Anxiety disorder: obsessive compulsive disorder Flashcards
What is OCD? How do you diagnose OCD?
Obsessions are recurrent, unwanted and intrusive thoughts/images/impulses in one’s mind, despite attempts to resist them
Compulsions are repeated and seemingly purposeful rituals that are carried out.
Symptoms must be present on most days for at least 2 successive weeks, and be the source of distress or interference with activities.
Sx’s must be recognized as the individual’s own thoughts or impulses.
Explored in the presenting complaint
What are the symptoms of OCD? What are the themes of thoughts?
Obsessional thoughts are unpleasant, unwanted, intrusive thoughts entering the mind despite attempts to resist them
Can be images, impulses or doubts
Themes:
- contamination
- sexual
- sacreligious
- doubts of not closing windows
- locking door
- impulse to do something dangerous
Are the thoughts in OCD the patient’s own?
Yes they are the patient’s own thoughts. They are recognised to be irrational but cause intense discomfort .
What questions do you ask about obsessions in OCD?
What questions should you ask about compulsions in OCD?
What is a method which is commonly used by patients to deal with OCD?
Engaging in compulsions to manage the discomfort
What are compulsions? Give examples of compulsions.
Compulsions are repetitive, stereotypical rituals
Compulsions srve to neutralise an obsessional thought and/or end the anxiety caused by obsessions
e.g. hand washing, checking, mental act like counting. They are done a certain number of times a day and cause a significant disruption to the person’s day
What are overvalued ideas in OCD?
Describes thought content: a reasonable belief that is pursued excessively, dominates the person’s life and causes distress to self/others e.g. beliefs about body shape. They are not unusual or bizzare beliefs and are socially acceptable.
What must you show has been excluded when documenting presence of overvalued ideas?
Must exclude delusions
What are the most common symptoms of OCD?
Symptoms must be recognised as the individual’s own thoughts or impulses:
- obsessive doubts 42 %
- fears of contamination 45 %
- bodily fears 36 %
- insistence on symmetry 31 %
- aggressive thoughts 28 %
- checking compulsions 63 %
- washing 50 %
- counting 36 %
How common is OCD? Who is it more common in?
- Prevalence is 1%
- F = M
- Neurodevelopmental subtype is more common in males
What is the aetiology of OCD?
- FH - MZ:DZ is 50-80% concordance, 35% of first degree relatives affected
- Between 11-80 % of Tourette’s patients have obsessional symptoms
- 20 % of OCD patients suffer from tics
- Personality traits: anankastic
- Stress
- Basal ganglia defects
- Frontal lobe abnormalities
What is the association between tics and OCD?
Between 11-80 % of Tourette’s patients have obsessional symptoms
20 % of OCD patients suffer from tics
What is the management of OCD?
- 1st line: CBT with ERP (exposure and response prevention)
- 2nd line: SSRI (continue for 12 months after remission) - fluoxetine
- 3rd line (after 12 weeks): clomipramine (highly serotonergic TCA) or alternative SSRI
- Psychosurgery (rare) - anterior cingulotomy
What does ERP consist of?
- Compulsions are analogous to escape in phobias
- CBT aims to prevent compulsive behaviour, allowing the tolerated anxiety to habituate
E.g. someone with obsessions about contamination is supported to touch something dirty and instead of immediately washing their hands, they are encouraged to experience anxiety and discuss it with the therapist
- A hierarchy of feared situations is used
- Effective in well-motivated patients
