Workshop​​ 
W14 -​​ Treating Obsessive-Compulsive Disorder: Enhancing Success​​ 

Saturday, 24 October 11:15 – 12:45 (1.5 hrs)
Peggy Richter*, MD, FRCPC

CanMEDS Roles:​​ 

  • Medical Expert​​ 

  • Scholar​​ 

  • Collaborator​​ 

At the end of this session, participants will be able to:​​ 1)​​ Utilize an evidence-based approach to​​ pharmacotherapy​​ for OCD;​​ 2) Describe​​ treatment alternatives for​​ severe/​​ refractory OCD, including residential treatment, repetitive transcranial stimulation and psychosurgery; and 3)​​ Incorporate key OCD-specific strategies to optimize treatment outcome.​​ 

Obsessive-compulsive disorder (OCD) tends to respond only modestly to first-line pharmacotherapy, leaving most sufferers with significant and disabling symptomatology even after attaining medication​​ ‘response’. Frequently, success is limited by lack of specific knowledge regarding disorder-specific differences in treatment for OCD, compared to other anxiety disorders, resulting in reduced treatment efficacy in typical outpatient practice than the evidence suggests or clinicians would hope. ​​ The focus of this course will be on providing clinicians with OCD-specific tips​​ and practical strategies​​ to optimize outcomes​​ in working with individuals with OCD. Pharmacotherapy will be reviewed,​​ starting with a review of an evidence-based approach to 1st​​ and 2nd​​ line options followed by an outline of emerging alternatives for treatment-resistant individuals. ​​ Other treatment options​​ for use when routine treatment fails​​ are​​ becoming increasingly​​ available in Canada​​ and will be introduced. The role of more intensive treatment for OCD will be reviewed and differences between residential/day hospital interventions and routine outpatient treatment discussed. Similarly, alternative biological​​ interventions​​ such as rTMS and psychosurgery​​ will be introduced​​ for use with patients with extremely severe and treatment-refractory illness. Key​​ points​​ will be illustrated by case presentations. ​​ There will be time​​ for attendees to discuss the application of these principles to their own cases in​​ this​​ highly​​ interactive session.

References:​​ 

  • Hirschtritt ME, Bloch MH, Mathews CA. Obsessive-compulsive disorder advances in diagnosis and treatment. JAMA 2017;317:1358-67.

  • Fineberg ​​ NA, Brown A, Reghunandanan S, et al. Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol 2012;15:1173-91.

 

/ Virtual Conference 2020