Diagnosis and Management of Obsessive-Compulsive Disorder in the Primary Care Setting

Obsessive-compulsive disorder is a common neuropsychiatric disorder that is often underdiagnosed or misdiagnosed. It is characterized by obsessions, which are intrusive and include unwanted thoughts, images, or urges that cause marked anxiety or distress. Obsessions also drive patients to engage in repetitive actions or thoughts, known as compulsions. The condition has a high prevalence of comorbid disorders and can be associated with functional impairment. Early recognition and treatment can lead to improved outcomes, and complete remission is possible. Validated tools, such as the Yale-Brown Obsessive-Compulsive Scale, are effective in diagnosing and monitoring obsessive-compulsive disorder and determining the severity of the condition. Severity varies among cases, and proper diagnosis and education about this condition are important for determining a treatment plan, which can include psychotherapy, pharmacotherapy, or both. Exposure and response prevention is the most effective form of psychotherapy, and selective serotonin reuptake inhibitors are the most effective pharmacotherapy. If monotherapy is not effective, psychotherapy and pharmacotherapy can be combined. Treatment of obsessive-compulsive disorder is typically recommended for at least 12 months for maintenance and prevention of relapse. In patients requiring augmentation, higher-risk or novel adjunctive treatments or investigational therapies should be managed by an experienced multidisciplinary team.