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6. Obsessive-Compulsive and Related Disorders > Canadian Clinical Practice Guidelines for Treatment of OCD > Flashcards

Canadian Clinical Practice Guidelines for Treatment of OCD Flashcards

1
Q

what is the mean age of onset of OCD

A

about 20 years old
–symptoms can occur before age 10
–few new cases after early 30s

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2
Q

what % of people with OCD seek treatment

A

estimated around 14-56% of patients–> OCD may be udner recognizes and under treated

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3
Q

name 3 risk factors for developing OCD

A

social isolation

hx physical abuse

negative emotionality

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4
Q

what % of people with OCD have attempted suicide

A

up to 25%

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5
Q

what % of people with OCD have a comorbid disorder

A

60-90%–> basically, MOST if not almost ALL

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6
Q

how does CBT compare to pharmacotherapy for OCD treatment?

A

CBT is equivalent or superior to pharmacotherapy

*results with CBT were generally similar in comparisons of interventions with an emphasis on ERP and those with an emphasis on cognitive elements

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7
Q

what type of CBT was found to be more efficacious than CBT-ERP for OCD with fears of contamination with infectious agents

A

cognitive intervention that had NO direct exposure called DIRT–> “danger ideation reduction therapy”

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8
Q

in which patients with OCD might cognitive interventions be more important to treatment

A

patients who do not have overt compulsions (because this makes ERP more difficult)

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9
Q

what is the main psychological treatment for OCD

A

CBT

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10
Q

other than CBT, what other psychological interventions may be useful for OCD treatment

A

acceptance and committment therapy (ACT)

modular cognitive therapy (CT) addressing OCD beliefs

CT addressing obsessional doubt

organizational training

mindfulness training

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11
Q

is EMDR recommended for OCD

A

in one RCT, was more effective than SSRIs but data = limited and not generally recommended for OCD

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12
Q

are therapist guided or self guided exposures more effective in OCD treatment?

A

both showed significant symptom reduction but THERAPIST-LED exposures were more effective in reducing symptoms

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13
Q

name a factor that has been associated with poorer response to both behavioural and pharmacological treatments for OCD

A

family accommodation
(family members taking part in performance of rituals, avoidance of anxiety provoking situations, or modification of daily routines to assist relative with OCD)

*may want to target family accommodation in order to improve treatment outcomes for some patients

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14
Q

what type of psychological treatment has been shown to improve symptoms of hoarding disorder

A

group CBT

“significantly reduced hoarding and depression symptoms”

(bibliotherapy alone did not)

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15
Q

what is best for OCD treatment: pharmacotherapy alone, CBT alone, or the combo

A

combo treatment is better than meds alone, but not better than CBT alone

therefore, if meds are required or preferred, adding CBT to meds may enhance response rates and reduce relapse rates

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16
Q

adding what medication may hasten onset of improvements with ERP?

A

d-cycloserine

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17
Q

are the benefits of CBT maintained over time after used for treatment of OCD

A

yes–> studies show lasting benefits at 1 and 5 years

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18
Q

what is the recommended first line medication class for OCD

A

SSRIs

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19
Q

list the first line medications for treatment of OCD

A

Every Fixed Fear Panics Sometime

Escitalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

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20
Q

second line medications for treatment of OCD

A

Crazy Counting Murders Vacation

Citalopram

Clomipramine

Mirtazapine

Venlafaxine XR

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21
Q

third line medications for treatment of OCD

A

IV citalopram

IV clomipramine

duloxetine

phenelzine

tramadol

tranylcypromine

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22
Q

are there any first line agents for adjunctive therapy in OCD

A

yes (2)

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23
Q

name the two first line adjunctive agents for treatment of OCD

A

abilify

risperidone

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24
Q

list the 3 second line adjunctive agents for treatment of OCD

A

memantine

quetiapine

topiramate

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25
Q

list third line adjunctive agents for treatment of OCD

A

amisulpride

celecoxib

citalopram

granisetron

haloperidol

IV ketamine

mirtazapine

N-acetylcysteine

olanzapine

ondansetron

pindolol

pregabalin

riluzole

ziprasidone

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26
Q

what medications are NOT recommended as adjunctive agents in OCD treatment

A

buspirone

clonazepam

lithium

morphine

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27
Q

what 3 agents are NOT recommended for treatment of OCD

A

clonazepam

clonidine

desipramine

28
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

duloxetine

A

third line

29
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

abilify

A

first line ADJUNCTIVE

30
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

fluoxetine

A

first line

31
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clonazepam

A

not recommended

32
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

escitalopram

A

first line

33
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

citalopam

A

second line

(and third line adjunctive)

34
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

memantine

A

second line adjunctive

35
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

risperidone

A

first line adjunctive

36
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

fluvoxamine

A

first line

37
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

sertraline

A

first line

38
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clomipramine

A

second line

39
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

phenelzine

A

third line

40
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

tramadol

A

third line

41
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

paroxetine

A

first line

42
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

mirtazapine

A

second line

43
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

venlafaxine XR

A

second line

44
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

tranylcypromine

A

third line

45
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

quetiapine

A

second line adjunctive

46
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

topiramate

A

second line adjunctive

47
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

lithium

A

not recommended

48
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

buspirone

A

not recommended

49
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clonidine

A

not recommended

50
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

desipramine

A

not recommended

51
Q

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

haloperidol

A

third line adjunctive

52
Q

what is the response rate to SSRIs in OCD

A

40-60%

53
Q

are there differences in response rates between SSRIs

A

not really with pooled response rates

54
Q

what types of OCD symptoms may be associated with poorer response to SSRIs

A

symmetry/hoarding symptoms

55
Q

what types of OCD symptoms may be associated with a BETTER response to SSRIs

A

aggressive, sexual, and religious symptoms

56
Q

why is it suspected that the symmetry/hoarding symptoms of OCD dont tend to respond as well to SSRIs

A

hypothesized they may be mediated by the DOPAMINE system

(whereas aggressive behaviours may be mediated by the serotonin system)

57
Q

why is clomipramine second line for OCD

A

similar efficacy to SSRIs but not as well tolerated

58
Q

did adjunctive olanzapine improve response rates in OCD

A

no not according to a meta analysis

59
Q

compared to abilify, risperidone may better target which: obsessions or compulsions

A

obsessions

60
Q

does topiramate seem to help more with compulsions or obsessions

A

compulsions

61
Q

is buproprion effective in treating OCD

A

no

62
Q

does ongoing treatment with SSRIs appear to reduce relapse rates in OCD

A

yes

63
Q

what invasive procedure may be effective in reducing symptoms in patients with severe, treatment refractory OCD

A

capsulotomy or cingulotomy

*usually considered last resorts

64
Q

what neurostim interventions may be beneficial in treatment of OCD but require more data

A

rTMS

deep brain stimulation

65
Q

what lifestyle intervention may improve OCD symptoms

A

moderate intensity aerobic exercise

6. Obsessive-Compulsive and Related Disorders (3 decks)

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