PSYCHIATRY 2 2.

3c
OCD and Trauma Related Disorders: TREATMENT
Dr. Los Baños Aug. 21, 2014

PHARMACOTHERAPY, BEHAVIOR THERAPY, OR A

Outline of topics: COMBINATION
I. Obsessive Compulsive Disorder  Effective in significantly reducing OCD symptoms
II. Post Traumatic Stress Disorder and Acute Stress Disorder
III. Reactive Attachment Disorder SSRI’S + BEHAVIORAL THERAPY
IV. Adjustment Disoders  Best clinical outcome
th  Beneficial effects of meds are longer lasting with behavior
Sources: Kaplan 10 ed., old trans, and lecture ppt therapy
OOBSESSIVE COMPULSIVE DISORDER EXPOSURE OR RESPONSE PREVENTION
PRINCIPLES IN OCD TREATMENT:
 Principal behavioral approaches in OCD
 Initial effects seen after 4-6 weeks of treatment, Maximal  For excoriation (skin-picking) disorder
therapeutic benefit after 8 - 16 weeks
SUPPORTIVE PSYCHOTHERAPY
STANDARD APPROACH:
 With continuous and regular contact with an interested,
 Start with an SSRI or clomipramine(second line)
sympathetic, and encouraging professional, patients may be
 Move to other pharmacological strategies if the serotonin-
able to function by virtue of this help, without which their
specific drugs not effective
symptoms would incapacitate them.
SSRI
FAMILY THERAPY
 Often useful in supporting the family, helping reduce marital
Fluoxetine HCl discord resulting from the disorder, and building a treatment
(Prozac 20) alliance with the family members for the good of the patient.
20 mg /capsule
#7 POST-TRAUMATIC STRESS DISORDER/
Sig: take 1-3 cap once a day for 1 week. (OCD: 20-60 ACUTE STRESS DISORDER
mg/day) SSRI
Refill: none  Considered first-line treatments for PTSD owing to their
Warning: watch out for anxiety, nervousness, insomnia, efficacy, tolerability, and safety ratings.
nervousness, fatigue, tremor, lightheadedness and
sweating.
Paroxetine HCl
Paroxetine HCl (Seroxat)
(Seroxat) 20 mg /tab
20 mg /tab #7
#7 Sig: Take 1 tab daily; may be increased in 10mg
Sig: Take 2 tabs daily. Start w/ 1tab/day, and may be increments weekly.
increased weekly in 10-mg increments. Max: 60mg daily. Refill: None
Refill: None Warning: increased cholesterol level, decreased appetite,
Warning: increased cholesterol level, decreased appetite, blurred vision, insomnia, agitation, abnormal dreams
blurred vision,insomnia, agitation, abnormal dreams including nightmares, dizziness, tremor and headaches.
including nightmares, dizziness, tremor and headaches.
TRICYCLIC DRUGS
 Alternative
SECOND LINE: TRICYCLIC ANTIDEPRESSANT  IMIPRAMINE (Tofranil) and AMITRIPTYLINE (Elavil) -
Both unavailable in the Phil.
Clomipramine (Anafranil)
OTHER DRUGS
25mg/tab
#7  MAOIs( phenelzine) Nardil
 Carbamazepine Tegretol
Sig (Children& Adolescents): take 1 tab once a day.  Valproate Depakene
ST
(during the 1 2 weeks, increase dose up to 3mg/kg or 100  RIMAs
mg, then up to 3mg/kg or 200mg)  Clonidine Catapres
Refill: None  Propanolol Inderal
Warning: Before initiating treatment, hypokalemia should be
treated. Watch out for the following: drowsiness, fatigue, PSYCHODYNAMIC PSYCHOTHERAPY
restlessness, tremor, increased appetite, dry mouth,  Reconstruction of the traumatic events with associated
sweating, constipation, visual disturbances, dizziness, abreaction and catharsis may be therapeutic in some cases
headache, nausea, and weight gain.  But psychotherapy must be individualized because
reexperiencing the trauma overwhelms some patients.
 Psychotherapeutic interventions for PTSD: behavior therapy,
cognitive therapy, and hypnosis.
OTHER DRUGS
 Valproate Depakene EXPOSURE THERAPY
 Lithium Eskalith
 Patient reexperiences the traumatic event through imaging
 Carbamazepine Tegretol techniques or in vivo exposure.
 Venlafaxine Effexor  Exposures can be intense, as in implosive therapy, or
 Pindolol Visken graded, as in systematic desensitization.
 MAOIs (phenelzine) Nardil
 Buspirone BuSpar METHODS OF STRESS MANAGEMENT
 Clonazepam Klonopil  Include relaxation techniques and cognitive approaches to
coping with stress.

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Bautista, Cruz, Gillera, Janolo, Merilles
 2.3c PSYCHIATRY 2
OCD and Trauma Related Disorders: TREATMENT August 21, 2014

GROUP THERAPIES AND FAMILY THERAPY

 Advantages: sharing of traumatic experiences and support
from other group members.

REACTIVE ATTACHMENT DISORDER

 Correct parenting
 Establish what was not established

ADJUSTMENT DISORDER
 Psychotherapy
 Group therapy
 Crisis intervention
 Pharmacotherapy toward the type of adjustment disorder

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