Obsessive-Compulsive Disorder (OCD) is one of those conditions that can be incredibly debilitating for patients, but the management is actually quite structured once you get the hang of it. For the UKMLA AKT, you'll want to focus on the diagnostic criteria and the specific "step-up" approach to treatment.

Diagnosis of OCD

According to ICD-11 and DSM-5 criteria, diagnosis requires the presence of obsessions, compulsions, or both, which are time-consuming (taking up more than 1 hour per day) or cause significant distress/impairment.

• Obsessions: Recurrent, persistent thoughts, urges, or images that are intrusive and unwanted (e.g., fear of contamination, need for symmetry).
• Compulsions: Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession (e.g., hand washing, checking, counting).

Management Strategy

In the UK, NICE guidelines recommend a stepped-care model based on the level of functional impairment.

CBT with ERP (Exposure and Response Prevention)

This is the "gold standard" psychological therapy for OCD.

• Exposure: The patient is encouraged to face the stimulus that triggers their obsession (e.g., touching a "dirty" doorknob).
• Response Prevention: They are then instructed to resist the urge to perform the compulsion (e.g., not washing their hands).
• Goal: Over time, the anxiety associated with the obsession decreases through a process called habituation.

Pharmacological Management: SSRIs

If a patient doesn't respond to therapy or has moderate-to-severe symptoms, we turn to Selective Serotonin Reuptake Inhibitors (SSRIs).

• Dosing: Unlike depression, OCD often requires higher doses of SSRIs (e.g., Fluoxetine up to 60mg or Sertraline up to 200mg).
• Duration: It takes longer to see a response in OCD—usually 12 weeks—so patients need to be counselled not to give up too early.
• Choice: Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, and Citalopram are all options. If one fails, try another SSRI or Clomipramine (a TCA with potent serotonergic effects).

Key Exam Point: If a patient is under 18, the management is more specialist-led, usually starting with CBT/ERP, and Fluoxetine is the only SSRI licensed for use in children/young people with OCD.

I'll pull up some high-yield lessons and a flowchart to help you visualize the management pathway.