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OCD (treatment-resistant) — MCCQE Part 1 MCQ

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ModerateAnxietyOCD (treatment-resistant)MCCQE Part 1

A 55-year-old man presents with OCD: repetitive hand-washing causing skin breakdown, contamination fears, insight preserved. Failed adequate SSRI trial. Most appropriate next step?

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Correct answer: B — Add CBT with exposure and response prevention

OCD: SSRIs first-line. If inadequate response, add CBT-ERP (strongest augmentation evidence). Clomipramine second-line SSRI alternative. Antipsychotic augmentation for SSRI-refractory after CBT-ERP trial.

Reference: CANMAT OCD Guidelines