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ACD 2 > Lecture 10: OCD 1 - Symptomatology and treatment > Flashcards

Lecture 10: OCD 1 - Symptomatology and treatment Flashcards

1
Q

active obsessionality

A

= patient actively takes something into obsession; during compulsions it’s the patient who shuts it’s attention off from the world to focus selectively on one subject

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1
Q

passive obsessionality

A

= patient is submissively being obsessed; during obsessions the patient’s attention for the world is shut off and focused on one object

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2
Q

objective compulsivity

A

= mechanisms through which one mental event is necessarily followed by another mental event

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3
Q

subjective compulsivity

A

= indicates the feeling of being compelled

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4
Q

explain what obsessionality and compulsivity look like in obsessions and compulsions

A

obsessions; compulsivity = direct (experienced from beginning, coincides with obsessionality); obsessionality = passive

compulsions; compulsivity = indirect (occurs only after a lap of time, result of typical process); obsessionality = active

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5
Q

what can all OCD themes essentially be narrowed down to

A

wanting certainty and control, sometimes specifically absolute certainty

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6
Q

what are 2 theoretical models of obsessions and compulsions

A
  1. conditioning model of obsessions and compulsions: pathological fear is acquired by classical conditioning and maintained through operant conditioning
  2. cognitive behavioural approaches: intrusive thoughts are normal experiences but they develop into distressing/time-consuming obsessions when someone mistakenly appraises them as threatening, personally significant or provoking unmanageable/intolerable uncertainty
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7
Q

why is reducing/controlling obsessions through compulsions and avoidance counterproductive (4)

A
  1. because they provide escape, they prevent person from learning that thoughts/anxiety/uncertainty is manageable
  2. prevents from learning that obsessional distress subsides naturally after feared consequences are confronted
  3. lead to an increase in obsessions
  4. preserve dysfunctional beliefs and misinterpretation of obsessional thought; if feared event doesn’t occur it can be attributed to ritual (compulsion)
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8
Q

what are 3 components of empirically supported treatments

A
  1. exposure treatment
  2. response prevention
  3. cognitive techniques
    - cognitive restructuring = challenging/correcting of dysfunctional thoughts/beliefs
    - behavioural experiments
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9
Q

what are 2 explanations for the effects of exposure therapy

A
  1. Habituation; emotional processing theory = original fear structure is replaced/competes with new non-fear structure
  2. Inhibitory learning; notion that fear associations are not removed but remain intact as new learning about stimulus happens
    Two meanings of feared stimulus:
    - fear-based meaning (excitatory)
    - safety-based meaning (inhibitory)
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10
Q

what are 3 interventions derived from ACT

A
  1. fostering willingness to experience obsessional distress
  2. recognising thoughts/feelings as neither right nor wrong
  3. using treatment to move toward what one values in life
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11
Q

how does one respond to fears of long-term/unknowable consequences

A

reframe problem as intolerance of uncertainty and implement ERP to disprove more immediate beliefs about not being able to tolerate uncertainty; highlight discrepancies between beliefs and outcomes after each exposure trial

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12
Q

when does accommodation occur (3) and what are the 4 consequences

A

1 - helps with avoidance strategies
2 - helps with avoidance strategies
3 - helps to resolve or minimise problems resulting from obsessions/compulsions

consequences:
- related to more severe obsessions/compulsions
- poorer treatment outcomes
- contributes to maintenance of obsessional fears
- decreases sufferers motivation to change

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13
Q

what are the 4 most common OCD symptoms dimensions

A
  1. Contamination and cleaning
  2. Responsibility for causing or not preventing harm and checking/reassuring seeking
  3. Taboo thoughts about sexual activity, violence and blasphemy & checking
  4. Need for order and symmetry & ordering/counting
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14
Q

what is the biggest difference between OCD and OCPD

A

in OCD, obsessions and compulsions are ego-dystonic (= people know they’re irrational and they don’t identify with them), in OCPD they’re ego-syntonic (= people believe they are correct and more people should be like them, they identify with them)

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15
Q

when are the 3 peaks in onset of OCD

A

between 5-10 years old, nearing 20s and between 25-30

16
Q

what is the prevalence of OCD

A

1.3%

17
Q

explain the model of OCD

A

it starts with recurrent negative thoughts/impulses/images (obsessions), they lead to anxiety and distress, this leads to repetitive behaviors (compulsions), and they lead to temporary reduction/relief in distress

18
Q

what are the 3 most common treatment methods for OCD

A
  • cognitive behavioral therapy
  • medication
  • neuromodulation (rTMS, DBS)
19
Q

what are 5 dysfunctional beliefs associated with obsessions

A
  1. Inflated responsibility; beliefs that one has the special power to cause and/or the duty to prevent negative outcome
  2. Overimportance of thoughts (thought-action fusion);
    - belief that the mere presence of a thought makes the thought important
    - thought has ethical or moral ramifications
    - thinking the thought increases the likelihood of performing corresponding behaviour
  3. Overestimation of threat; belief that negative events are especially likely and awful
  4. Perfectionism; belief that mistakes and imperfections are intolerable
  5. Intolerance for uncertainty; belief that it is necessary and possible to be completely certain that negative outcomes will not occur
20
Q

what are 2 cognitive techniques for overcoming dysfunctional beliefs

A
  1. Estimation of catastrophe; calculation of the probability of the catastrophe
  2. Estimation of responsibility; pie technique; listing factors that contributed to the situation to show that the blame isn’t all on the person
21
Q

what is the medication protocol for OCD

A

1 - start with SSRIs, max dosage, minimum of 3 months
2 - switch to different SSRIs
3 - switch to clomipramine, max dosage, minimum of 3 months
4 - add low dosage of antipsychotic

22
Q

explain the 2 neuromodulation techniques in short

A

Deep brain stimulation (DBS) for OCD involves implanting electrodes in specific areas of the brain, such as the subthalamic nucleus or the nucleus accumbens, to deliver controlled electrical impulses. This aims to modulate abnormal neural activity associated with OCD symptoms, providing relief for patients who do not respond to conventional treatments.

Repetitive transcranial magnetic stimulation (rTMS) for OCD uses a non-invasive device to deliver magnetic pulses to targeted brain regions, typically the dorsolateral prefrontal cortex. These pulses aim to alter neural activity and connectivity in circuits implicated in OCD, offering symptom improvement for some patients, particularly those who are treatment-resistant.

23
Q

what are effective target of rTMS

A
  1. low frequency preSMA
  2. high frequency bilateral clPFC
  3. low frequency right dlPFC (highest efficacy)
24
Q

what are the 5 rating dimensions on the Y-BOCS

A
  1. time spent or occupied
  2. interference with functioning or relationships
  3. degree of distress
  4. resistance to
  5. control of

ACD 2 (6 decks)

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