Dsm V Ocsd And Ocrds

Innovative and practical treatments

Ryan Boxill, PhD
Clinical Psychologist and Behavior Therapist

Leslie Shapiro, MSW
Behavior Therapist

Darin D. Dougherty, MD
Director of Medical Education, Massachusetts General Hospital Obsessive-Compulsive Disorder Institute at McLean Hospital, Belmont, Mass

How can you differentiate obsessivecompulsive disorder from psychosis? And once thediagnosis is made, how do you determine a course of treatment or predict whether it will be successful? This article will help you answer those questions.

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Current
pSYCHIATRY

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for obsessive-compulsive disorder

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Box 1

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hen you suspect a patient has obsessivecompulsive disorder (OCD) (Box 1), how can youdifferentiate OCD from psychosis? Once you have made the diagnosis, what critical factors suggest treatment will be successful—or unsuccessful? Is behavioral therapy more effective than medication? Which medications are most likely to be effective? The answers to these questions can help you improve the well-being of your patients with OCD.
Differential diagnosis

therapy without medication. Patientswith both OCD and schizotypal personalities respond poorly to both behavior therapy and psychotropic medications.4

Meeting the criteria for OCD

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Unfortunately, many patients with severe OCD are misdiagnosed with psychosis or schizophrenia spectrum disorder and spend many years suffering without proper treatment.3 Despite many similarities between patients with severe OCD and psychosis—including rigid belief systems, unrealistic concerns, magical thinking, and odd behaviors—patients with OCD can recognize the irrational nature of their beliefs when they are not in the throes of anxiety. Patients with OCD also will usually respond to behavioral interventions within a few weeks while patients who are psychotic usually get progressively worse. Treatment must be given time as bothcohorts will get anxious or increase their negative symptoms initially, but patients with OCD should soon habituate and find symptom relief. Some patients have OCD with psychotic features and tend to have more difficulty responding to behavior

bsessions are intrusive and unwanted thoughts, images, or impulses that produce anxiety. They commonly consist of obsessive fears involving causing harm toothers, contamination, safety, religiosity, incompletion, pathological doubt, magical thinking, and the need for certainty, and symmetry. Usually, obsessions will be accompanied by compulsions, which are behaviors or thoughts performed to reduce the anxiety caused by the obsessions. Compulsions typically consist of excessive washing, checking until it “feels right,” and mental retracing. In rarecases, patients present with only obsessions, which are more difficult to treat than compulsions. Most patients will have several types of symptoms. To meet the criteria for OCD, patients must be preoccupied by obsessive thoughts and engage in compulsions, which will be frequent, intense, of long duration (more than 2 hours/day), and interfere with the individual’s ability to function. TheYale-Brown Obsessive Compulsive Symptoms Checklist and Scale1 are reliable assessment tools to identify types of symptoms and degree of severity.

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Treatments for obsessive-compulsive disorder

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‘All I can eat is milk – and one brand of peanut butter’

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Anne also began a regimen of fluoxetine, which ultinne is a 53-year-old widow whose OCD symptomsmately improved her ability to use the behavior therapy consisted of not letting anything pass her lips that techniques. She was started at 5 mg/d in liquid form. she considered contaminated, lest she become ill with The dosage was increased to 40 mg/d across 1 month, cancer. Her symptoms became so severe that she then changed to pill form and titrated to 80 mg/d, which restricted her diet to a...