Obsessive-Compulsive and Related Disorders DSM (all) Flashcards
1
Q
define obsessions
A
recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted
*not pleasurable and not experiences as voluntary
2
Q
define compulsions
A
repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
*not done for pleasure though some people experience relief from anxiety or distress
3
Q
how do obsessive compulsive and related disorders differ from developmentally normative peoccupations and rituals
A
by being EXCESSIVE or persisting beyond developmentally appropriate periods
4
Q
list symptom dimensions (themes) that are common in OCD
A
cleaning
symmetry
forbidden or taboo thoughts
harm
5
Q
are the body-focused repetitive behaviours that characterize trichotillomania and excoriation disorder triggered by obsessions or preoccupations?
A
no
but may be preceded or accompanied by various emotional states such as anxiety or boredom
may also be preceded by an increasing sense of tension or may lead to gratification, pleasure, or sense of relief when hair pulled out or skin picked
6
Q
criterion A for OCD
A
presence of obsessions, compulsions, or both
7
Q
define obsessions per criterion A of OCD
A
- recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as INTRUSIVE and UNWANTED and that in most individuals cause marked ANXIETY and DISTRESS
AND - individual attempts to ignore or SUPPRESS such thoughts, urges or images or to NEUTRALIZE them with some other thought or action i.e by performing a compulsion
8
Q
define compulsion per criterion A of OCD
A
- repetitive behaviours (i.e hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
AND - behaviours or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation –> however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
9
Q
criterion B OCD
A
obsessions are TIME CONSUMING (i.e take more than 1 hour per day) OR cause clinically significant distress or impairment
10
Q
criterion C for OCD
A
symptoms not attributable to physiological effects of a substance or another medical condition
11
Q
criterion D OCD
A
not better explained by another mental disorder
12
Q
what specifiers are there for OCD in the DSM
A
- with good or fair insight–> individual recognizes that the O-C disorder beliefs are definitely or probably not true or that they may or may not be true
- with poor insight–> things OCD beliefs are probably true
- with absent insight/delusional beliefs–> individual completely convinced that OCD beliefs are true
- specify if “tic related”–> individual has current or past history of tic disorder
13
Q
name some common dysfunctional beliefs found in individuals with OCD
A
an inflated sense of responsibility
tendency to overestimate threat
perfectionism
intolerance of uncertainty
over-importance of thoughts (i.e believing that having a forbidden thought is as bad as acting on it) and the need to control thoughts
14
Q
what proportion of people with OCD have absent insight/delusional beliefs
A
about 4% or less
15
Q
how does degree of insight in OCD help prognostically
A
while degree of insight can vary of the course of the illness, generally poorer insight has been linked to worse long term outcome
16
Q
what proportion of people with OCD have a lifetime tic disorder? which populations tends to present with this constellation of symptoms?
A
about 30%
*most common in males with onset of OCD in childhood
*these individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course and pattern of familial transmission
17
Q
how do those with both tics disorders and OCD tend to differ from those with OCD but no tic disorder
A
those with tic-related OCD had:
–more OC symptoms, including more aggressive, religious and sexual obsessions
–more checking, counting, ordering, touching and boarding compulsions
18
Q
are OCD themes generally consistent over time for adults with the disorder or do they change over time
A
generally consistent
(may be associated with different neural substrates)
people tend to have symptoms in more than one dimension
19
Q
what is the 12 month prevalence of OCD
A
about 1-2%
males more commonly affected in childhood, females more commonly affected in adulthood
20
Q
what % of cases of OCD start before/by age 14 years
A
25%
21
Q
what is the upper limit of the normal age of onset of OCD
A
onset of OCD above age 35 is rare but does happen
22
Q
what is the mean age of onset of OCD in the USA
A
19.5 years
23
Q
what is the typical course of onset of OCD symptoms
A
typically gradual but acute onset has also been reported
24
Q
who has earlier age of onset of OCD, males or females
A
males–> nearly 25% of males have age of onset before age 10
25
what is the usual course of OCD if untreated
usually CHRONIC often with WAXING and WANING symptoms
some people have EPISODIC course
minority have deteriorating course
26
what are remission rates in adults if OCD remains UNtreated
remission rates LOW if untreated--> 20% for those reevaluated 40 years later
however, 40% of people with onset of OCD in childhood and adolescence may experience remission by early adulthood
27
name 3 temperamental risk factors for OCD
greater internalizing symptoms
higher negative emotionality
behavioural inhibition
28
list environmental risk factors for OCD
physical and sexual abuse in childhood
other stressful or traumatic events
various infectious agents and post infectious autoimmune syndrome (ie PANDAS) have been associated with sudden onset OCD
29
how does having a first degree relative with OCD affect someones risk of developing OCD themselves
risk is 2x higher if you have a first degree relative with the disorder
BUT--> if your first degree relative had onset in childhood or adolescence, risk increases by 10x
30
dysfunction in which three brain regions is most strongly implicated in OCD
orbitofrontal cortex
anterior cingulate cortex
striatum
31
is the presentation of OCD fairly consistent worldwide
yes--> substantial similalarity across cultures in gender distribution, age at onset, and comorbidity of OCD, as well as in symptom structure involving cleaning, symmetry, taboo thoughts or fear of harm
(there is some regional variation though)
32
which gender is more likely to have comorbid tic disorders with OCD
males
33
which gender is more likely to have symptoms in the cleaning symptom dimension in OCD
females
34
which gender is more likely to have symptoms in the forbidden thoughts dimension in OCD
males
35
which gender is more likely to have symptoms in the symmetry dimension in OCD
males
36
is there a period of life that is an at risk time for development or exacerbation of OCD symptoms
have been reported in the peripartum period (including aggressive obsessions leading to avoidance of the infant)
37
SI occurs in what proportion of those with OCD?
