diagnosed with ‘anxiety’. He was initially placed on fluoxetine at 20 mg without improvement and remained on this regimen for four years. At that time was switched to buprioprion, titrated to 300 mg, and had remained there for three months with no change. Upon presentation to our clinic, buproprion was discontinued and escitalopram was initiated and titrated as rapidly as he could tolerate it to 40 mg daily for a diagnosis of OCD and tic disorder. Risperidone 0.5 mg nightly was added as an augmentation strategy. The patient experienced a partial improvement of symptoms after six months, but still had significant issues with flicking light switches off and on. He remained at this level of improvement for three years, but after receiving services for job training, the parents wished to see if he could obtain greater improvement on a different regimen. His SSRI was switched to fluvoxamine 450 mg daily, and the risperidone augmentation was changed to aripiprazole 10 mg. He had further gains in his rituals; his parents noted that his light switch rituals were lessened significantly to a few minutes at a time. His only side effect to these medications was an increase in sleep to 10 hours a day, and the patient and his parents were pleased with his improvement. While in the office, the principles of exposure with response prevention therapy (ERP) were explained to the patient and his parents. The patient had good insight into the ego-dystonic nature of his obsessions, and was able to understand the concepts of the treatment, including the increased anxiety during exposures and the goal of habituation. A single trial of ERP was initiated during an office visit, and patient was able to do the tasks assigned. Family reported a resultant decrease in flicking of light switches at home after this trial. However, he was not able to come into our clinic on a weekly basis for therapy as their stravel time was greater than 2 hours. In addition, there are no therapists trained in ERP in his geographical region. As a result, behavior therapy has unfortunately not commenced on a regular basis, and treatment at this time is exclusively pharmacologic.

diagnosticeret med 'angst'. Han blev oprindeligt anbragt på fluoxetin ved 20 mg uden forbedring og forblev på dette regime i fire år. På det tidspunkt blev skiftet til buprioprion, titreret til 300 mg og havde været der i tre måneder uden ændring. Efter præsentation på vores klinik blev buproprion afbrudt, og escitalopram blev initieret og titreret så hurtigt, som han kunne tåle det til 40 mg dagligt til diagnose af OCD og tic-lidelse. Risperidon 0,5 mg om natten blev tilsat som en forstærkningsstrategi. Patienten oplevede en delvis forbedring af symptomerne efter seks måneder, men havde stadig betydelige problemer med at tænde og slukke for blinkende lys. Han forblev på dette forbedringsniveau i tre år, men efter at have modtaget tjenester til jobtræning ønskede forældrene at se, om han kunne opnå større forbedring på et andet regime. Hans SSRI blev skiftet til fluvoxamin 450 mg dagligt, og risperidonforstørrelsen blev ændret til aripiprazol 10 mg. Han havde yderligere gevinster i sine ritualer; hans forældre bemærkede, at hans lysafbryderritualer blev mindsket markant til et par minutter ad gangen. Hans eneste bivirkning ved disse lægemidler var en stigning i søvn til 10 timer om dagen, og patienten og hans forældre var tilfredse med hans forbedring. Mens man var på kontoret, blev principperne for eksponering med responsforebyggende terapi (ERP) forklaret for patienten og hans forældre.Patienten havde god indsigt i den ego-dystoniske karakter af sine besættelser og var i stand til at forstå begreberne i behandlingen, herunder den øgede angst under eksponeringer og målet om tilvænning. Et enkelt forsøg med ERP blev indledt under et kontorbesøg, og patienten var i stand til at udføre de tildelte opgaver. Familien rapporterede et resulterende fald i flicking af lysafbrydere derhjemme efter dette forsøg. Imidlertid var han ikke i stand til at komme ind i vores klinik på en ugentlig basis for terapi, da deres straveltid var over 2 timer. Derudover er der ingen terapeuter uddannet i ERP i hans geografiske område. Som et resultat er adfærdsterapi desværre ikke påbegyndt regelmæssigt, og behandling på dette tidspunkt er udelukkende farmakologisk.