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Content Update

April 4, 2019

Transcranial Magnetic Stimulation (TMS) for Obsessive-Compulsive Disorder (OCD): In August 2018, the U.S. Food and Drug Administration (FDA) cleared BrainsWay deep TMS (dTMS) system for treatment of OCD. Despite the FDA permitting first-time marketing of a dTMS device for OCD based on one unpublished study by the device manufacturer, the significant heterogeneity across published study designs and outcomes exploring the use of TMS in OCD requires careful interpretation and application. Neuromodulatory approaches including TMS augmentation should continue to be reserved for patients with severe, debilitating OCD who have not achieved a sustained response with standard of care therapies.

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. The short-term goal in posttraumatic stress disorder (PTSD) is reduction in core symptoms, while the long-term goal is remission.

  • Image not available. Cognitive behavioral therapy and eye movement desensitization and reprocessing are the most effective nonpharmacologic methods to reduce symptoms of PTSD.

  • Image not available. The selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are considered first-line treatments for PTSD.

  • Image not available. An adequate trial of SSRIs in PTSD requires appropriate dosing and duration of treatment.

  • Image not available. Patients with PTSD who respond to pharmacotherapy should continue treatment for at least 12 months.

  • Image not available. SSRIs are the drugs of choice for the treatment of obsessive-compulsive disorder (OCD).

  • Image not available. Augmentation of SSRI treatment of OCD with low doses of antipsychotics may be helpful.

  • Image not available. If an inadequate response to an SSRI for OCD occurs after 4 to 6 weeks at the maximum dose, switch to another SSRI.

  • Image not available. Medication taper can be considered after 1 to 2 years of treatment in patients with OCD.

Traumatic or stressful events (eg, wars, terrorist attacks, torture, natural disasters, robbery, physical assault) can lead to development of posttraumatic stress disorder (PTSD). Initially diagnosed in veterans of war, PTSD is now acknowledged as a significant psychiatric illness in the civilian population and among deployed service personnel of the Afghanistan and Iraq campaigns in whom the suicide rate has escalated.1,2 PTSD continues to be poorly recognized and diagnosed in clinical practice.3,4 Because of its co-occurrence with anxiety disorders, depression, substance abuse, and traumatic brain injury, the overlapping symptoms can lead to diagnostic uncertainty. Advances in the science and treatment of PTSD can assist clinicians in all fields of healthcare to screen patients for a history of trauma and effectively manage PTSD if it is present.

Intrusive obsessive thoughts and compulsive ritualistic behaviors characterize obsessive-compulsive disorder (OCD). OCD can be severely debilitating and impair functioning in social, family, and work settings, with an overall decrease in quality of life (QOL). OCD is associated with an increased risk of suicide, with 15% of patients reporting a previous history of suicide attempt.5 Increased understanding of symptom dimensions and treatment response ...

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