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OCD Partial Response Management — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersOCD Partial Response ManagementMRCPsych Paper B

A 30-year-old man with obsessive-compulsive disorder has contamination obsessions and washing rituals. He is adherent to sertraline 200 mg daily and has tolerated it without significant adverse effects. During the preceding 16 weeks, he has also completed more than 10 therapist hours of CBT including exposure and response prevention, with at least 12 weeks of treatment given concurrently with sertraline. His Y-BOCS score has fallen from 32 to 22, but his symptoms continue to cause marked occupational impairment. According to NICE CG31, which treatment should now be offered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Offer a switch to a different SSRI or to clomipramine

The correct answer is A. Despite measurable improvement, he has persistent functionally impairing OCD after an adequate trial of combined CBT with ERP and an SSRI. NICE CG31 recommends offering a different SSRI or clomipramine after an inadequate response to at least 12 weeks of combined treatment. Antipsychotic augmentation is not the immediate next step: NICE places it after unsuccessful trials of an SSRI alone, combined SSRI plus CBT/ERP, and clomipramine alone, with specialist multidisciplinary review. Continuing unchanged and discharging him is inappropriate because clinically significant impairment remains. Benzodiazepines are not recommended as long-term OCD treatment, and psychodynamic psychotherapy is not an evidence-based replacement for ERP in this treatment sequence.

Reference: National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), recommendations 1.5.4.3 and 1.5.4.7. 2005. https://www.nice.org.uk/guidance/cg31/chapter/Recommendations