Post by DJM on Mar 8, 2003 22:02:58 GMT -5
Exposure therapy is effective; its essential element is exposure to situations or persons that trigger obsessions, rituals, or discomfort. After exposure, rituals are delayed or prevented, allowing the anxiety triggered by exposure to diminish through habituation. The patient learns that rituals are unnecessary to decrease discomfort. Improvement usually persists for years, probably because patients who have mastered this self-help approach continue to use it without much effort as a way of life after formal treatment has ended.
Many experts believe that combining behavior therapy and pharmacotherapy is the best treatment. Potent serotonin reuptake inhibitors (SRIs), selective serotonin reuptake inhibitors (SSRIs--eg, fluoxetine, fluvoxamine, paroxetine, sertraline), and clomipramine (a tricyclic antidepressant) are effective. For most SSRIs, small doses (eg, fluoxetine 20 mg/day, fluvoxamine 100 mg/day, sertraline 50 mg) are as effective as large ones. The minimum effective dose of paroxetine is 40 mg. Some data support the use of monoamine oxidase inhibitors, but they are seldom indicated or needed because most patients respond to SRIs. Using haloperidol to augment SRIs is effective for many patients with obsessive-compulsive disorder and tic disorders (eg, Tourette syndrome). Augmentation with atypical antipsychotics may help patients without comorbid tics.
Many experts believe that combining behavior therapy and pharmacotherapy is the best treatment. Potent serotonin reuptake inhibitors (SRIs), selective serotonin reuptake inhibitors (SSRIs--eg, fluoxetine, fluvoxamine, paroxetine, sertraline), and clomipramine (a tricyclic antidepressant) are effective. For most SSRIs, small doses (eg, fluoxetine 20 mg/day, fluvoxamine 100 mg/day, sertraline 50 mg) are as effective as large ones. The minimum effective dose of paroxetine is 40 mg. Some data support the use of monoamine oxidase inhibitors, but they are seldom indicated or needed because most patients respond to SRIs. Using haloperidol to augment SRIs is effective for many patients with obsessive-compulsive disorder and tic disorders (eg, Tourette syndrome). Augmentation with atypical antipsychotics may help patients without comorbid tics.