Content area
Full Text
Guideline source: American Psychiatric Association
Literature search described? Yes
Evidence rating system used? Yes
Published source: American Psychiatric Association Web site
Available at: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm
In 2007, the American Psychiatric Association (APA) published treatment recommendations for obsessive-compulsive disorder (OCD). Patients with OCD usually experience symptoms that wax and wane over time. Treatment should be considered when the symptoms interfere with patients' functioning or cause them significant distress. Management of OCD can involve many therapeutic actions depending on the needs, capacities, and desires of the patient. Coordinating care with other physicians and social agencies (e.g., schools, vocational rehabilitation programs) with which the patient is involved is important. Physicians should advise patients with OCD of the genetic risk of passing the disorder to their children. Genetic counseling may be recommended to patients who want more information.
Psychiatric Management
ESTABLISHING A THERAPEUTIC ALLIANCE
To effectively plan and implement treatment for OCD, the physician should establish a strong therapeutic alliance with the patient. This can involve tailoring a communication style to the patient's needs, explaining symptoms in understandable terms, and encouraging and comforting the patient. Because patients with OCD may experience excessive doubting, it may be helpful to repeat explanations and give the patient extra time to make decisions regarding treatment. The physician should also take into account how the patient feels about him or her and what the patient expects from treatment.
ASSESSING THE PATIENT'S SYMPTOMS
When establishing a diagnosis using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR), it is important to distinguish the obsessions, compulsions, and rituals of OCD from similar symptoms found in other disorders.
USING RATING SCALES
The 10-item Yale-Brown Obsessive Compulsive Scale can measure the baseline severity of the patient's symptoms, which provides a way to assess the patient's response to therapy. If a rating scale is not used, it is advisable to record the patient's estimate of how much time is spent obsessing and performing compulsive behaviors throughout the day, and how much effort is spent trying to resist the behaviors.
ENHANCING THE SAFETY OF THE PATIENT AND OTHERS
The physician should evaluate the patient's potential for self-injury or suicide. Patients with OCD alone or with OCD and a concomitant disorder are at higher risk...