L16 - Lower Prevalence Conditions Flashcards
What does OCD refer to?
Obsessive Compulsive Disorder
What are the two main features of OCD?
Obsessions and Compulsions
What do obsessions refer to in OCD?
- Recurrent and persistent thoughts, urges, or images that are experienced as intrusive, unwanted and inappropriate or distressing
- The person attempts to ignore or suppress these thoughts, urges or images, or to neutralize them with some other thought or action (i.e., performing compulsion).
What do compulsions try to do for people with OCD?
A way to try and neutralise the obsessive thoughts.
What type of behaviours do we see in compulsions in OCD?
Repetitive Behaviours
(e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rigid rules
Why do people with OCD engage in compulsive behaviours?
The behaviours or mental acts are aimed at preventing or reducing anxiety / distress or preventing some dreaded event or situation;
but the behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
According to the DSM-5, what do the obsessions/compulsions have to impact on in order for the subject to be classified with OCD?
Obsessions / compulsions are time-consuming (take more than 1 hour per day) or cause clinically significant distress / impairment in social, occupational / other important areas of functioning.
What are some examples of common obsessions for people with OCD?
• Fear of contamination/germs, fire, robbery, rape or assault, becoming ‘insane’, insulting others, impulsive swearing, harming another person by acting on a sudden impulse (e.g., stabbing a friend), engaging in an inappropriate sexual act, blasphemy…
• Checking (e.g., power points, door locks), counting, washing/cleaning, ritualistic
thoughts/mantras, tapping a surface, leaving and re-entering a room, arranging objects
in a certain order…
What is the lifetime prevalence of people with OCD in Australia?
4%
What % of adults with OCD report that their symptoms began before the age of 18?
80%
How do we assess whether someone has OCD?
Yale-Brown Scale of Obsessive-Compulsive Symptoms (Y-BOCS)
• Child version (CY-BOCS)
and
• Clinical assessment/interview
Describe the OCD cognitive model.
- People experience an obtrusive thought
- Overinflation of the feared experience
- This generates a negative emotion
- In order to neutralise the negative emotion they feel like they need to do something
In the OCD cognitive model, what stage do clinicans focus on to try and stop the behaviour?
Maladaptive Appraisal
What treatment do we use to treat OCD?
A Cognitive Behavioural Therapy Techniques called Exposure and Response Prevention
How does exposure and reponse prevention work?
Develop a structured hierarchy with the specific phobia using Subjective Units of Distress (SUDS) ratings (i.e. how distressed would you be in this situation from 1-100)
Work with the person which you have a trusted relationship with
Gradually work up hierarchy of feared situation (lowerst SUDS to highest SUDS)
Why do we use exposure and response prevention
Cognitive Restructuring
Trying to restructure that negative appraisal.
Addressing maladaptive appraisal of intrusive thoughts with the use of behavioural experiments (in E&RP) to assist with restructuring
Does medication work for OCD?
Only for some people, for most ERP (exposure response prevention) is the best method to use.
How do responsibility pies help people with OCD?
By showing them that they are not entirely control of the outcomes and their compulsions are most likely not helping.
Restructuring cognitive beliefs
If someone with OCD has a ‘fear of contamination’, how might exposure therapy help?
By slowly exposing them to the contamination so that they realise that it is not as harmful as they believe.
Slowly altering their behaviour to reduce the amount that they engage in the compulsion.
What are the two key features of psychotic disorders?
- Disturbances in perception of reality (i.e., delusions/hallucinations)
- Disturbances in organization of thoughts and/or behaviour
What is the lifetime prevalence of psychotic disorders?
0.5-2%
For psychotic disorders is there a higher prevalence in males or females?
Males - 3:2 ratio
When is the age of onset for psychotic disorders?
Usually late adolescence or early adulthood
What % of individuals with psychotic disorders experience a severe impact on their ability to function in daily life?
90%
What % of people with a psychotic disorder are employed in comparison to the general population?
- 5% - Psychotic Disordered Individuals
(72. 4% general population)
What % of people with psychotic disorders have experienced homelessness in the previous year?
13%
What % of people with psychotic disorders are able to find a married partner?
17%
(61% for the general population)
How did psychotic disorders change from the DSM-4 to the DSM-5?
A shift from subtypes of schizophrenia to a spectrum approach
“Schizophrenia spectrum and other psychotic disorders”