Treatments for Obsessive Compulsive Disorder (OCD)

Drug Therapy:
- Antidepressants (SSRIs) increase serotonin levels. Common SSRIs:
  - Fluoxetine (Prozac) for adults.
  - Sertraline for children (6+ years).
  - Fluvoxamine for children (8+ years).
  - Treatment duration: 12-16 weeks.
- Anxiolytics reduce anxiety.
- Antipsychotics (dopamine-lowering) are used if SSRIs are ineffective or cause side effects.
- Beta-blockers reduce physical symptoms by lowering adrenaline/noradrenaline.
Psychosurgery and Deep-Brain Stimulation:
- Psychosurgery destroys brain tissue in the corticostriatal circuit using radio frequency waves.
- Deep-brain stimulation uses magnetic pulses on the supplementary motor area.

SSRIs block transporter molecules, increasing serotonin in the synapse.
Issari et al. (2016): Meta-analysis showed Y-BOCS scores significantly lower in the SSRI group after two weeks.
SNRIs (e.g., venlafaxine) are alternatives with fewer side effects for treatment-resistant symptoms.
Yaryura-Tobias et al (1996): 43% improvement with venlafaxine vs. 0% in the placebo group.
Side effects of SSRIs/SNRIs: diarrhea, constipation, sedation, insomnia, tremors, headaches, suicidal thoughts.
SSRIs show approximately 50% effectiveness within 2 weeks; SNRIs may take longer.

Psychotherapy addresses life situations and subjective understanding of psychological problems.

Based on behaviorist approach: behaviors are learned and can be unlearned.
Involves identifying cues that trigger obsessional thoughts.
Therapist helps identify triggers (places, people, objects, automatic thoughts).
ERP is similar to systematic desensitization, using fear hierarchies.
Habituation: stimuli become neutralized through response prevention.
Patients are prevented from engaging in compulsions.
Imaginal exposure helps recognize that thoughts don't relate to real events.
Therapist and client discuss the experience and create a relapse prevention plan.
Typically 15 sessions, each lasting 1.5-2 hours.

Effective across settings and symptom severity.
Eddy et al. (2004): ERP led to significant improvement for 68.8% of participants vs. 56.6% for cognitive therapy (CT).
CT had a higher recovery rate (49.8%) compared to ERP (38.2%).
ERP plus medication is more effective than medication alone.
Simpson et al. (2008, 2013): ERP increases SSRI effects better than stress management or additional drugs.
35-40% do not recover completely due to poor compliance, lack of insight, comorbid depression.
20-30% drop out due to the time commitment or challenge.

Addresses cognitive biases, such as attentional and interpretation bias.
- Attentional bias: selectively attending to negative stimuli.
- Interpretation bias: interpreting ambiguous events negatively.
CBM-A targets attentional bias by shifting attention from negative to positive stimuli.
CBM-I targets interpretive biases by resolving ambiguity in a positive way.

Williams and Grisham (2013): CBM-I reduced interpretative bias but did not impact perfectionism or overestimation of threats.
Habedank et al (2017): CBM-A reduced attentional bias but did not significantly reduce daily OCD symptoms.
Amir et al (2015): sERP augmented with CBM-I shows positive outcomes.

May be useful for patients with comorbid conditions or OCD developed due to interpersonal stressors.

Aims to connect patients with their emotional experiences and improve interpersonal relationships.
Focuses on social interactions and replacing negative attributions with positive ones.
Weekly sessions (45 minutes) for up to 12 months, with Daily Connection Sheets.