[10] Obsessive Compulsive Disorder Flashcards
What is obsessive compulsive disorder?
A disorder characterised by recurrent obsessional thoughts or compulsive acts, or commonly both
What are obsessions?
Unwanted intrusice thoughts, images, or urges, that repeatedly enter the individual’s mind. They are distressing for the individual, who attempts to resist them, and recognises them as absurd (egodystonic) and a product of their own mind
What are compulsions?
Repetitive, stereotyped behavours or mental acts that a person feels driven into performing. They may be overt (observable by others) or covery (mental act, not observable)
What factors does the aetiology of OCD involve?
Biological, psychoanalytic, and behavioural
What is the biological component of the development of OCD?
- Reduced serotonin
- Abnormalities of the frontal cortex and basal ganglia
- Genetics
- Childhood group A ß-haemolytic stretococcal infection
How is it theorised childhood A ß-haemolytic streptococcal infection have a role in the development of OCD?
By setting up an autoimmune reaction which damages the basal ganglia
What is the psychoanalytical component of the development of OCD?
Filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering consciousness
How is operant condition involved in the development of OCD?
Compulsive behaviour is learnt and maintained by operant conditioning, as the anxiety caused by the obsession is reduced by performing the compulsion, and subsequently the need to perform the compulsion is increased
What are the risk factors for OCD?
- History of childhood abuse
- Other stress-inducing events
What conditions are associated with OCD?
- Depression
- Schizophrenia
- Sydenham’s chorea
- Tourette’s syndrome
- Anorexia nervosa
What are some common obsessions in OCD?
- Contamination, e.g. from dirt, germs, bodily fluid
- Fear of harm
- Excessive concern with order or symmetry
- Sex
- Violence
- Blasphemy
What are some common compulsions in OCD?
- Checking things, e.g. gas taps, water taps, doors
- Repeating acts, e.g. counting or arranging objects, mental compulsions
- Hoarding
What features must obsessions and compulsions have?
- Failure to resist – at least one obsession or compulsion is present which is unsuccessfully resisted
- Originates from patients mind – they must acknowledge that the obsessions or compulsions originate from their own mind, and are not imposed by outside persons or influences
- Repetitive and distressing – at least one obsession or compulsion must be present, which is acknowledged by the patient as obsessive and unreasonable
- Carrying out the obsessive thought or compulsive act is not in itself pleasurable, but reduces anxiety levels
What is the OCD cycle?
Obsessions can create anxiety, which continues to build up until a compulsion is carried out in order to provide relief
What are the ICD-10 diagnostic criteria for OCD?
Either obsessions or compulsions present on most days for a period of at least 2 weeks. Obsessions must show the previously mentioned features, and they must cause distress, or interfere with the subject’s social or individual functioning, usually by wasting time.
According to the ICD-10, what can a diagnosis of OCD be defined as?
- Predominantly obsessional thoughts or ruminations
- Predominantly compulsive acts
- Mixed obsessional thoughts and acts
How is OCD investigated?
- History
- MSE
- Questionnaires
What are the differential diagnoses of OCD with obsessions and compulsions?
- Eating disorders
- Anankastic personality disorder
- Body dysmorphic disorder
What are the differential diagonses of OCD that is primarily obsessions?
- Anxiety disorders, e.g. phobic anxiety
- Depressive disorder
- Hypochondriacal disorder
- Schizophreniaa
What are the differential diagnoses of OCD with primarily compulsions?
- Tourette’s syndrome
- Kleptomania
What are the organic differential diagnoses for OCD?
- Dementia
- Epilepsy
- Head injury
How is OCD managed?
- Pharmacological management
- Psychological intervention
- Psychoeducation, distracting techniques, and self-help books
- Identifying and managing any potential suicide risk
- Identifying and treating co-morbid depression
What is the first line pharmacological agent in OCD?
SSRIs - fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram
What is the use of clomipramine in OCD?
It is an alternative drug therapy, which can be combined with citalopram in more severe cases
What is the role of anti-psychotics in OCD?
They can be added in with an SSRI or clomipramine
What does the method of treatment in OCD depend on?
The degree of functional impairment, which can range from mild to severe
How is mild OCD treated?
Low intensity psychological intervention
How is moderate OCD treated?
With an SSRI or high intensity psychological intervention
How is severe OCD treated?
With a combination of an SSRI and CBT
