skip to main content

OCD treatment — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatry (outpatient management)OCD treatmentUSMLE Step 3

A patient with severe OCD remains disabled after two adequate SSRI trials, including a maximally tolerated current SSRI, and a completed course of therapist-delivered exposure and response prevention. Adherence is verified. Which next medication strategy has the strongest support?

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

Reveal the answer and explanation

Correct answer: D — Add low-dose risperidone with scheduled benefit and safety review

The best answer is “Add low-dose risperidone with scheduled benefit and safety review”. Low-dose antipsychotic augmentation, particularly risperidone, is a supported next pharmacologic strategy after adequate serotonin-reuptake-inhibitor and exposure-and-response-prevention trials. It should be time-limited, reassessed for benefit, and monitored for metabolic and extrapyramidal harms. The other proposed adjuncts have weaker evidence for refractory OCD, and combining clomipramine with a maximally dosed SSRI creates important serotonergic and pharmacokinetic safety concerns.

Reference: APA Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf