Review Question - QID 220752

Obsessive-Compulsive Disorder Treatment Medical QID: 220752 (M2.OMB.4758)

QID 220752 (Type "220752" in App Search)

A 24-year-old man presents to the university mental health clinic with a 6-month history of anxiety. He is a graduate student and has begun worrying that he was messing up his experiments in the lab. Over time, this fear has progressed to the point where he needs to pipette each sample dozens of times to make sure he gets exactly the right quantity in each tube. He also takes so long checking the components of each kit that often he cannot finish a protocol before the reaction spoils. He does not want to have these thoughts but says that he cannot help himself. He finally came to be evaluated because these behaviors have threatened his ability to be productive in the lab. His principal investigator says that he will be let go if things don't change. His temperature is 98.6°F (37°C), blood pressure is 111/65 mmHg, pulse is 87/min, respirations are 12/min, and oxygen saturation is 98% on room air. An ECG is shown in Figure A. In addition to cognitive behavioral therapy, which of the following medications is the most appropriate treatment for this patient?

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Fluoxetine

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Fluphenazine

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Lithium

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Methylphenidate

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Selegiline

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This patient with intrusive worrying thoughts of messing up experiments that are relieved by repeatedly checking, most likely has obsessive-compulsive disorder. The most appropriate treatment for this disorder is cognitive behavioral therapy, along with selective serotonin reuptake inhibitors such as fluoxetine.

Obsessive-compulsive disorder (OCD) is characterized by recurring intrusive thoughts that cause distress and repetitive actions that relieve distress. The thoughts in this disorder are ego-dystonic insofar as the individual experiencing them realizes that they are not reasonable or productive. Nonetheless, patients with OCD will not be able to control the thoughts that cause increasing distress over time. After the thoughts cause distress, patients with OCD will then perform repetitive actions that relieve the distress. These actions can be extremely prolonged or exaggerated to the degree where they result in considerable impairment in daily function. A combination of cognitive behavioral therapy and selective serotonin reuptake inhibitors can be used to treat OCD.

Liebowitz et al. studied the effect of fluoxetine on patients with OCD. They found that the medication was safe and took 8 weeks to develop a therapeutic effect. They recommend considering this medication for patients with OCD.

Figure/Illustration A is an ECG that demonstrates normal sinus rhythm without abnormalities on the rhythm strip (red circle). This finding is consistent with a diagnosis of OCD without underlying cardiac pathology.

Incorrect Answers:
Answer 2: Fluphenazine is an antipsychotic medication that is used in the treatment of schizophrenia. Schizophrenia will present with positive symptoms such as delusions and hallucinations, as well as negative symptoms such as social withdrawal and flat affect.

Answer 3: Lithium is a mood stabilizer that is used in the treatment of bipolar disorder. Bipolar disorder will present as episodes of mania combined with extended episodes of depression.

Answer 4: Methylphenidate is a stimulant that is used in the treatment of attention deficit hyperactivity disorder. This disorder will present with an inability to concentrate and increased activity in more than one context.

Answer 5: Selegiline is a monoamine oxidase inhibitor that is specific for the B isoform of this protein. This drug is used in the treatment of Parkinson disease.

Bullet Summary:
Obsessive-compulsive disorder can be treated with a combination of cognitive-behavioral therapy and selective serotonin reuptake inhibitors.