W14 - Treating Obsessive-Compulsive Disorder: Enhancing Success
Saturday, 24 October 11:15 – 12:45 (1.5 hrs)
Peggy Richter*, MD, FRCPC
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.
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.