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Obsessive-Compulsive Disorder

OCD, a surprisingly common disorder, is often hidden by patients who have insight into the inappropriateness of their obsessional concerns and the excessive rituals they feel compelled to perform to ward off exceedingly low risk danger or more vague feelings of discomfort. Onset in childhood is common and many suffer lifelong with a few becoming incapacitated by incessant demands of their disorder.

Diagnosis is straightforward once obsessions and rituals are admitted. Once recognized, treatment with cognitive behavior therapy (CBT) and potent serotonin reuptake inhibitors (SRIs) is often helpful, alone or in combination. For those with disorders unresponsive to these standard treatments, somatic treatment with multiple medications and rarely, deep brain stimulation or neurosurgical lesions may be helpful. The largest obstacle to effective treatment of OCD at present is the difficulty obtaining effective CBT which is twice as beneficial, on average, as SRIs.

CME Disclosure

John Greist, M.D., Distinguished Senior Scientist, Madison Institute of Medicine; Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Grant/Research Support: Astra Zeneca, Bristol-Myers Squibb, Lilly, Forest, GlaxoSmithKline, Janssen, Merck, NIMH, Novartis, Organon, Pfizer, Solvay, UCB, Wyeth. Consultant: Bristol-Myers Squibb, Lilly, GlaxoSmithKline, Pfizer, Solvay. Principal: Healthcare Technology Systems, Inc. HTS has licensed IVR assessments for Phase I-IV pharmaceutical trials to ClinPhone. Other Financial or Material Support: Various, from time to time, from the pharmaceutical companies listed above.

James W. Jefferson, M.D., Clinical Professor of Psychiatry, University of Wisconsin Medical School, Distinguished Senior Scientist, Madison Institute of Medicine, Inc., Director, Healthcare Technology Systems, Inc., Madison, Wisconsin.

Grant/Research/Support: Bristol-Myers Squibb, Forest, GlaxoSmithKline, Lilly, Novartis, Organon, Janssen, Pfizer, Solvay, UCB, Wyeth. Consultant: GlaxoSmithKline, Schawrz, Shire, Organon. Lecture Honoraria: Abbott, Astra Zeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Lilly, Pfizer, Myeth. Stock Shareholder: Bristol-Myers Squibb, GlaxoSmithKline, SciClone. Principal: Healthcare Technology Systems, Inc. Other Financial or Material Support: Various, from time to time, from the pharmaceutical companies listed above.

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Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder

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