EpistemisCompulsions
Specialty: Psychiatry.
Why it occurs
- Obsessive-compulsive disorder (OCD)
- Tourette syndrome or other tic disorders
- Autism spectrum disorder (stereotypies and behavioral rigidity)
- Binge eating disorder or abnormal eating behaviors
- Substance abuse with ritualized consumption patterns
Initial workup
Y-BOCS scale; dermatological examination of hands/skin if there are cleansing rituals; neurological evaluation to rule out basal ganglia involvement (as in PANDAS in pediatrics).
red flags
Washing compulsions that cause severe dermatitis with skin superinfection, self-harm due to repetitive rituals, or total inability to leave the home due to endless checking rituals.
Standard management
- Clomipramine — highly effective tricyclic in the control of motor rituals
- Fluoxetine — High dose SSRIs, e.g. e.g., 60-80 mg/day, to reduce the urgency of the ritual
- Risperidone — adjuvant at low doses to modulate motor rigidity and compulsive impulse
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 3