When considering a patient’s long history of Obsessive compulsive disorder (OCD) symptoms, in addition to medication a consulting psychiatrist also recommends psychotherapy for her.
Which of the following types of psychotherapy is most likely to be helpful for this patient?
Correct Answer A:
Cognitive-behavioral therapy (CBT) is a helpful adjunct to pharmacotherapy of OCD. Some studies show that the long term gains achieved with CBT exceed and are more durable than SSRIs alone.
A 49 year old male is diagnosed with Obsessive-Compulsive Disorder.
Which of the following is considered the first line treatment for this patient?
Correct Answer B:
First-line pharmacologic treatments consist of SSRIs (fluoxetine, sertraline, fluvoxamine, paroxetine, citalopram), and clomipramine, a tricyclic antidepressant. Possible alternatives include venlafaxine, a serotonin norepinephrine reuptake inhibitor.
Clomipramine (Anafranil), a tricyclic antidepressant with a strong serotonergic effect, was historically the first-line pharmacologic treatment for OCD. However, because of concerns about the safety and adverse effects of tricyclic agents, SSRIs have become first-line pharmacologic treatments for OCD.
Which one of the following is recommended for the treatment of patients with obsessive compulsive disorder?
Cognitive-behavioral therapy is the recommended treatment for obsessive-compulsive disorder (OCD). Psychoanalytic therapy has not been shown to help treat OCD. Family therapy can help reduce family tensions that result from the disease. Psychodynamic psychotherapy and motivational interviewing may help patients overcome their resistance to treatment.
In which one of the following situations, would it be unethical for a psychiatrist to break confidentiality, and notify the authorities?
Correct Answer D: A physician may break confidentiality in the following situations:
A 62-year-old man with a history of depression has been self-treating his symptoms with St. John's wort for one week. His medical history includes hyperlipidemia, congestive heart failure, atrial fibrillation, and hypertension, for which he is taking atorvastatin (Lipitor), digoxin, warfarin, and verapamil (Calan).
Which one of the following statements is correct?
Correct Answer D:
St. John's wort interacts with a large number of medications. In most cases, St. John's wort decreases the effectiveness of the medication; in other cases, however, St. John's wort may increase the effects of a medication.
St. John’s Wort may increase the breakdown of verapamil in the stomach, causing a decreased effect of verapamil. It is best to avoid using St. John’s Wort while taking Verapamil. If these products must be used together, you may need to adjust the dose of verapamil especially when St. John’s Wort is either started or stopped.
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