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Psychiatry > Obsessive-compulsive and related disorders > Flashcards

Obsessive-compulsive and related disorders Flashcards

1
Q

What is OCD?

A

Obsessions or compulsions or both

Obsessions:
recurrent and persistent thoughts, urges, or images
experienced as intrusive and unwanted
cause anxiety

Compulsions:
repetitive behaviours or mental acts
in response to an obsession or according to rules that must be applied rigidly
prevent events or relieve distress

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2
Q

Epidemiology of OCD

A

2-3 % of population
Females slightly >males, males earlier
Onset late adolescence/young adulthood

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3
Q

Why is it important to know the epidemiology

A

Common
Debilitating & high socioeconomic cost
Delayed help-seeking

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4
Q

Pathogenesis of OCD

A

Genetics
25-50% in twin studies

Neurobiology
CSTC ‘loops’: impaired control of inhibition
Serotonin: SSRI’s improve symptoms
Dopamine: Iatrogenic (methylphenidate,cocaine)

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5
Q

What is CSTC loops? And how does each component in the pathway work? How is it related to OCD?

A

Cortico-Striatal-Thalamo-Cortical Circuit
Cortex = GM on outer brain
- A decision-making hub
- Frontal lobe - responsible for error detection, working memory, goal-directed behaviour - sends signal through the striatum

Striatum = GM deep within WM

  • Initiates & co-ordinates motor actions
  • Either passes the signal on from the frontal lobe on or acts as a break and inhibits it

Thalamus

  • Filters stimuli, a processing “relay station”
  • In part controls subconscious movements, receives signal from the striatum and sends it back to the frontal lobe.
  • If signal is too loud, it can disrupt activity

OCD shows overactivity of CSTC loops
hyperactivity in frontal cortex & basal ganglia
One theory: compulsive behaviours a person experiences are caused by misfiring in one or more neural circuits within the loop.

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6
Q

Diagnosis of OCD

A 
First step is to ask
Patient and their family
How?
Screening with Z-FOCS takes <60s
If identified, then a detailed enquiry
Why?
Longer untreated OCD is associated with poorer treatment outcomes
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7
Q

List the questions asked in Z-FOCS

A

Do you wash/clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you would like to get rid of but can’t?
Do your daily activities take a long time to finish?
Are you concerned about orderliness or symmetry?

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8
Q

List possible co-morbidities in OCD

A 
Anxiety (76%) also eating disorders/alcohol
MDD (66%)
Tic disorders (up to 30%)
Children – ADHD/ASD
Suicide Risk
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9
Q

Definition of obsession and/or compulsion in DSM - 5

A

Obsessions: recurrent and persistent thoughts/urges/images experienced as intrusive/unwanted & cause anxiety/distress
Compulsions: repetitive behaviours/mental acts that feel driven to perform in response to obsession or according to rules that must be applied rigidly. The acts aim to reduce anxiety/distress, but are not realistic/are too excessive. Wasting of time (>1hour/day)/↓functioning/distress

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10
Q

DSM 5 symptom clusters

A

Obessesion

  • contamination concerns,
  • harm to self/others, sexual/religious concers,
  • symmetry, precision concerns
  • Completeness concerns/inability to discard

Compulsions:

  • Washing, bathing, showering
  • Checking, praying, asking for reassurance
  • Arranging, ordering
  • Collecting/hoarding
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11
Q

Pharmacological management of OCD

A

SSRI (e.g. Fluoxetine/Citalopram)

  • Consider availability/SE’s/interactions
  • General: higher doses & longer durations than MDD

Specialist Level:
Another SSRI OR Clomipramine (TCA)
Augment with antipsychotic

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12
Q

Non-pharmacological management of OCD

A

CBT (Cognitive Behavioural Therapy)

ERP (Exposure & Response Prevention)

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13
Q

Non-pharmacological management of OCD

A

CBT (Cognitive Behavioural Therapy)

ERP (Exposure & Response Prevention)

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14
Q

Other management that could be added to OCD

A

Transcranial magnetic stimulation
Neurosurgical interruption of CSTC
Deep Brain Stimulation

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15
Q

List OCD related disorders

A 
Body dysmorphic disorder
Hoarding disorder
Trichotillomania (hair-pulling)
Excoriation (skin-picking)
“Other”: due to substance/medication or AMC or un/specified
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16
Q

Body dysmporphia DSM 5 definitions

A

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

At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his or her appearance with that of others) in response to the appearance concerns

Causes clinically significant distress or impairment

17
Q

Commonly affected areas on the body in body dysmorphic disorder and to whom do these patients first present?

A

Skin, hair and nose

Often present to dermatologists/plastic surgeons first

18
Q

Prevalence of body dysmorphic disorder

A

0,7-2,4%

19
Q

Treatment of body dysmorphic diorder

A

Treatment very similar to OCD
High dose SSRI’s
CBT/ERP

20
Q

Hoarding disorder DSM 5 definitions

A

Persistent difficulty discarding or parting with possessions, regardless of their actual value
This difficulty is due to a perceived need to save the items and distress associated with discarding. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.
Causes clinically significant distress/impairment

21
Q

Prevalence of of hoarding disorder

A

2 - 6%

22
Q

Treatment of hoarding disorder

A

More resistant to treatment
Treatment
- SSRI’s
- Therapy (MI/CBT)

23
Q

Trichotillomania (hair-pulling) DSM 5

A

Recurrent pulling out of one’s hair, resulting in hair loss
Repeated attempts to decrease or stop hair pulling
The hair pulling causes significant distress and impairment in at least one important area of functioning

24
Q

Prevalence of trichotillomania

A

12 month prevalence 1-2%, females 10x more likely

25
Q

Treatment

A

Limited research

Habit Reversal Therapy/CBT

26
Q

Excoriation (skin-picking) DSM 5 definitions and description

A

Recurrent skin picking resulting in skin lesions
Repeated attempts to decrease or stop skin picking
Causes clinically significant distress/impairment

Not in DSM 5:
Often follows a dermatological condition (e.g. acne/psoriasis)
Can also cause life-threatening infection

27
Q

Treatment of excoriation

A

Limited research
SSRI’s = mixed results
Habit Reversal Therapy

27
Q

Treatment of excoriation

A

Limited research
SSRI’s = mixed results
Habit Reversal Therapy

Psychiatry (13 decks)

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