Anxiety and related disorders: SSRI-resistant OCD: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Anxiety and related disorders: SSRI-resistant OCD

Sample item

A woman with OCD has had adequate trials of two SSRIs at maximum tolerated doses over 12 weeks each, along with good-quality exposure and response prevention, and still has marked symptoms. Which option is an evidence-based augmentation?

AStopping the SSRI and using psychotherapy aloneBAdding bupropionCAdding low-dose risperidone or aripiprazole to the SSRIDAdding a benzodiazepine

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Adding low-dose risperidone or aripiprazole to the SSRI

In OCD that responds partially to an adequate SSRI, augmentation with a low-dose dopamine antagonist such as risperidone or aripiprazole has the best evidence. Benzodiazepines and bupropion lack evidence and do not treat obsessions.

Option by option

A. Stopping the SSRI and using psychotherapy alone
She has already had good-quality therapy, so withdrawing the SSRI would lose partial benefit.
B. Adding bupropion
Bupropion has no established benefit in OCD.
C. Adding low-dose risperidone or aripiprazole to the SSRI (correct)
Correct. Low-dose antipsychotic augmentation is the best-supported strategy for SSRI-resistant OCD.
D. Adding a benzodiazepine
Benzodiazepines may reduce anxiety but do not treat OCD and carry dependence risk.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Adding low-dose risperidone or aripiprazole to the SSRI. In OCD that responds partially to an adequate SSRI, augmentation with a low-dose dopamine antagonist such as risperidone or aripiprazole has the best evidence.

Why is "Stopping the SSRI and using psychotherapy alone" not the answer?

She has already had good-quality therapy, so withdrawing the SSRI would lose partial benefit.

Why is "Adding bupropion" not the answer?

Bupropion has no established benefit in OCD.

Why is "Adding a benzodiazepine" not the answer?

Benzodiazepines may reduce anxiety but do not treat OCD and carry dependence risk.

What concept does this question test?

It tests Anxiety and related disorders: SSRI-resistant OCD in Psychiatry. Benzodiazepines and bupropion lack evidence and do not treat obsessions.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anxiety and related disorders: SSRI-resistant OCD?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.