12/3/2023 0 Comments Acting on intrusive thoughts ocd![]() This is ironic because “inexperienced master’s students with no postgraduate training can be as capable as experienced and certified behavior therapists in treating OCD patients, as long as therapists adhere to a standardized treatment manual and adequate training and supervision is provided.” 8 So presumably an experienced CBT therapist could follow the manual and do well the first time. 7īut ERP is hard to access: very few CBT specialists also regard themselves as ERP specialists. ERP yields slightly more improvement than does antidepressant medication 6 and it is obviously preferable as a long-term treatment, since its benefits last when treatment is stopped. Indeed, ERP is a good place to start for all OCD patients. The OCD symptoms might remit.Īnd if they don’t? Then first turn to the non-medication approach to OCD: the variation of cognitive- behavioral therapy (CBT) known as exposure and response prevention (ERP). 5 Thus, when one sees bipolar disorder and OCD together, treat the bipolar first. 4 Even a case of hoarding remitted when serotonin reuptake inhibitors were discontinued in favor of lamotrigine. (Oh, all right, yes, you should consider bipolar disorder in nearly every patient very few conditions in the DSM do not warrant bipolar disorder in the differential.)Ĭan treating the bipolar make the “OCD” go away? The answer is clearly yes, though not in all such cases. Therefore, in a patient whose OCD symptoms clearly come and go and who also has episodes of depression, one should consider the possibility of a bipolar disorder before treating with antidepressants. In one study, they worsened then remitted in 75% of the OCD-bipolar patients versus only 3% of pure OCD patients. ![]() 3 Importantly then, in the overlapping presentation, OCD symptoms often cycle. 2 When found together, the conditions interact: OCD symptoms worsen during depression and improve during mania (most but not all of the time). Are these just unlucky people with 2 problems? Or do these folks have bipolar disorder, with an OCD-like presentation?Ĭombination bipolar disorder–OCD patients are more likely to have a family history of mood disorders and less likely to have a family history of OCD, “supporting the view that the majority of cases of comorbid BD-OCD are, in fact, BD cases.” 1 This is not just an academic issue: if in these overlap cases the OCD symptoms are somehow part of bipolar disorder, treatment can focus on bipolar and the “OCD” may resolve without adding an antidepressant that could worsen bipolar cycling, induce mixed states, or even cause psychosis.īipolar disorder–OCD overlap is common: between 15% and 20% of patients with bipolar disorders also meet criteria for OCD. Is there some sort of overlap between OCD and bipolar disorder? If so, how can one treat the OCD without worsening the bipolar? On the issue of overlap, a search of PubMed yields many articles describing a clear connection between the two, from genetics to prevalence to clinical occurrence. Only after she is given an antidepressant for her presumed obsessive-compulsive disorder (OCD) does she begin to have delusional thoughts. A 30-year-old woman with subtle paranoia and a history of mood cycling and obsessive preoccupations is brought by her family for treatment.
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