Which of the following is the drug of choice in OCD?

Obsessive-compulsive disordercan significantly impair functioning, but with symptom reduction, gradual reintegration into normal roles is encouraged. Stressful events like job interviews may temporarily heighten anxietyas part of exposure to feared situations. Supportive interventions focus on validating the client’s experience, maintaining forward progress, and providing practicalcoping strategies. Encouraging adaptive problem-solving helps sustain recovery while avoiding reinforcement of avoidance behaviors.

Rationale for correct answers

4.Validates the emotional experienceand offers a concrete coping option, supporting both autonomy and progression toward the client’s vocational goal.

Rationale for incorrect answers

1.Pressuring exposure without acknowledging feelingscan increase resistance and diminish trust, risking relapse into avoidance patterns.

2.Suggesting the client is not readyreinforces avoidance and undermines progress made in symptom management.

3.Misinterpreting the anxiety as lack of motivationinvalidates the client's efforts and may damage therapeutic rapport.

Take Home Points

• Anxiety may spike temporarily during exposure to real-life challenges in OCD recovery.
• Validating feelings encourages trust and self-efficacy.
• Avoidance reinforcement can hinder functional reintegration.
• Supportive, practical solutions help bridge the gap between therapy and real-world functioning.

Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcus (PANDAS)is a condition where autoantibodiestarget neuronal tissue following a Group A Streptococcal infection. These antibodies cross-react with brain structures, particularly the basal ganglia, leading to abrupt onset of obsessive-compulsive behaviors and motor tics. The basal ganglia regulate motor control, behavior, and emotion, making them central to the neuropsychiatric symptoms seen in PANDAS. The pathophysiology involves molecular mimicry, where streptococcal antigens resemble neuronal proteins, triggering an autoimmune response.

Rationale for correct answers

1.The basal gangliaare the primary target of autoantibodies in PANDAS, leading to dysfunction in motor and behavioral regulation. This explains the sudden onset of OCD and tics.

Rationale for incorrect answers

2.The hippocampus is involved in memory and spatial navigation, not typically affected in PANDAS. Autoantibody targeting here would not explain OCD or motor tics.

3.The cingulate cortex modulates emotion and decision-making, but it is not the primary site of autoimmune attack in PANDAS. Its involvement is secondary, if at all.

4.The mammillary bodies are linked to memory consolidation and are not implicated in the autoimmune pathology of PANDAS. Their dysfunction does not produce OCD-like symptoms.

Take Home Points

• PANDAS is triggered by Group A Streptococcal infection leading to autoimmune attack on basal ganglia.
• Symptoms include abrupt onset of OCD, motor tics, and emotional dysregulation.
• Differentiation from Tourette syndrome and Sydenham chorea is essential due to overlapping features.
• Treatment may involve antibiotics, immunomodulatory therapy, and psychiatric support.