Obsessive-compulsive disorder — RACGP Fellowship MCQ

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ModerateMental healthObsessive-compulsive disorderRACGP Fellowship

A 45-year-old woman describes intrusive thoughts about contamination and spends three hours daily washing her hands. She knows the behaviour is excessive and is late for work. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: C — Offer exposure and response prevention therapy and consider an SSRI

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

The correct answer is E. Current evidence-based first-line management of OCD combines psychological intervention (specifically exposure and response prevention, ERP) and pharmacotherapy (SSRI). ERP has the strongest evidence among psychological treatments. SSRIs are first-line pharmacotherapy; higher doses are used than for depression. Combined therapy is more effective than either modality alone. In this case, the patient has moderate-to-severe OCD with clear functional impairment, so both interventions are appropriate. A is incorrect: family reassurance perpetuates avoidance and compulsions. B is wrong: antipsychotics are not first-line in non-psychotic OCD and are used only as augmentation in treatment-resistant cases. C is incorrect: benzodiazepines are not standard and risk dependence. D is clearly wrong: OCD is not a psychotic disorder and requires active treatment.

Reference: Australian Prescriber: Managing obsessive compulsive disorder. https://australianprescriber.tg.org.au/articles/managing-obsessive-compulsive-disorder.html (August 2015); Soomro GM. Selective serotonin re-uptake inhibitors versus placebo for OCD. Cochrane Database Syst Rev 2009;(1):CD001765.