Text adapted from "The patient with obsessive compulsive disorder" in Psychiatry in primary care by Peggy A. Richter and Steven Selchen (CAMH, 2019).
Obsessive-compulsive disorder (OCD) is a frequently severe psychiatric condition that tends to be overlooked compared with other psychiatric disorders. The lifetime prevalence is approximately 2.5 per cent, but the disorder is seen far more often in general practice because of its chronicity and severity. However, patients often go more than a decade before the symptoms are recognized and they receive an accurate diagnosis. Correct diagnosis is important because OCD requires a unique treatment approach, one with specific adaptations to routine pharmacotherapy (i.e., for mood and anxiety disorders) and psychotherapy.
What is reasonable to expect of a primary care practitioner?
- Routinely screen for OCD symptoms.
- Be aware of the obsessive-compulsive–related disorders.
- Discuss probable diagnosis with patients.
- Provide psychoeducation.
- Identify and address family accommodation.
- Provide pharmacotherapy:
- Be familiar with first-line and at least two second-line options.
- Be comfortable augmenting medication with an antipsychotic.
- Help patients to make an informed treatment choice about medications and CBT, even if you do not have CBT training.
- If you cannot provide CBT, initiate referrals to CBT early in treatment.
- Discuss self-help and bibliotherapy options with patients and support them in using these resources.
When to refer to a specialist
- Diagnostic clarification
- Complex or comorbid presentations
- Specialized CBT
- Refractory illness that has not responded to numerous medications
- Severe OCD: consider urgent/emergency evaluation if OCD is so severe that the patient is not eating regularly, or is not able to take medication, attend to medical or basic self-care needs or leave home.