How Should Primary Care Physicians Treat OCD?

The highly respected journal American Family Physician provided a detailed analysis of treating OCD in the primary care setting. For the record, they summarized obsessive-compulsive disorder as: a neuropsychiatric disorder characterized by recurrent distressing thoughts and repetitive behaviors or mental rituals performed to reduce anxiety. We at Beyond OCD believe primary care physicians should be focusing more resources on identifying and treating this undertreated disorder. A good family PCP should be able to recognize various differing presentations or symptoms of OCD and look for clues of its existence in patients showing even faint signs.

Treatment Steps for Primary Care Physicians

Important first steps in facilitating recovery include:

  • diagnosis and educating the patient about the nature of OCD
  • start treatment when OCD symptoms cause impaired function or sizable distress
  • explain that symptomatic relief is possible with setting realistic goals such as spending less than 1 hour per day on OCD behaviors

PC Physicians need to be knowledgeable of the facts concerning OCD medications. They will usually exceed those needed for other indications and the treatment duration will be longer before results surface.

When a patient is showing a strong resistant to treatments, please consider:

  • treatment augmentation of an SSRI with an atypical antipsychotic
  • that due to high rate of relapse treatment should be stopped with caution
  • monitoring the patient to detect possible co-occurring depression and suicidal ideas

Other clinical treatment recommendations, many of which were addressed to PCP recruiters on the newsletter include:

  • cognitive behavioral therapy
  • Selective serotonin reuptake inhibitors
  • atypical antipsychotic agents (SSRI augmentation)
  • exposure and response prevention "booster" sessions
  • monitoring for psychiatric comorbidities

Finally, remember that patients should be referred to subspecialists when appropriate, such as with severe symptoms or treatment resistant responses.