Obsessive compulsive disorder

Question 1

Diagnostic criteria symptom duration should be?

Answer 1

At least 2 successive weeks

Question 2

What are the diagnostic criteria of OCD?

Answer 2

Obsessions
1. Recurrent and persistent thoughts, urges, images that are experienced,as intrusive and unwanted, causing marked anxiety/distress

2. Individual attempts to ignore/suppress such thoughts, urge, images/ neutralize them with some other thought/ action

and/or

Compulsions
1. Repetitive behaviours/ mental acts that the individual feels driven to perform in response to an obsession or according to rule that must be applied rigidly.

2. Aimed at preventing/ reducing anxiety or distress, or preventing some dreaded event/ situation; but serve no realistically useful purpose or are clearly excessive

+
Severity (time-consuming/ distress or impairment in social, occupational, other important areas of functioning)

+
- exclude SA, other medical condition

Question 3

OCD diagnosis shall be specified with if? (2)

Answer 3

1. with good/fair/poor/absent insight

2. tic-related (current/past)

Question 4

What is ego-dystonic?

Answer 4

= resisted (in OCD)

Question 5

What is the diagnosis for these features?

1. Enduring behavior pattern of rigidity, doubt, perfectionism, pedantry
2. Thoughts are ego-syntonic

Answer 5

• ego-syntonic = thoughts are not resisted
• OCPD (obsessive compulsive personality disorder)

(personality disorder that’s characterized by extreme perfectionism, order, and neatness.)

Question 6

Is morbid fear of fatness a overvalued idea or a delusion?

Answer 6

overvalued idea

> > > Eating disorder

• not recognised by patient as excessive/ unreasonable
• ego-syntonic

Question 7

List 4 DDx from OCD that are obsession predominant.

Answer 7

1. Depressive disorder
   - OC symptoms occur simultaneously with/ after onset of depression and resolve with treatment
2. Phobias, GAD
3. Hypochondriacal disorder (fear of having serious disease)
4. Schizophrenia (thought insertion, lack of insight)

Question 8

List 2 DDx from OCD that are compulsion predominant.

Answer 8

1. Habit and impulse control disorder (pathological gambling, kleptomainia, trichotillomania)
   - repetitious impulses and behaviour, ego-syntonic
2. Tourette’s
   - motor and vocal tics, echolalia, coprolaqlia

Question 9

What are the 4 characteristics of obsessions?

Answer 9

1. Repetitive
2. Involuntary despite resistance
3. Recognize as from own mind
4. Irrational
5. Distress

Question 10

Characteristics of compulsions? (4)

Answer 10

1. In response to the obsession
2. For prevention and reduction of anxiety
3. Clearly excessive
   - time-consuming
   - stereotype
   - endured with distress
4. Irrational but ego-dystonic

Other themes:

• checkers
• counter
• arranger

Question 11

Management of OCD?

Answer 11

1. Psychological
   - CBT: ERP = Exposure and response prevention
   - Behaviour: prevent ritualistic behaviour
2. Pharmacological
   - First line: SSRI > escitalopram/ fluoxetine/ sertraline/ paroxetine

• Second line: TCA > clomipramine
• Augmentation: antipsychotics

3. Physical:
   - ECT if severe suicidal
   - DBS (deep brain stimulation) if servere refractory
   - TMS (transcranial magnetic stimulation)

Question 12

Differences between OCD and OCPD? (3)

Answer 12

1. Age of onset
   - OCD: adult
   - OCPD: since young
2. Characteristics
   - OCD: obsessions are intrusive, unwanted and cause marked anxiety
   - OCPD: pervasive pattern of preoccupation fo with orderliness, perfectionism, mental and interpersonal control
3. Resistance
   - OCD: ego-dystonic, initial resistance
   - OCPD: ego-syntonic

Question 13

Why is SSRI useful in OCD?

Answer 13

1. useful for any comorbid depressive symptoms

2. may be helpful in relieving sleep disturbance due to sedative effects in the long term