suicide attempts occur in what proportion of those with OCD?
SI--> occurs at some point in about half of people with OCD
attempts--> reported in about 25% of people with OCD
38
what comorbidity increases the risk of suicide in those with OCD
MDD
39
ddx OCD
anxiety disorders
MDD
other OCD and related disorders
eating disorders
tics
stereotyped movements
psychotic disorders
other compulsive like behavious (i.e paraphilias, gambling, substance use_
OCPD
40
how do you distinguish between the recurrent thoughts in other anxiety disorders like GAD vs those found in OCD
in GAD--> recurrent thoughts generally about real-life concerns
in OCD--> recurrent thoughts generally do not involve real-life concerns and can include content that is "odd, irrational or seemingly of a magical nature"
+compulsions often present and usually linked to obsessions
41
how do you distinguish between the rumination of MDD vs OCD
MDD--> usually mood congruent and not necessarily experienced as intrusive or distressing + no compulsions
42
how does one distinguish between other compulsive like behaviours (i.e gambling, paraphilias) and OCD
usually in the other behaviours, the person derives pleasure from the behaviour and only wishes to refarin from it due to deleterious consequences
43
how does OCPD differ from OCD
OCPD--> enduring and pervasive maladaptive pattern of excessive PERFECTIONISM and RIGID CONTROL
OCD--> O-C symptoms
44
can you have both OCPD and OCD
yes
45
what is the most common comorbidity with OCD
anxiety disorders--> 76% of adults with OCD have a lifetime diagnosis of anxiety disorder
46
other than anxiety disorder, what are some other common comorbidities with OCD
depressive or bipolar disorder (most commonly MDD--> 41%)
OCPD (23-32%)
tic disorder (up to 30%)
47
there is a triad of disorders including OCD that can be seen in children--what are the other two disorders in that triad?
OCD, tic disorders and ADHD
48
list disorders that occur more commonly in those with OCD than those without OCD
BDD
trichotillomania
excoriation disorder
*there is also an association between OCD and some disorder related to impulsivity like ODD have been reported
49
rates of OCD are elevated in people with which other disorders?
(i.e if someone gets diagnosed with one of these other disorders, you should assess for OCD as the rates of OCD are higher in these people than would be expected based on the general population rates)
schizophrenia or schizoaffective disorder --> prevalence of OCD = 12%
bipolar disorder
eating disorders
tourettes disorder
50
criterion A for BDD
preoccupation is ONE or MORE perceived DEFECTS or flaws in PHYSICAL APPEARANCE that are NOT observable or appear SLIGHT to others
51
criterion B for BDD
at some point during the course of the disorder, the individual has performed REPETITIVE BEHAVIOURS (i.e mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (i.e comparing their appearance to that of others) in response to the appearance concerns
52
criterion C for BDD
preoccupation causes clinically significant distress/impairment
53
criterion D for BDD
not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
54
list specifiers associated with BDD
1. with muscle dysmorphia--> preoccupied with idea body build is too small or insufficiently muscular
2. indicate degree of insight (i.e with good or fair insight, with poor insight or with absent insight/delusional beliefs)
55
which body areas are most commonly the cause for concern in BDD
skin--> perceived lines, acne, scars, wrinkles, paleness
hair--> "thinning" hair or "excessive" body hair or facial hair
nose--> size or shape
*however any body area can be area of concern i.e eyes, teeth, weight, stomach, breasts, chin, eyebrows etc
*some individuals are concerns with perceived asymmetry of body areas
56
how would you describe the nature of the body related preoccupations in BDD
intrusive
unwanted
time consuming
usually difficult to resist or control
57
how much time during the day do the body related preoccupations in BDD typically occur for
on average 3-8 hours per day
58
what is "muscle dysmorphia"
a form of BDD occurring almost exclusively in MALES--> preoccupation with idea that ones body is too small or insufficiently lean or muscular
typically have normal looking body or are muscular
may also be preoccupied with other body areas
majority (not all) use diet, exercize and/or lift weights--> may cause body damage--> may use anabolic steroids or other substances to make body look bigger and more muscular
59
what is BDD by proxy?
