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Are Obsessive Thoughts Of Hurting Yourself And Others Signs Of OCD?
Question: hello i have constant thoughts of hurting myself and others for 9 years. I currently take prozac 120 mg ive been on a higher dose of it since december 5 80 mg and i dont feeel that it is working yet. i also got switched from latuda to risperadal i currently take 2mg of risperadal along with klonopin for sleep the only one that works is the klonopin for sleep. I have been diagnosed with harm ocd but for some reason none of the medications work. could this be anything else. I have all day bad thoughts towards my children urges and images about shooting, police officers all scary things. I feel like i could do something illegal.
Brief Answer:
adding clomipramine can help, CBT can also help
Detailed Answer:
Hello,
Thanks for writing to us.
You are suffering from many illnesses. You are likely taking different medicines for the same. There are many medicines which can cause false positive results for amphetamines and methamphetamine. let me know details of medicines so I can clarify that possibility.
PKD can cause such problem or not is not confirmed. However possibility is there when kidney function is affected much. Sometimes, body chemistry may play a role in your “false positive” results because of a build-up of chemicals in your body due to the fact that you may have problems with the metabolism of the same.
Let me know your renal function test reports - creatinine and urea.
Hello XXXXXXX
Thanks for writing to us again.
Your symptoms are suggestive of Obsessive compulsive disorder (OCD) only and in that obsessive thoughts of hurting yourself or others are there.
In general OCD is treated with SSRI drug like prozac or fluvoxamine. Benzodiazepine like klonopin gives relief in anxiety symptoms. Your doctor is on right track. However many of the patients do not respond to sufficient dose (80-100 mg) of prozac alone. Most of the psychiatrists like me used to add clomirpamine with prozac when sufficient improvement is not there.
Risperidone is also good augmentation agent for treatment resistant OCD. That is also right step by your doctor.
CBT is also helpful in many patients. Cognitive behavior therapy (CBT) is a type of psychotherapy and very helpful in many psychiatric problem including OCD. If you have not tried CBT yet, ask your doctor for that also apart from recommendations of medicines given by me.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
adding clomipramine can help, CBT can also help
Detailed Answer:
Hello,
Thanks for writing to us.
You are suffering from many illnesses. You are likely taking different medicines for the same. There are many medicines which can cause false positive results for amphetamines and methamphetamine. let me know details of medicines so I can clarify that possibility.
PKD can cause such problem or not is not confirmed. However possibility is there when kidney function is affected much. Sometimes, body chemistry may play a role in your “false positive” results because of a build-up of chemicals in your body due to the fact that you may have problems with the metabolism of the same.
Let me know your renal function test reports - creatinine and urea.
Hello XXXXXXX
Thanks for writing to us again.
Your symptoms are suggestive of Obsessive compulsive disorder (OCD) only and in that obsessive thoughts of hurting yourself or others are there.
In general OCD is treated with SSRI drug like prozac or fluvoxamine. Benzodiazepine like klonopin gives relief in anxiety symptoms. Your doctor is on right track. However many of the patients do not respond to sufficient dose (80-100 mg) of prozac alone. Most of the psychiatrists like me used to add clomirpamine with prozac when sufficient improvement is not there.
Risperidone is also good augmentation agent for treatment resistant OCD. That is also right step by your doctor.
CBT is also helpful in many patients. Cognitive behavior therapy (CBT) is a type of psychotherapy and very helpful in many psychiatric problem including OCD. If you have not tried CBT yet, ask your doctor for that also apart from recommendations of medicines given by me.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
it was technical error
Detailed Answer:
Dear XXXXXXX
Sorry for technical error. That part for other patient's query.
Please consider your answer beginning from hello XXXXXXX
Take care.
it was technical error
Detailed Answer:
Dear XXXXXXX
Sorry for technical error. That part for other patient's query.
Please consider your answer beginning from hello XXXXXXX
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
yes it seems OCD
Detailed Answer:
Hi Dear,
Sorry for delayed response.
Your feelings of acting on your urges and consequently someone call police seem OCD symptoms only.
We should wait up to maximum four weeks for getting optimum response of the prozac. In your case it has already been used in maximum possible dose and not effective completely. However it does not mean that we can stop it and start other drug. It is always advisable to add something to prozac like clomipramine.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page with three follow up questions.
Take care.
yes it seems OCD
Detailed Answer:
Hi Dear,
Sorry for delayed response.
Your feelings of acting on your urges and consequently someone call police seem OCD symptoms only.
We should wait up to maximum four weeks for getting optimum response of the prozac. In your case it has already been used in maximum possible dose and not effective completely. However it does not mean that we can stop it and start other drug. It is always advisable to add something to prozac like clomipramine.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page with three follow up questions.
Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
can the symptoms be all day my thoughts and urges are all my waking hours. the only relief i get is when i sleep. can that still be ocd i have taken prozac for a totla of 2 1/2 months i started on 20mg could the medication still work do you count from the highest dose of prozac for the amount of weeks i have been on it?
Brief Answer:
no response to prozac does not mean that it is not OCD
Detailed Answer:
Dear XXXXXXX
Thanks for follow up question.
In severe OCD thoughts remain throughout the day. You are on more than 80 mg since 5th December. There is no significant improvement. This happens in few patients with OCD. However no response to prozac does not mean it is not OCD.
I of course understand about your thought of reconsidering diagnosis. To help in that regard can you provide more information?
- Details about the symptoms.
- What is your /your doctor's opinion about other possible diagnosis?
- Have you been given any other medications?
- Is there any family history of other psychiatric problem?
no response to prozac does not mean that it is not OCD
Detailed Answer:
Dear XXXXXXX
Thanks for follow up question.
In severe OCD thoughts remain throughout the day. You are on more than 80 mg since 5th December. There is no significant improvement. This happens in few patients with OCD. However no response to prozac does not mean it is not OCD.
I of course understand about your thought of reconsidering diagnosis. To help in that regard can you provide more information?
- Details about the symptoms.
- What is your /your doctor's opinion about other possible diagnosis?
- Have you been given any other medications?
- Is there any family history of other psychiatric problem?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
the symptoms are as soon as i get up. they are images urges and thoughts to cause harm to myself or others. my doctor diagnoses it as harm ocd. ive tried other ssris none of them work. but wasnt on them along time. just depressiiion family history in my aunts and uncles. what else could it be if it isnt ocd. if it was psychosis would the risperadal help. I always get worried ill act on my thoughts.
Brief Answer:
it is likely treatment resistant OCD
Detailed Answer:
Hello,
Thanks for information.
I want to mention latest detail diagnostic criteria for OCD according to DSM- 5 so you also can confirm that your diagnosis is OCD.
To receive an OCD diagnosis, you must meet these general criteria:
You must have obsessions and compulsions
The obsessions and compulsions must significantly impact your daily life
You may or may not realize that your obsessions and compulsions are excessive or unreasonable
Your obsessions must meet specific criteria:
Intrusive, repetitive and persistent thoughts, urges, or images that cause distress
The thoughts do not just excessively focus on real problems in your life
You unsuccessfully try to suppress or ignore the disturbing thoughts, urges, or images
You may or may not know that your mind simply generates these thoughts and that they do not pose a true threat
Your compulsions must meet specific criteria:
Excessive and repetitive ritualistic behavior that you feel you must perform, or something bad will happen. Examples include hand washing, counting, silent mental rituals, checking door locks, etc.
The ritualistic compulsions take up a least one hour or more per day
You perform these physical rituals or mental acts to reduce the severe anxiety caused by the obsessive thoughts.
From these it is clear that you have OCD.
Almost 10% of the patients with OCD do not respond well to SSRI. You are likely one of them. In that case combination of the drugs like SSRI, TCA, Anti Psychotic, Mood-stabilizer should be used.
