OCD

Key points

• OCD: obsessions (intrusive, ego-dystonic thoughts/images/urges) and/or compulsions (repetitive behaviours/mental acts to reduce anxiety).
• Patients have INSIGHT (unlike psychosis) — thoughts are recognised as their own.
• Management: CBT with exposure and response prevention (ERP) first-line.
• SSRI (fluoxetine/sertraline) or clomipramine — higher doses and longer trials (8–12 weeks) than in depression.
• Screen children with abrupt OCD for PANDAS (post-streptococcal).

Decision points in this pathway

• Medication needed?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.