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OCD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersOCDMRCPsych Paper B

A 25-year-old woman has contamination-related obsessive-compulsive disorder. Despite good adherence to a 12-week trial of sertraline, titrated to 200 mg daily and well tolerated, she has had only a partial response, with no clinically significant improvement in functioning. She has not previously received cognitive behavioural therapy. A multidisciplinary review confirms the diagnosis, adherence and her willingness to undertake psychological treatment. According to NICE CG31, what should now be offered?

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Correct answer: D — Continue sertraline and add CBT including ERP

The correct answer is D. Following multidisciplinary review, NICE recommends combined treatment with an SSRI and CBT including exposure and response prevention when an adult has had an inadequate response to SSRI monotherapy within 12 weeks. Sertraline should therefore be continued while CBT with ERP is added. ERP alone would unnecessarily withdraw a tolerated treatment that has produced some benefit. Switching to another SSRI or clomipramine is appropriate after failure of 12 weeks of combined treatment, or when there has been no response to SSRI monotherapy or the patient has not engaged with CBT. Antipsychotic augmentation is reserved for substantially more treatment-refractory OCD after adequate SSRI, combined-treatment and clomipramine trials, with specialist multidisciplinary involvement.

Reference: National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), recommendations 1.5.4.1–1.5.4.3. Published 2005; updated May 2024. https://www.nice.org.uk/guidance/cg31/chapter/Recommendations