Therapy: Behaviour modification is an effective mode of therapy, with a success rate as high as 80%, especially for the compulsive acts. It is customary these days to combine CBT with BT at most centres. Thought-stopping (and its modifications). Response prevention. Systematic desensitisation. Modelling> Drug Treatment: Benzodiazepines (E.g. Alprazolam, Clonazepam) have a limited role in controlling anxiety as adjuncts and should be used very sparingly. Antidepressants: Some patients may improve dramatically with specific serotonin reuptake inhibitors (SSRIs). Clomipramine (75-300 mg/day), a non-specific serotonin re-uptake inhibitor (SRI), was the first drug used effectively in the treatment of OCD. The response is better in the presence of depressive symptoms, but many patients with pure OCD also improve substantially. Fluoxetine (20-80 mg/day) is a good alternative to clomipramine and often preferred these days for its better side-effect proule. Fluvoxamine (50-200 mg/day) is marketed as a specific anti-obsessional SSRI drug, whilst Paroxetine (20-40 mg/day) & Sertraline (50-200 mg/day) are also effective in some patients. Antipsychotics: These are occasionally used in low doses (e.g. haloperidol, risperidone, olanzapine, aripiprazole, pimozide) in the treatment of severe, disabling anxiety. Buspirone has also been used beneficially as an adjunct for augmentation of SSRIs, in some patients.> Electroconvulsive Therapy: In presence of severe depression with OCD, ECT may be needed. ECT is particularly indicated when there is a risk of suicide and/or when there is a poor response to the other modes of treatment. ECT is not the treatment of First choice in OCD.> Psychosurgery: Psychosurgery can be used in treatment of OCD that has become intractable & is not responding to other methods of treatment. It is worth mentioning that psychosurgery is only available as a treatment choice at a very few centres throughout the world. The best responders are usually those who have significant associated depression, although pure obsessives also do respond. The main benefit is the marked reduction in associated distress and severe anxiety.
Fluoxetine
Clomipramine
Behaviour therapy
Electroconvulsive therapy
Miscellaneous