How do you approach pharmacologic management of OCD in patients with comorbid bipolar disorder, particularly when considering SSRIs or clomipramine?  

This is a great question! Depending on the study you read, anywhere from 10% to 25% of patients with bipolar disorder have comorbid OCD.  The challenge, as you might imagine, is that treatment with SRIs in the absence of a mood stabilizer may run the risk of inducing a manic episode. A larger ...

Not too complex. The chances of the switch are minimal, particularly if you have a reasonable level of lithium. The only consideration is that you'll need about twice the approved doses, and you will have to wait 8-12 weeks. Also, if you do not have ERP CBT, do not expect miracles. As to memantine o...

First, I always reevaluate the diagnosis; did I miss the frenetic hyperactive thoughts for OCD? Am I seeing a patient with ADHD core symptomatology who has learned to organize by anxiety energy and OC patterns to stay organized and functional? Otherwise, the above responses in clear cases are great ...