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OCD Treatment — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersOCD TreatmentMRCPsych Paper B

A 22-year-old woman with obsessive-compulsive disorder and moderate functional impairment chose pharmacological treatment. She has taken fluvoxamine 100 mg daily as prescribed for 8 weeks. She reports partial improvement but continues to have clinically significant symptoms. She has no significant adverse effects. What is the most appropriate next management step?

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Correct answer: B — Gradually increase the fluvoxamine dose

The correct answer is B. She has partially responded to a standard fluvoxamine dose, is adherent and has no significant adverse effects. NICE advises considering a gradual SSRI dose increase after 4–6 weeks when response to a standard dose is inadequate. The fluvoxamine SmPC permits titration for OCD up to 300 mg daily, according to response and tolerability. Switching to another SSRI or clomipramine is premature before an adequate optimised trial; clomipramine is generally considered after at least one SSRI has been ineffective or poorly tolerated. Combined CBT with ERP becomes the recommended next treatment following review when SSRI monotherapy has not produced an adequate response within 12 weeks, although CBT may be offered earlier according to severity and preference. Antipsychotic augmentation is reserved for substantially more treatment-resistant OCD.

Reference: National Institute for Health and Care Excellence. CG31, Obsessive-compulsive disorder and body dysmorphic disorder: treatment, recommendations 1.5.3.13–1.5.4.7, 2005 (current recommendations page): https://www.nice.org.uk/guidance/cg31/chapter/Recommendations