Monitoring
Follow-up and Patient Monitoring
Follow-up visits are done a few days to 2 weeks after the initiation of therapy. The frequency of visits will depend on the severity of the symptoms, the complexities of co-occurring conditions, the presence of suicidal ideation, and side effects. Psychotherapy should be done as often as necessary.
Multidisciplinary Review
Multidisciplinary Team
A multidisciplinary team is one with expertise in obsessive-compulsive disorder and is referred to when treatment options fail to produce an adequate response. The team supports and collaborates with those professionals already involved in the patient’s care.
Recommendations after Multidisciplinary Review
Combination therapy with cognitive-behavioral therapy and selective serotonin reuptake inhibitor for patients with inadequate response to selective serotonin reuptake inhibitor alone within 12 weeks or cognitive-behavioral therapy of >10 therapist hours per patient. Another selective serotonin reuptake inhibitor, or Clomipramine should be offered for patients with an inadequate response to combined treatment of selective serotonin reuptake inhibitors and cognitive-behavioral therapy, no response to selective serotonin reuptake inhibitors alone, or who have not engaged with cognitive-behavioral therapy. Clomipramine should be considered after an adequate trial of at least one selective serotonin reuptake inhibitor that has been ineffective or poorly tolerated, the patient prefers Clomipramine, or has a good response previously to Clomipramine. Other options if there is no response after a full trial of at least one selective serotonin reuptake inhibitor alone, combination therapy with cognitive-behavioral therapy and selective serotonin reuptake inhibitor and Clomipramine alone include: Additional cognitive-behavioral therapy; additional antipsychotic to a selective serotonin reuptake inhibitor or Clomipramine; and combine Clomipramine and Citalopram.