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Difficulty: EasyAnxiety, OCD, and Trauma-Related Disorders

A 19-year-old college student presents to the student health clinic reporting that he is spending over three hours a day organizing his dorm room. He states that all his books, clothes, and desk items must be perfectly aligned and symmetrical. If a roommate moves an object even slightly, he experiences intense distress and feels an overwhelming urge to rearrange everything until it feels "just right." He recognizes that this behavior is excessive and says it is severely interfering with his ability to study and attend classes. He has no other medical or psychiatric history. Which of the following is the most appropriate first-line pharmacotherapy for this patient's condition?

  1. FluoxetineAnswer
  2. B
    Alprazolam
  3. C
    Risperidone
  4. D
    Valproate
  5. E
    Bupropion

Answer

Fluoxetine
The patient's presentation of time-consuming, ego-dystonic obsessions (need for symmetry) and compulsions (rearranging items) is classic for Obsessive-Compulsive Disorder (OCD). The first-line pharmacologic treatment for OCD is a Selective Serotonin Reuptake Inhibitor (SSRI). Among the choices provided, Fluoxetine is the only SSRI and is therefore the most appropriate initial medication.

Step-by-Step Solution

1
Identify the primary clinical syndrome based on the patient's symptoms.
The patient exhibits obsessions (intense distress regarding symmetry) and compulsions (spending hours organizing until it feels 'just right'), which are time-consuming and cause functional impairment.
This establishes the diagnosis of Obsessive-Compulsive Disorder (OCD).
2
Determine the first-line pharmacotherapy for the diagnosed condition.
First-line treatments for OCD include Cognitive Behavioral Therapy (specifically Exposure and Response Prevention) and Selective Serotonin Reuptake Inhibitors (SSRIs).
OCD pathophysiology is closely tied to serotonergic dysfunction.
3
Select the correct medication from the available options.
Fluoxetine is the only SSRI listed among the choices.
Other options include a benzodiazepine, an antipsychotic, a mood stabilizer, and an NDRI, none of which are first-line for OCD.

Key Concept

The first-line pharmacotherapy for Obsessive-Compulsive Disorder (OCD) involves the use of Selective Serotonin Reuptake Inhibitors (SSRIs).
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Topics

Anxiety, OCD, and Trauma-Related Disorders

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