Medical Evaluation

A variety of medical conditions are associated with symptoms that resemble obsessions and compulsions. These conditions, however, are rarely the cause of the OCD symptoms except in certain cases. The clinician may consider a medical workup when the OCD (1) has onset after the age of approximately 40, or (2) is temporally associated with recent seizures, head trauma, or new neurological symptoms.

Multiple medical conditions have been associated with OCD but these have been only in case reports and details are often not available. Table 2.1 lists key pathologies along with potential diagnostic tests and interventions.

Medical Work-Up

OCD and related disorders are still largely diagnosed through a careful clinical evaluation. In the majority of cases, there is no need for laboratory or neurodiagnostic work-ups. In the case of an atypical representation or a presentation of OCD with associated new-onset neurological symptoms, further medical work-up may be appropriate.

Treatment Planning

Treatment planning is based on a careful clinical evaluation. The treatment plan should be tailored to the patient’s needs, preferences, capacities, situation, and history.

Therapy and/or Medication

For the patient with mild to moderate OCD, a combination of exposure response prevention therapy plus a serotonin reuptake inhibitor (SRI) (i.e., a special class of antidepressant medications which include clomipramine, fluoxetine, paroxetine, sertraline, citalopram, escitalopram, and fluvoxamine) is a reasonable initial strategy. The patient may prefer one of these treatment options instead of another. Either could be effective on its own. The person could begin with one approach and add the other if only partial response is achieved with the initial treatment option. If the mild to moderate OCD patient also has depression, then using an SRI with therapy may be preferred.

If the patient has moderate to severe OCD and the obsessions prevent the person from taking part completely with therapy, an SRI may be a useful starting point to decrease symptoms enough that the person can take advantage of therapy.

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