form of BDD in which individuals are preoccupied with defects they perceive in another person's appearance
60
on average, what is people's insight like when they have BDD
generally poor--> 1/3 or more currently have DELUSIONAL BDD beliefs
61
why do we care about level of insight in BDD
those with delusional BDD tend to have greater morbidity in some areas i.e suicide
62
what is a common type of idea/delusion in BDD
ideas or delusions of reference (believing that other people take special notice or mock them becuase of how they look)
63
what other features are often associated with those who have BDD
high levels of anxiety
social anxiety
social avoidance
depressed mood
neuroticism
perfectionism
low extroversion
low self esteem
64
what interventions to those with BDD often undertake due to their disorder
majority receive cosmetic treatment to try and improve perceived defects--> derm treatment and surgery are most common
some people may perform surgery on themselves
65
do cosmetic treatments tend to help in BDD
no--> BDD tends to respond poorly to such treatments and sometimes becomes worse
some individuals take legal action or are violent against the clinician because they are dissatisfied with the cosmetic outcome
66
what neurocognitive dysfunctions have been associated with BDD
executive dysfunction
visual processing abnormalities
--> bias for analyzing and encoding details rather than holistic or configural aspects of visual stimuli
tend to have a bias towards negative or threatening interpretations of facial expressions and ambiguous scenarios
67
what is the prevalence of BDD in the general population
about 2% (very slightly higher in females)
68
what is the prevalence of BDD amongst dermatology patients? cosmetic surgery patients? adult orthodontia patients? those presenting for oral or maxillofacial surgery?
derm--> 9-15%
cosmetic surgery--> 7-16%
adult orthodontia--> 7-8%
oral surgery--> 10%
69
what is the usual age of onset for BDD
mean/median is around 15-17 years but most common age is 12-13 years old
(2/3 have onset before age 18)
70
what is a bad prognostic factor for BDD
onset before age 18
onset before age 18 means person is more likely to attempt suicide, have more comorbidity, and have gradual, rather than acute, disorder onset
71
name an environmental RF for BDD
childhood abuse and neglect
72
name a genetic risk factor for BDD
higher rates in people with a first degree relative with OCD
73
how do males and females with BDD differ
actually have more similarities than differences (i.e in severity, disliked body areas, types of repetitive behaviours, illness course)
males--> more likely to genital preoccupations
females--> more likely to have comorbid eating disorder
muscle dysmorphia = almost exclusively males
74
does BDD affect suicide risk
yes--> SI and SA rates are high in this population
75
on average, how much functional impairment is there in BDD
psychosocial functioning and quality of life for those with BDD tends to me "markedly poor"
about 20% of youth with BDD report dropping out of school primarily due to their BDD sx
high proportion of adults and kids with BDD have been hospitalized
76
ddx for BDD
normal appearance concerns and clearly noticeable physical defects
eating disorders
other O-C and related disorders
illness anxiety disorder
MDD
anxiety disorders
psychotic disorders
other disorders and symptoms
77
which tends to have worse insight, OCD or BDD
BDD
78
when should you diagnose BDD vs excoriation disorder
if the skin picking is intended to improve the appearance of perceived skin defects
(same with trichotillomania and hair()
79
what is body identity integrity disorder
(not DSM)
involves desire to have a limb amputated to correct an experience of mismatch between a persons sense of body identity and his or her actual anatomy --> concern does not focus on limbs appearance
80
what is "koro"
a culturally related disorder that usually occurs in epidemics in SE Asia = fear that the penis (or labia/nipples/breasts in females) is shrinking or retracting and will disappear into the abdomen
often accompanied by belief that death will result
*focus is often on death rather than perceived ugliness so differs from BDD
81
what is apotemnophilia
another word for body identity integrity disorder (not DSM)
82
what is olfactory reference syndrome
not DSM
belief that one emits foul or offensive body odor
83
what is the most commonly comorbid disorder with BDD
MDD
-> onset usually after BDD
------
social anxiety, OCD, SUDs are also common
84
criterion A for hoarding disorder
persistent difficulty discarding or parting with possessions regardless of their actual value
85
criterion B for hoarding disorder
