college 3 - anxiety and OCD Flashcards
difference OCD and anxiety
- both contain unwanted thouggts, but OCD tends:
- to be unrealistic
- lead to obsessive behaviour to reduce anxiety
DSM OCD
A) presence of of obsessions (unwanted ideas) compulsions (repetitive behaviour) or both
B) obsessions/compulsions are time consuming or cause clinically sign distress/imoairment in functioning
C) symptoms not attributable to physiological effects. of substance/medical condition
D) symptoms not better explained by other mental disorder
fear habituation model + pitfalls
- repeated exposure to feared stimuli
- reduction in fear response due to habituation of fear response
pitfalls:
- spontaneous recovery
- renewal of conditional fear in other contexts
- reinstatement of conditional fear if adverse event occurs
- rapid reacquistion if conditioned stimulus/unconditioned stimulus are paired again
inhibitory learning based model
- aims to strengthen conditional stimulus & no unconditional stimulus association
> both associations are still there but inhib strengthens one route - more effective in reducing OCD in adolescents than fear habituation
- has more long lasting treatment outcomes than fear habituation
enhancing inhibitory learning
fundamental
- expectancy violation
- attention to feared stimuli/situation
- removal of safety signals
- mental rehearsel after exposure
advanced
- deepened extinction
- occassional reinforced extinction
promoting generalization of learning
- stimulus variability
- multiple contexts
- retrieval cues
- affect labelling
aetiology OCD - Barton
- genetic componeent: serotoninergic, dopaminergic & glutaminergic pathways
- increased activation in lateral & medial orbito frontal cortex (CBT targets this)
- smaller globus pallidus
ICD: at least 2 weeks
symptom dimensions
- contamination & cleaning
- harm (agressive) obsessions and checking
- symmetry, ordening, repeating, counting
- hoarding
- sexual & religious obsessions
OCD related disorders
- body dismorphic disorder
- hoarding disorder
- trichotillomania (hairpulling) (TTM)
- excoriation (skin picking) (SPD)
> lots of comorbitiy
differential diagnosis: ASD, Tourette
> but can also be comorbid
PANS
pediatric onset neuropsychiatric syndrome
- subtype of OCD where child presents with acute onset neuropsychiatric symptons, ocd and or tics
> seek organic trigger
PANDAS
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections
- Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever
compulsions vs childhood rituals
childhood rituals mostly related to food, toys, clothes
> rituals are not distressing, do not take up excissive time, do not stop children from doing things and are self limiting
ASD VS OCD
- compulsions cause distress
- ASD enjoys rituals
- in ASD higher prevalence OCD than general popu
> difficult to assess because: - dificult to assess mental state
- intelectual disability & non-verbal
- anxiety caused by stopping compulsion can easily be confused by stopping autistic ritual
OCD vs ED
differentiating: concern about body image
> lots of comorbidity
Treatment
CBT (incl exposure) of CBT + SSRI
