Lecture 9: OCD 1 Flashcards
onset of OCD
usually between:
- 5 and 10
- 15 and 20
- 20 and 30
-> because of stressful periods
course of OCD
usually very chronic. overall only partial remission. often periods with waves of symptoms around periods of stress
OCD-related disorders=
- hoarding disorder
- body dysmorphic disorder
- trichotillomania
- skin picking disorder
- obsessive-compulsive or related disorder due to substance/medication
- obsessive-compulsive or related disorder due to a somatic condition
- otherwise specified obsessive-compulsive or related disorder
- unspecified obsessive-compulsive or related disorder
model van OCD
obsessions cause anxiety, distress, or other negative feelings, which brings about compulsions to reduce them. When these compulsions are performed, there is a temporary reduction in distress, which acts as negative reinforcement.
wat is het doel van CBT voor OCD
normalize the obsessions so that they are not appraised a s a real threat, personally significant or provoking a high level of uncertainty (vooral via het aanpakken van cognitieve biases)
cognitive techniques for overcoming cognitive biases
- 2-column technique: finding evidence for and against the beliefs, which often shows that there is much more evidence against.
- weighing the alternative: ask what an alternative explanation could be, and weighing the likelihood of both
- measuring chance: asking what the real chance is taht the belief would actually come true (for some patients this doesnt work because the chance is not always 0%).
- worst-case scenario: walkthrough the worst-case scenario that the patient imagines. just jump in deep and face your fears in exposure.
- estimation of catastrophe: inschatten hoe likely alles is en dan cumulative chance berekenen.
- pie chart technique: for estimation of responsibility
pharmacotherapy voor OCD
Antidepressants (SSRIs) are often used for OCD. The protocol is often to start with a maximum dosage of SSRI, then switch to a different SSRI, clomipramine and finally a low dosage of an antipsychotic.
Medication can lower the experienced fear, which can help exposure therapy. Of course, antidepressants always have side-effects. On top of that, they need at least a 1-year continuation without lowering the dosage.
neurobiology of OCD
cortical-striatal-thalamo-cortical (CSTC) loop
Cortical-striatal-thalamo-cortical (CSTC) loop
a brain network that, among others, consists of the orbito-frontal cortex (OFC), the nucleus accumbens (NAcc), the putamen, and the caudate. OCD is highly characterized by a dysfunctional CSTC network, in which there is hyperactivity.
wat doen ze voor mensen die nonresponders zijn
Around 10% of OCD patients does not respond to the CBT and pharmacotherapy. For this patient group, deep brain stimulation (DBS) is sometimes used.
deep brain stimulation=
a treatment method in which an electrode is implanted in the CSTC network. This area is subsequently stimulated. This is a method that is successfully used for (heavy) compulsive patients. Affective symptoms improve within minutes to hours, obsessions within days, and compulsions within a few weeks. Thus, this symptom improvement is rather rapid.
adverse effects associated with DBS:
- Complications: there can be complications related to the surgical implantation of the device or device or hardware-related problems.
- Stimulation: there are several undesired effects caused by stimulation or reduction of stimulation (hypomania). Fortunately, it is brief or at least reversible.
OCD symptom dimensions
I. Contamination & cleaning
I. Responsibility for causing or not preventing harm &
checking/ reassurance seeking
III. Taboo thoughts about sexual activity, violence and
blasphemy & checking
IV. Need for order and symmetry & ordering/ counting
specifiers of OCD
- With good or fair insight: acknowledges/ reluctantly admits absurdity or excessiveness of ideas.
- With poor insight: ideas are not unreasonable/ absurd, but acknowledges validity of contrary evidence.
- With absent insight/delusional beliefs: The individual is completely convinced that obsessive compulsive disorder beliefs are true.
- Tic-related: current or past history of tics.
- Medical disorders: dementia, TBI, PANDAS
- Medication/ drugs: clozapine, amphetamines, cocaine
- Excessive worries in generalized anxiety disorder or major depressive disorder
- Preoccupation with appearance in body dysmorphic disorder
- Difficulty discarding or parting with possession in hoarding disorder
- Repetitive and stereotyped behavior in autism spectrum disorder, Tourette syndrome, mental
retardation, frontal lobe lesion, Parkinson, schizophrenia - Ritualized eating behavior (eating disorders)
- Preoccupation with substances or gambling (substance-related and addictive disorders)
- Sexual urges or fantasies (paraphilic disorders)
- Thought insertion or delusional ideas (schizophrenia spectrum and psychotic disorders
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