Simultaneously CBT should be continued.
If you can tell me which drugs have you taken until now and in which dose and for how much duration, then I can guide better for specific treatment.
All the best.
it is likely treatment resistant OCD
Detailed Answer:
Hello,
Thanks for information.
I want to mention latest detail diagnostic criteria for OCD according to DSM- 5 so you also can confirm that your diagnosis is OCD.
To receive an OCD diagnosis, you must meet these general criteria:
You must have obsessions and compulsions
The obsessions and compulsions must significantly impact your daily life
You may or may not realize that your obsessions and compulsions are excessive or unreasonable
Your obsessions must meet specific criteria:
Intrusive, repetitive and persistent thoughts, urges, or images that cause distress
The thoughts do not just excessively focus on real problems in your life
You unsuccessfully try to suppress or ignore the disturbing thoughts, urges, or images
You may or may not know that your mind simply generates these thoughts and that they do not pose a true threat
Your compulsions must meet specific criteria:
Excessive and repetitive ritualistic behavior that you feel you must perform, or something bad will happen. Examples include hand washing, counting, silent mental rituals, checking door locks, etc.
The ritualistic compulsions take up a least one hour or more per day
You perform these physical rituals or mental acts to reduce the severe anxiety caused by the obsessive thoughts.
From these it is clear that you have OCD.
Almost 10% of the patients with OCD do not respond well to SSRI. You are likely one of them. In that case combination of the drugs like SSRI, TCA, Anti Psychotic, Mood-stabilizer should be used.
Simultaneously CBT should be continued.
If you can tell me which drugs have you taken until now and in which dose and for how much duration, then I can guide better for specific treatment.
All the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ive taken luvox 300mg for a few months didnt work, all the ssris pretty much but not long duration did i take them. this is the longest i have been on meds i always stoppped then due to side effects .ive been on risperadal for a week and a half now im at 2mg. I dont feel any improvement from it. the only improvement i feel is the klonopin helps me sleep but does nothing for me during the day.i tried anafranail for like 2 weeks or something so not long. im gonna see the doctor this friday and let him know that nothing is working so far. what do you do if you dont respond to medicaitons for this
Brief Answer:
need to take anafranil for longer,elctrostimulation & surgical options
Detailed Answer:
Hi,
Sorry for delayed response.
In your case not there is need of combination of prozac 80 mg, anafranil 150 mg and risperdal 2 mg for 4 weeks. If no response then we can add sodium valproate 500 mg for augmentation. Klonopin should be continued to reduce anxiety and for sleep.
Recently Namenda(memantine) has shown effects in OCD, it can be added later on.
If there will be no significant improvement even after using multiple medicines for sufficient duration, we can go for electro-stimulation.
In electro-stimulations options are ECT, rTMS, DBT and last but not the least capsultomy or cingulotmy are the neuro-surgical procedures for severe OCD.
You can discuss about these recommendations to your treating doctor next Friday.
You are always welcome to clear your doubts if any after you consult your doctor on Friday.
http://bit.ly/drchintansolanki
Take care dear.
need to take anafranil for longer,elctrostimulation & surgical options
Detailed Answer:
Hi,
Sorry for delayed response.
In your case not there is need of combination of prozac 80 mg, anafranil 150 mg and risperdal 2 mg for 4 weeks. If no response then we can add sodium valproate 500 mg for augmentation. Klonopin should be continued to reduce anxiety and for sleep.
Recently Namenda(memantine) has shown effects in OCD, it can be added later on.
If there will be no significant improvement even after using multiple medicines for sufficient duration, we can go for electro-stimulation.
In electro-stimulations options are ECT, rTMS, DBT and last but not the least capsultomy or cingulotmy are the neuro-surgical procedures for severe OCD.
You can discuss about these recommendations to your treating doctor next Friday.
You are always welcome to clear your doubts if any after you consult your doctor on Friday.
http://bit.ly/drchintansolanki
Take care dear.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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