Abstract
Introduction: Obsessive Compulsive Disorder (OCD) is a common disease causing to significant deterioration in the personÂ’s social and occupational functions. In this case report cognitive behavioral therapyÂ’s location in treatment-resistant patients is discussed from pharmacotherapy and ECT resistant an OCD patient.
Case: 46 years old male patient had recourse to with complaints that loved ones arrive per accident or sexual thoughts about inappropriate people that led to the unintentional and occurred to distress so repetitive behaviors to get rid of that woes. These thoughts and behaviours was taking patientÂ’s almost all his time and to avoid these situations he was spending his entire day exiting out of bed.
The patientÂ’s complaints was sexual or per relatives considerations related to a negative event in mind and repeat some behaviours (spitting, gulping, turning, to step on-touch to certain places or to keep away from these) and expressions for unthinking these ideas 20 years ago. And these ideas could appear on just any activity (eat, step on a point while walking, either one of them to pass through from etc.). PatientÂ’s these complaints had started at light level. 6 years ago there was an increment about his complaints and it starts to abstruct his daily activities; in this process he had sufficient time and dose fluoxetine and clomipramine treatments standing and lying. He hospitalized for treatment because of to intensify his symptoms in spite of treatment in the last 6 months. In the first 6 months of entering to clinic pharmacotherapy (fluvoxamine + trifluperazin, fluvoxamine + risperidone, clomipramine + olanzapine) and 3 times a week in 20 EKT session was completed but he didnÂ’t answer to these treatments. Thereupon CBT was started to patient. Therapy process started with evaluation and cross-sectional case formulation, afterward psychoeducation that contains OCD and OCDÂ’s CBT model was done, the patient's symptoms and the findings are evaluated in that context. Then CBT rationale that perform to the patient had been transferred. PatientÂ’s coping methods with his current shortage and its results had been analyzed. Cognitive reconfiguration techniques related his current comments had been practised. Rationale of exposure and response prevention therapies were transferred. Hypothesized about each situation before ERP therapy and these hypothesis had been looked over with patient after ERP therapy.
Results: CBT is among the first treatments in the treatment of OCD. Hovewer, CBT is an effective treatment for treatment-resistant patients with pharmacotherapy and ECT.
Key Words:Obsessive Compulsive Disorder, treatment-resistant OCD, Cognitive Behaviour Therapy