this difficulty (with discarding or parting with possessions) is due to a perceived need to save the items and to distress associated with discarding them
86
criterion C for hoarding disorder
difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and sustantially compromises their intended use
if living areas are uncluttered, it is only because of the interventions of third parties
87
criterion D-F for hoarding disorder
clinically significant distress/impairment
not attributable to another medical condition
not better explained by another mental disorder
88
what medical conditions may be associated with hoarding behaviours
brain injury
cerebrovascular disease
prader-willi syndrome
89
what specifiers are there for hoarding disorder
1. with excessive acquisition
2. related to insight (good or fair insight--> recognizes behaviours are problematic, poor insight--> mostly does not think behaviours are problematic despite evidence to the contrary, absent insight/delusional beliefs--> completely convinced behaviours are not problematic)
90
what is hoarding disorder "with excessive acquisition"
is this common?
hoarding disorder + if difficulty discarding possessions is accompanied by excessive acquisition of items that are NOT NEEDED or for which there is NO SPACE
yes--> approx 80-90% of those with hoarding disorder display excessive acquisition
ppl with hoarding disorder tend to experience distress is unable to or prevented from acquiring items
91
what are the most common methods of excessive acquisition in hoarding disorder
most common--> buying
next common--> acquisition of free items (i.e leaflets, items discarded by others)
stealing is less common
92
is the saving of items intentional or passive in hoarding disorder
intentional
(differs from other psychopathology in which you can have the passive accumulation of detritus)
93
how does normative collecting differ from hoarding disorder
normative collecting = systematic, organized; does not produce the clutter, distress or impairement typical of hoarding disorder
94
list some other common features found in those with hoarding disorder
indecisiveness
perfectionism
avoidance
procrastination
difficulty planning and organizing tasks
distractability
95
why do some people with hoarding disorder live in unsanitary conditions
may be logical consequence of the hoarding behaviours and/or challenges with planning and organizing
96
what are the most prominent differences between animal hoarding and object hoarding
extent of unsanitary conditions and poorer insight in animal hoarding
(those who hoard animals though tend to also hoard objects)
97
what is the estimated point prevalence of hoarding disorder
2-6%
98
is there a gender difference in hoarding disorder
significantly greater prevalence in males
(though clinical samples are predominantely female)
99
how does age affect prevalence of hoarding symptoms
almost 3x more prevalence in older adults (55-94 years) compared with younger adults
100
what is the usual age of onset and course of hoarding disorder
appears to begin EARLY in life and to be chronic and worsening
sx may first appear around ages 11-15--> start interfering with functioning in mid 20s--> clinically significant impairment by mid-30s
severity of hoarding increases with each decade of life
course is often chronic --> few people report waxing and waning
101
what is a prominent temperamental risk factors for hoarding disorder
indecisiveness
102
what is an environmental risk factor for hoarding disorder
stressful and traumatic life events preceding onset of disorder
103
does hoarding disorder run in families?
yes--> about 50% of people with hoarding disorder report a family member who also hoards
twin studies--> about 50% of variability in hoarding behaviour is genetic factors
104
is hoarding a western phenomenon?
no--> little data but appears to be universal with consistent clinical features
105
how does hoarding disorder tend to present differently in females vs males
females tend to display more excessive acquisition, particularly excessive buying, than males
106
ddx hoarding disorder
other medical conditions
neurodevelopmental disorders
schizophrenia spectrum and other psychotic disorders
MDE
OCD
neurocognitive disorders
107
damage to which parts of the brain has been particularly associated with excessive accumulation of objects
anterior ventromedial prefrontal and cingulate cortices
(in people with damage to this part of the brain, hoarding was not present before the brain damage and presents shortly after the injury)
108
do you diagnose hoarding disorder if the hoarding is felt to be direct consequence of i.e autism or other neurodevelopmental d/o
no
109
can you get hoarding behaviours in OCD?
