Summary
The protocol defines obsessive-compulsive disorder as a condition involving recurrent intrusive thoughts, images, or urges and/or repetitive behaviors or mental rituals. Symptoms typically cause distress, consume substantial time, or interfere with daily, social, and occupational functioning. It covers presentations dominated by obsessions, those dominated by compulsions, and mixed forms, as well as childhood- and adult-onset features, varying insight, severity, and commonly coexisting psychiatric conditions.
Diagnosis is based on clinical interview and history, with assessment of the content, frequency, duration, controllability, and functional impact of symptoms. The FLY-BOCS scale is included to quantify the severity of obsessions and compulsions. Physical examination, laboratory tests, and instrumental investigations do not directly establish OCD; they are used to exclude relevant medical or neurological conditions and to support safe pharmacological planning. Differential assessment includes depression, tic disorders, obsessive-compulsive personality features, eating and body-image disorders, impulse-control conditions, and obsessive symptoms occurring within schizophrenia-spectrum disorders.
The principal treatments are cognitive behavioral therapy, including exposure and response prevention, and pharmacotherapy with serotonergic antidepressants. The treatment algorithm emphasizes confirming an adequate trial and evaluating tolerability before changing strategy. It describes switching to another first-line medicine or clomipramine when response is insufficient, followed in resistant cases by specialist-supervised augmentation and selected neuromodulation approaches. Once improvement is achieved, prolonged relapse-prevention treatment and gradual review or reduction of therapy are considered. Rehabilitation aims to reduce disability, restore social and occupational participation, improve quality of life, and address stress and other factors affecting adaptation. The appendices provide diagnostic and treatment algorithms, a structured symptom-rating instrument, and patient-oriented information about the disorder and its management.