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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10547
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have been diagnosed with harm ocd I have constant thoughts

Customer Question

Hello I have been diagnosed with harm ocd I have constant thoughts of shooting myself and others and all violent stories I hear on the news stays with me forever I feel like I vividly see it in my minds wye I am currently taking latuda 40mg at nite for
two weeks and has not helped yet I worry that it is psychosen cause I can't seem to control thr thoights and they have urges with it like I will act on it
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

*This website DOES NOT constitute treatment and only provides information and advice in a Q&A format. For treatment (therapy and/or medications) you must go to a licensed professional in your area.

Hello and thank you for your question. I am very sorry that you have been struggling with Harm OCD, I can understand how distressing this can be for you. I am not sure why you were prescribed Latuda on its own as that is an atypical antipsychotic medication and is not considered a primary medication to treat any type of OCD disorder. You can see on this link how Latuda is not considered a first line treatment for OCD.

https://iocdf.org/about-ocd/treatment/meds/

Now I am not saying Latuda cannot be used, but usually it is as an augment to a primary medication. You want to either go back to your psychiatrist or find a different one and be put on a SSRI antidepressant like Luvox, Lexapro, Zoloft, Celexa, or Paxil as these are considered excellent first round medications to treat all forms of OCD, including Harm OCD. Latuda can be used as an augment, but should not be used as a primary medication. In addition, other medications that have shown greater effectiveness of treating Harm OCD would be Anafranil, Lamictal, and Remeron. Now the medications will probably have to take around 4-6 weeks to be effective as it takes time for the medications to circulate in your system, so you cannot expect results right away. Your doctor can prescribe a Benzodiazepine to lessen your anxiety and stress, which are common triggers of OCD behavior, and a Benzodiazepine like Xanax, Klonopin, or Ativan will start to lessen your anxiety and stress within 30-60 minutes.

In addition to any medications, you need to be in a dual form of therapy with a psychologist called Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) as the medications only treat the symptoms, not the core causes of your disorder.

So please consider going back to your psychiatrist or trying a different psychiatrist to get on a more effective regimen of medications and therapy to help treat and "cure" this disorder.

I hope this answers your questions and gives you some guidance on this issue. Please let me know if you have any questions or concerns as I am happy to assist and support you regarding this issue.

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Customer: replied 1 year ago.
I have tried all ssri and anafranil wit no success he does have me on klonopin at nite ad well I am in cbt therapy once a week at the University of Pennsylvania with the thoughts of shooting and stuff should I be concerned with more of a psychotic disorder and is latuda a drug that would be used for psychois
Expert:  Dr. Z replied 1 year ago.

Your psychiatrist should have considered trying a SNRI antidepressant, other TCA antidepressants, Remeron, and Lamictal before trying Latuda as that medication has just not been adequately explored as a treatment for OCD. I am not saying that Latuda cannot be used for treating OCD, it is just not a primary treatment and has not been studied as a treatment for OCD because it has only been on the market for 2 years. It is possible your psychiatrist may be thinking this is a mood disorder (e.g. Bipolar Disorder) combined with your OCD because you have not responded to other treatment for OCD, but because your diagnosis has not changed your psychiatrist may be just trying different medications that he/she believes has a chance to work. The psychiatrist can be speculating that a mood disorder is making your OCD worse, so by treating a possible mood disorder it may help you respond better to previous OCD treatments that have failed. I doubt he/she is thinking this is a psychotic disorder as you would have been put on a stronger antipsychotic like Risperdal, Geodon, or Zyprexa. Latuda is a primary treatment for mood disorders like Bipolar Disorder before being used as a treatment for psychosis. But like I said according to studies the other medications I listed have a better chance of working for you than the Latuda. Here are a couple good links on Treatment Resistant OCD options that you can discuss with your doctor (this article even says that monotherapy with an antipsychotic achieves poor results) and a case report on the use of Lamictal in treatment resistant OCD

http://www.currentpsychiatry.com/home/article/treatment-resistant-ocd-options-beyond-first-line-medications/2f58cf84551917e368f476a892fb713c.html

http://jop.sagepub.com/content/24/3/425.short

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