yes--> and if felt to be specifically related to the OCD then you just diagnose OCD
110
how do hoarding behaviours tend to differ if a result of OCD vs hoarding disorder
in OCD--> behaviour generally unwanted, no pleasure or reward
excessive acquisition generally not present
more likely to accumulate bizarre items like trash, feces, urine, nails, hair, used diapers, rotten food (accumulation of these items in hoarding disorder is very rare)
usually secondary to feelings of incompleteness (i.e losing identity, need to document all life experiences) or to avoid onerous rituals (i.e decontamination rituals)
111
what are the most commonly comorbid conditions with hoarding disorder
MDD (up to 50%)
social anxiety disorder
GAD
OCD (up to 20%)
*these comorbidities are often main reason for consult as people are unlikely to spontaneously report hoarding symptoms and are often not asked about in routine interviews
112
what % of people with hoarding disorder have a comorbid mood or anxiety disorder
about 75%
113
what are the criteria for trichotillomania in the DSM
A--recurrent pulling out of one's hair, resulting in hair loss
B--repeated attempts to DECREASE or stop hair pulling
C--the hair pulling cuases clinically significant distress/impairment
D--hair pulling or loss is not attributable to another medical condition
E--not better explained by another mental disorder (i.e BDD)
114
what are the most common sites for hair pulling in trichotillomania
scalp
eyebrows
eyelids
115
how does the hair pulling in trichotillomania present during the day
may be brief periods scattered throughout the day or may be less frequent but more sustained periods that can continue for hours
hair pulling pay persist for months or years
116
what types of behaviours may accompany the hair pulling in trichotillomania
may search for particular kind of hair to pull (i.e particular texture or color)
may try to pull hair in a specific way (i.e so root comes out intact)
may visually examine or tactilely or orally manipulate the hair after it is pulled
117
what types of affective states may accompany hair pulling in trichotillomania
may be preceded or accompanied by varied states
may be triggered by anxiety or boredome
may be preceded by increasing sense of tension either immediately before pulling hair or trying to resist pulling
may have gratification, pleasure, sense of relief when pulls out hair
118
does pain usually accompany hair pulling in trichotillomania
no
119
what sensation do many people with trichotillomania describe before pulling hair
an "itch like" or tingling sensation in the scalp that is relieved by the hair pulling
120
what is "tonsure trichotillomania"
pattern of nearly complete baldness except for narrow perimeter around outer margins of the scalp, particulalry at nape of the neck
121
does hair pulling in trichotillomania usually occur in the presence of others
no, not usually (except for immediate family members)
122
is the urge to pull hair in trichotillomania exclusive to ones own hairs?
some people have urges to pull hair from others and may sometimes try and find opportunities to do so surrepticiously
may pull hair from dolls, pets or other fibrous materials
123
do people with trichotillomania have other body focused repetitive behaviours
yes--> majority have one or more other behaviours such as skin picking, nail biting, lip chewing
124
what is the prevalence of trichotillomania in the general population
1-2% (12 month prevalence)
125
what is the gender difference in trichotillomania
females affected more than males in 10:1 ratio
(may also reflect help seeking patterns rather than true difference between affected individuals--in kids with trichotillomania, males and females are more equally represented)
126
is hair pulling ever normal
can be seen in infants but this behaviour typically resolves during early development
127
onset of hair pulling in trichotillomania often coincides with or follows onset of what period of life
puberty
128
what is the usual course of trichotillomania
chronic
some waxing and waning if untreated
symptoms may worsen in females with hormonal changes i.e menstruation, perimenopause
for some, disorder may come and go from weeks/months at a time
minority remit without subsequent relapse after a few years
129
name risk factors for trichotillomania
genetic vulnerability
more common in those with OCD and their first degree relatives
130
how might you differentiate trichotillomania from other types of hair loss if the person does not admit to hair pulling
(usually people admit to the hair pulling so this is not necessary)
can do skin biopsy or dermoscopy--> would see short vellus hair, decreased hair density, and broken hair with different shaft lengths
131
what are some of the possible medical consequences of trichotillomania
may be irreversible damage to hair growth and hair quality
digit purpura
MSK injury (i.e carpal tunnel)
blepharitis
dental damage due to hair biting
swallowing of hair may lead to trichobezoars--> can lead to anemia, abdo pain, hematemesis, N/V, bowel obstruction, perforation
132
what is tricophagia
swallowing of hair
133
ddx trichotillomania
normative hair removal/manipulation
other OC related disorders
neurodevelopmental disorders
psychotic disorder
another medical condition
SUDs
134
is it trichotillomania if hair removed solely for cosmetic reasons?
