A 9-year-old boy has mild OCD (Children's Yale-Brown scale score 13) with hand-washing rituals lasting under an hour daily. His parents wish to avoid medication if possible. What is the best initial management?

• A Reassure the family and review after one year without intervention
• B Start fluoxetine immediately alongside therapy
• C Start clomipramine as monotherapy
• D Cognitive behavioural therapy with exposure and response prevention alone ✓

Explanation

For mild paediatric OCD, guidelines recommend cognitive behavioural therapy with exposure and response prevention as the sole initial treatment, reserving SSRIs for moderate to severe illness or failure of therapy alone. Immediate combination treatment is appropriate for severe presentations, not mild ones. Clomipramine is second line in children because of anticholinergic, cardiac, and seizure liability. Watchful waiting without active therapy allows symptom consolidation.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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