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45 yr old, suspect OCD, habit of constantly washing hands and feet. Any different line of treatment ?

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Psychiatrist
Practicing since : 2004
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HI DOCTOR ! MY PROBLEM IS FOR MY SISTER IN LAW WHO SEEMS TO BE HAVING OCD , SHE IS 45 YEARS OLD AND HAS A HABIT OF CONSTANTLY WASHING HER HAND AND FEET , SHE GETS UP SHARP AT 4A.M AND STARS DOING HER WASHING ,SHE HAS A HABIT OF USING ALL THE TAPS AND ANY WASHING ITEMS SUCH AS , DETERGENT POWDER .,FACE WASHES , SOAPS ., SOPS USED FOR WASHING UTENSILS, AND HER SPECIALLY KEPT SOAPS TOO ,FOR NEARLY TWO -THREE HOURS AT A STRETCH AND AGAIN SHE STARS DOING THE SAME IN THING AFTER SHE HAS TAKEN HER BREAKFAST AND IN THE EVENING AND ALSO STATS IT BEFORE GOING TO BED , AND IF SHE THINKS OF TAKING A BATH SHE HAS STATED BATHING FOR NINE HOURS ,SHE REFUSES TO STOP , AND ENGAGES THE BATHROOM THE WHOLE DAY , SHE BECOMES VERY VIOLENT SOME TIMES AND IS CONTENIEUSLY NAGGING HER MOM WHO IS ABOVE SEVENTY YEARS OLD . WE HAVE TAKEN HER TO THE PYSCIATIST HERE BU T THERE HAS BEEN NO IMPROVEMENT IN THE HABITS .
Posted Fri, 13 Jul 2012 in Mental Health
 
 
Answered by Dr. Ashish Mittal 2 hours later
Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     45 year old female
•     Known case of OCD (depression and psychosis. Her anger outburst may be related to that.

OCD occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter.

In drug treatment two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like Exposure and Response prevention (ERP) also takes weeks to show its effect.

All these process is complex. I have just simplified it to make you understand it.

Some time patient (40% cases) did not improve with initial treatment (like in her case), in that case one of the following steps are used:
-Start concurrent Non drug treatment like Exposure and Response prevention (ERP). But trained therapist is not easily available for ERP
-Increase the dose of current medicine
-Change of existing medicine
-Addition of other medicine
-Admission of patient in psychiatric facility for few weeks
-Treatment of medical conditions if any

All this process take time. But we have seen many cases improving by persistence with treatment.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

Above answer was peer-reviewed by
 
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