The psychologist’s training has all come back to me now and I think it is impressive. However, at the time I felt it wasn’t viable or even relevant and I am now very surprised to find that I’ve absorbed so much from the course. The problem with the ‘Mind Lock’ course is that you cannot gain from it when your OCD is extreme; you have to be ‘within reach’, if you like. This is Inhibitors,research,lifescience,medical the hardest part and this new drug could provide the answer. Case 3 This 44-year-old divorced man had had worsening OCD symptoms from childhood. His childhood had been blighted by emotional neglect and he and his siblings were abandoned by their parents and brought up in care. His life was taken over by obsessional

thoughts concerning dirt and contamination with compensatory compulsions of cleaning, checking and

mental counting. He also had the compulsion to shave off all his body hair so as to ensure that his person was rendered as Inhibitors,research,lifescience,medical germ free as possible. His marriage had broken down as a result of his OCD and he had been unable to work for 12 years on account of his OCD symptoms. He was significantly depressed. Although he was bright, insightful and articulate, his educational attainment was poor and he was unable to read and write, which was probably the result of unrecognized childhood ADHD coupled with emotional Inhibitors,research,lifescience,medical abuse and neglect. As an adult he still manifested the ADHD symptoms of fidgeting, poor concentration span and explosive, staccato speech, which rendered him socially awkward and unable to sit still and to watch a TV programme through to the end, although distraction caused by his OCD symptoms also contributed to this difficulty. At the time of referral he was taking fluoxetine 40 mg daily without any impact

Inhibitors,research,lifescience,medical on his OCD symptoms (Y-BOCS 36). Increasing the fluoxetine Inhibitors,research,lifescience,medical to 60 mg daily did not result in improvement so he was switched to clomipramine and the dose increased in stages to 175 mg at night, but later reduced to 150 mg at night on account of the side effects of postural hypotension. This resulted in significant improvement in his depressive symptoms but made little impact on his OCD symptoms. Quetiapine XL was EPZ004777 research buy introduced and the dose however increased in stages to 200 mg at night. This resulted in further improvement in his depressive symptoms and some improvement in his OCD symptoms (Y-BOCS 34) in that he was not checking as much and was able to watch TV for longer without being distracted by his OCD. He participated in a CBT ‘Brain Lock’ group, which he found very supportive, although there were no improvements in his OCD symptoms. He agreed to a trial of buprenorphine augmentation and was started on sublingual buprenorphine 200 μg twice a day, which after 2 days resulted in substantial improvement in his OCD (Y-BOCS 20). His symptoms returned some 4 days after the buprenorphine was discontinued.