A 55-year-old man repeatedly washes his hands until they bleed and spends three hours daily checking the locks. He recognises that this is excessive but cannot stop. What is the first-line treatment for this condition?
Answer and explanation
Correct answer: A. CBT with exposure and response prevention, or an SSRI
- Step 1: Insight into intrusive, repetitive acts indicates obsessive-compulsive disorder.
- Step 2: NICE recommends CBT with ERP, and an SSRI for moderate to severe impairment.
Answer
CBT with exposure and response prevention, or an SSRI.
Why not the others: Diazepam each day for six months, with review in the surgery: Benzodiazepines do not treat OCD. Lithium carbonate as the first choice, with levels checked weekly: Lithium is a mood stabiliser. An antipsychotic alone, started at a low dose and titrated upwards: Antipsychotics alone are not first-line.
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