no
135
do tics commonly lead to hair pulling
no--> tics rarely lead to hair pulling
136
name a class of substance that may lead to hair pulling
stimulants
less likely that substances are the cause of persistent hair pulling however
137
what are the most commonly comorbid conditions with trichotillomania
MDD
excoriation disorder
138
what are the criteria for excoriation (skin picking) disorder
A--recurrent skin picking resulting in SKIN LESIONS
B--repeated attempts to DECREASE or stop skin picking
C--skin picking causes clinically significant distress or impairment
D--not attributable to substance (i.e cocaine) or medical condition (i.e scabies)
E--not better explained by another mental disorder (i.e delusions or tactile hallucinations, BDD beliefs, NSSI, stereotypies)
139
what are the most commonly picked sites on the body in excoriation (skin picking) disorder
hands
arms
face
*may pick at healthy skin, skin irregularities, lesions like pimples or calluses, scabs from nervous picking
140
what other behaviours may be present in addition to skin picking in excoriation (skin picking) disorder
skin rubbing, squeezing, lancing, biting
141
how much time do people with excoriation (skin picking) disorder tend to spend picking at skin
often significant amounts of time-->sometimes several hours per day
may endure for months or years
142
what is the gender difference in excoriation (skin picking) disorder
3/4 affected are female
143
excoriation (skin picking) disorder is more common in which population
those with OCD or their relatives
144
when does excoriation (skin picking) disorder often begin
around puberty
145
how much time does skin picking generalyl take up in excoriation (skin picking) disorder
most spend at least 1 hour per day picking at skin, thinking about picking and resisting urges to pick
146
ddx excoriation (skin picking) disorder
psychotic disorder
other O-C related disorder
neurodevelopmental disorders
somatic symptoms and related disorders
NSSI
other medical conditions
sub/med induced
147
when might you see skin picking in psychosis
i.e due to delusion like parasitosis or tactile hallucination ie formication
148
what neurogenetic condition may be associated with early onset of skin picking
prader-willi
149
what disorders are commonly comorbid with excoriation (skin picking) disorder
OCD
trichotillomania
MDD
150
criterion A for substance/medication induced O-C and related disorder
obessions, compulsions, skin picking, hair pulling or other body focused repetitive behaviour or other symptoms characteristic of the O-C and related disorders predominate in the clinical picture
(B--> evidence from hx, physical or lab that its related to a sub/med and that that sub/med can cause those symptoms)
151
what substances may be known to cause symptoms that would meet criteria for substance/medication induced O-C and related disorder
stimulants (incl cocaine)
heavy metals and toxins
152
what is Sydenham's chorea
the neurological manifestation of rheumatic fever (due to Group A strep infection)
has motor and nonmotor features
nonmotor features: obsessions, compulsions, attention deficit, emotional lability
153
what would be the diagnosis for someone who presents with Sydenham's chorea/evidence of GAS followed by obsessive and compulsive symptoms?
obsessive-compulsive and related disorder due to another medical condition
*Sydenham's chorea often presents with other signs of the underlying infectious cause like carditis, arthritis, as well as the motor symptoms of chorea
154
name two manifestations of obsessive-compulsive and related disorder due to another medical condition
Sydenham's chorea
PANDAS
disorders leading to striatal damage (i.e stroke)
155
what is PANDAS
a post infectious autoimmune disorder (after strep infection) characterized by sudden onset of obsessions, compulsions, and/or tics accompanied by variety of acute neuropsychiatic symptoms in absence of chorea, carditis, or arthritis
*remains controversial dx though there is body of evidence for it
*PANS/CANS are modified versions of PANDAS removing the GAS etiological requirement
156
list some disorders that would fall under the "other specified O-C and related disorders" category
1. body dysmorphic-like disorder with actual flaws
2. body-dysmorphic like disorder without repetitive behaviours
3. body-focused repetitive behaviour disorder
4. obsessionla jealousy
5. shubo-kyofu
6. koro
7. jikoshu-kyofu
157
what is obsessional jealousy
nondelusional preoccupation with partner's perceived infidelity
may lead to repetitive behaviours or mental acts in response to the infidelity concerns and cause clinically significant distress/impairment
158
what is "shubo-kyofu"
variant of taijin kyofusho--> similar to BDD--> excessive fear of having a bodily deformity
159
what is "jikoshu-kyofu"
variant of taijin kyofusho--> fear of having an offensive body odor
aka olfactory reference syndrome
