Behind the obsessions: a guide to obsessive-compulsive disorder

Case scenario

Mitchell, 28, presents with a new prescription for sertraline 50 mg daily, following a recent diagnosis of obsessive-compulsive disorder. While his medicine is being dispensed, Mitchell discloses that he has stopped driving. He explains that he is plagued by intrusive thoughts that he might hit a pedestrian or cyclist without realising it, leading him to repeatedly retrace his route to check no one is injured. He knows the thoughts make no sense, but he cannot stop them. Mitchell’s girlfriend uses 50 mg of sertraline for depression, and he questions why the GP told him he might increase Mitchell’s dose when he returns for a review.

Introduction

Obsessive-compulsive disorder (OCD) is a mental health condition commonly diagnosed in children and young adults.^1–4 OCD is managed initially with psychological therapy, such as cognitive behavioural therapy (CBT) with exposure and response prevention (ExRP), which involves exposure to the triggers that cause anxiety.¹ Selective serotonin reuptake inhibitors (SSRIs) may be added, with supratherapeutic doses often needed.^1–4 If there is a poor response to SSRIs alone, switching to or adding clomipramine or low-dose atypical antipsychotics as adjunct therapies has shown promising results.^1,3

Learning outcomes After reading this article, pharmacists should be able to: Describe the relationship between obsessions and compulsions.