A 18 year old male washes his hands 6 times every time he uses the toilet. On his way out of the toilet, he has to switch off the light, turn it back on and turn it off once more. What is the SINGLE most appropriate management?
A. Psychodynamic therapy
B. Electroconvulsive therapy (ECT)
D. Cognitive behavioural therapy (CBT)
Obsessive–compulsive disorder (OCD) A common, chronic condition, often associated with marked anxiety and depression, characterized by ‘obsessions’. It is characterized by recurrent obsessions or compulsions that are recognized by the individual as unreasonable. Obsessions are anxiety-provoking, intrusive thoughts, commonly concerning contamination, doubt, guilt, aggression, and sex. Compulsions are peculiar behaviors that reduce anxiety, commonly hand-washing, organizing, checking, counting, and praying. Management CBT is recommended by NICE, but essentially takes a behavioural approach, including exposure and response prevention (ERP). SSRIs (licensed): escitalopram, fluoxetine, sertraline or paroxetine should be considered first-line (no clear superiority of any one agent). Other (unlicensed) agents include citalopram For PLAB, electroconvulsive therapy (ECT) be the answer for treatment of OCD → If patient is suicidal or severely incapacitated