A 40-year-old man states that he is feeling somewhat down and in conflict with his wife. You elicit that he has always been somewhat rigid; he is a conscientious hard worker at his employment. You note that he is dressed very neatly and that, while giving his personal history, he rambles and gives you all the details.
The most likely personality type is:
Correct Answer E: People with obsessive-compulsive personality disorder are markedly preoccupied with orderliness, perfectionism, and control. They lack flexibility or openness. Their preoccupations interfere with their efficiency despite their focus on tasks. They are often scrupulous and inflexible about matters of morality, ethics, and values to a point beyond cultural norms. They are often stingy as well as stubborn.
A 34 year old white female comes to the office for a Papanicolaou (Pap) test. On a review-of-system checklist, she checks “yes” to depressive symptoms, insomnia, and anxiety. On questioning, she admits to feeling depressed for about 4 months, after a recent job change. She is not suicidal. With probing, she admits that she repeatedly checks her locks and constantly worries about cleanliness; she has been this way “all of her life”, but finds it very time-consuming.
Which one of the following drugs is the best choice for this patient?
Correct Answer E:
The patient most likely has obsessive-compulsive disorder (OCD) with a depressive episode. SSRIs are most frequently used. Risperidone and clonazepam are considered second-line drugs and are used as augmentation drugs when there is a partial response to an SSRI. There is no evidence that clorazepate or imipramine is effective in OCD.
Which one of the following is the preferred treatment for patients with obsessive-compulsive disorder?
Correct Answer C:
Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive behaviors that impair everyday functioning. SSRIs such as fluoxetine and fluvoxamine are FDA-approved and considered first-line agents in the treatment of this condition. None of the other agents listed is recommended for the treatment of obsessive-compulsive disorder. Lithium is useful in bipolar disorder and depression, alprazolam is used in generalized anxiety and panic disorder, and amitriptyline is used in depression and chronic pain syndromes. Valproic acid is primarily an anti-epileptic agent.
Which one of the following is true concerning the treatment of patients with obsessive-compulsive disorder (OCD)?
Correct Answer D:
Stopping SSRIs causes a high rate of relapse of obsessive-compulsive symptoms. Obsessive-compulsive patients are usually very aware that their behavior is illogical, and behavioral therapy is very effective in treating obsessions. SSRIs are effective in both adults and children, and are more effective than tricyclic antidepressants for treating obsessive compulsive disorder.
An 18-year-old female presents with a fear of having run over someone when she is driving. She has had to stop her car and get out to see if there is a body in the road every time she drives over a bump. When you ask her about other worries, she states she checks her stove, iron, and coffee pot multiple times a day to ensure they are turned off. She has tried to stop doing these things because she feels they don’t make sense, but feels intense anxiety if she doesn’t stop and check.
The medications used to treat this disorder work primarily through which neurotransmitter?
Correct Answer B:
Obsessive-compulsive disorder is thought to occur due to serotonin dysregulation. The areas of the brain that are thought to be involved are the frontal lobes, the basal ganglia, and the cingulum. Treatment includes selective serotonin reuptake inhibitors such as fluvoxamine or fluoxetine, or the tricyclic agent clomipramine.
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