The Use of Antipsychotics in the Treatment of Obsessive‐Compulsive Disorder

O bsessive-compulsive disorder (OCD) is a common anxiety disorder, affecting 1% to 3% of the population. Patients struggle with obsessive thoughts, compulsive rituals, and avoidance behaviors. Symptoms are time-consuming, intrusive, and difficult to resist. The disorder is chronic, tends to wax and wane in severity over a patient’s lifetime, and rarely remits spontaneously. Suicide attempts have been reported by 10% to 27% of patients with OCD and are particularly likely in those with more severe illness or depressive comorbidity. The use of serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT) with exposure and ritual prevention (E/RP) revolutionized the care of this previously untreatable illness. The Expert Consensus Panel for OCD has recommended CBT alone as first-line treatment for milder OCD in adults and an SRIwith or without CBT for more severe OCD. Proper implementation of these interventions, however, requires patience and expertise. Response to SRIs in treatment of OCD is slower than that seen in treatment of depression. For instance, in one clomipramine trial, maximum symptom reduction did not occur until the 10th week of treatment. Because OCD symptoms respond more slowly to SRI treatment, an adequate trial would be 8 to 12 After reading this article, the practitioner should be able to: