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3018 > Lecture 4 OCD > Flashcards

Lecture 4 OCD Flashcards

1
Q

DSM-V OCD and related disorders

A

OCD

body dysmorphic disorder

hoarding disorder

excoriation disorder

trichotillomania

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2
Q

Common features of DSM-V OCD disorders

A
  • repetitive behaviours or mental acts, difficult to decrease or stop
  • highly comorbid with each other
  • likely to be present in first degree relatives of probands
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3
Q

DSM-V criteria for OCD (4)

A

A) presence of obsessions, compulsions, or both

B) obsession or compulsion time-consuming (>1 hour a day)

C) symptom not attributable to physiological effects of substance or medical condition

D) disturbance not better explained by symptoms of another mental disorder

specify if:

  • with good insight
  • tic-related
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4
Q

Obsessions defined by 1) and 2)

A

1) recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted, that caused marked anxiety or distress
2) attempts to ignore or suppress such thoughts, urges or images, or to neutralise them with some other thought or action

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5
Q

Compulsions defined by 1) and 2)

A

1) repetitive behaviours or mental acts that individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2) behaviour or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event. not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive

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6
Q

4 dimensions of presenting symptoms in OCD

A

cleaning
-contamination obsessions and cleaning compulsions

harm
-fears of harm to oneself or others and related checking compulsions

symmetry
-symmetry obsessions and repeating, ordering, and counting compulsions

forbidden or taboo thoughts
-aggressive, sexual, and religious obsessions and related compulsions

*often symptoms in more than one dimension

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7
Q

Common compulsions in OCD (5)

A

Washing and cleaning

  • washing hands excessively
  • excessive showering, cleaning

Checking

  • that you did not harm others or self
  • that nothing terrible happened, you didn’t make a mistake

Repeating
-rereading or rewriting, repeating routine activities or body movement

Mental compulsions
-counting while performing a task, cancelling, undoing

Ordering and arranging objects

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8
Q

Lifetime prevalence of OCD

A

2-3%

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9
Q

Age of onset

A

mean 19.5, 25% start by 14

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10
Q

Gender difference

A

more common in women, men often earlier onset (before 10)

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11
Q

Course

A

chronic if untreated, 80% still diagnosed after 40 years

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12
Q

Comorbity

A

76% comorbid anxiety disorder

63% comorbid major depression or bipolar

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13
Q

How does operant reinforcement maintain OCD

A
  • compulsion negatively reinforced by reduction of anxiety
  • avoidance maintains anxiety
  • obsession=>anxiety=>compulsion=>relief

obsession: constant thoughts about whether…
anxiety: strong, uncomfortable feelings of anxiety
compulsion: repeatedly checking to confirm
relief: relief from anxiety, obsessive response strengthened for the future

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14
Q

Cognitive model of OCD

A
  • obsessions are not qualitatively different from intrusive thoughts in the general population
  • response to thoughts is different
  • OCD results from misinterpretation of intrusive thoughts, they think thinking = doing
  • cognitive factors

-attempts to suppress intrusive thoughts:
trying makes matter worse, results in checking for thoughts thereby creating them

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15
Q

Cognitive factors associated with OCD (4)

A

intolerance of uncertainty

inflated responsibility

thought-action fusion

magical ideation

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16
Q

Treatment of OCD

A

Medication 40- 60% benefit

  • tricyclic antidepressant: anafranil
  • SSRI(serotonin reuptake inhibitors)

CBT

  • Exposure and Response Prevention: 75% benefit
  • cognitive restructuring: challenge beliefs about intrusive thoughts, consequences of not engaging in complusions
  • behavioural experiments
17
Q

Hoarding disorder (6)

A

A) Persistent difficulty discarding or parting with possessions, regardless of actual value.

B) difficulty is due to perceived need to save the items and distress associated with discarding

C) Accumulation of possessions that clutter living areas and compromises their intended use. If living areas uncluttered, it is only because of the interventions of third parties

D) causes clinically significant distress or impairment in social, occupational, or other areas of functioning

E) not attributable to another medical condition

F) not better explained by the symptoms of another mental disorder

Specify:

  • excessive acquisition
  • good or fair insight

prevelance: 2-6% at any point
most above age 65 but starts quite early

18
Q

Body dysmorphic disorder (4)

A

A) Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others

B) At some point during the course of the disorder, individual has performed repetitive behaviors or mental acts in response to the appearance concerns.

C) preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) appearance preoccupation not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for eating disorder.

Specify:

  • insight from good to absent/delusional
  • with muscle dysmorphia
19
Q

Muscle dysmorphia specifier

A
  • preoccupied with the idea that his or her body build is too small or insufficiently muscular.
  • used even if the individual is preoccupied with other body areas
20
Q

Functional consequence of body dysmorphic disorder

A
  • impaired psychosocial functioning
  • avoidance of social situation, relationships, intimacy
  • 20% youth drop out of school
  • can be completely housebound
  • elevated suicide risk
21
Q

Trichotillomania (5)

A

A) Recurrent pulling out of one’s hair, resulting in hair loss.

B) Repeated attempts to decrease or stop

C) hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

D) hair pulling or hair loss is not attributable to another medical condition

E) hair pulling is not better explained by the symptoms of another mental disorder

22
Q

Excoriation (5)

A

A) Recurrent skin picking resulting in skin lesions

B) Repeated attempts to decrease or stop

C) The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

D) The skin picking is not attributable to the physiological effects of a substance or another medical condition

E) The skin picking is not better explained by symptoms of another mental disorder

3018 (23 decks)

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