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Adult Obsessive-Compulsive Disorder
Adult Obsessive-Compulsive Disorder
Diagnosis
Medication
Recommendation
Does the patient have comorbid psychiatric disorder(s)?
Yes
No
Does the patient have an impairing tic disorder?
Yes
No
X
No
Yes
Adequate response
(>35%)
Yes
Partial response
Inadequate response
Combination
Adequate response
No
Partial response
(25-35%)
Inadequate response
(<25%)
Obsessive-Compulsive Disorder
Is comorbidity present?
and treat concurrently
Treat OCD with serotonergic agents
CBT with exposure/
response prevention
if available
SOR A
See corresponding
decision support and
treat concurrently
Impairing tic
disorders
1. Alpha 2 agonist
2. Aripiprazole
3. Risperidone
SSRI
SOR A
Follow up and titrate
dose as appropriate q 1-2 weeks
toward max dose
Maintenance;
continue medication
for minimum 1-2 years
SOR A
Max dose NOT
achieved due to
side effects
Fluvoxamine
Sertraline
Fluoxetine
Max dose achieved with
inadequate response after
8-12 week trial
First time failing SSRI?
Second trial of SSRI
(consider higher dosing range)
Augment
SOR B
1. Clomipramine*
(≤ 75mg)
* Combination SSRI and TCA
therapy requires careful patient
selection, education, shared
decision making, and monitoring
2. Atypical
antipsychotic
Aripiprazole
Risperidone
Olanzapine
Quetiapine
Clomipramine
SOR A
Continue
clomipramine
Psychiatry referral
(if available)
Augment and
maximize CBT
Augment with
atypical
antipsychotics
Discontinue
clomipramine
Psychiatry referral
(if available)
Atypical
antipsychotic
Risperidone
Olanzapine
Aripiprazole
Quetiapine
ECG before initiation and
at each dose increase