Obsessive compulsive disorder

Question 1

Define OCD.

Answer 1

Anxiety disorder in which patient suffers from time soncuming anxieties and obsessions interfering with daily life.

Question 2

What are risk factors for OCD?

Answer 2

Some genetic basis (serotonin dysfunction) frontal cortex and basal ganglia abnormalities.

Psychoanalytical models see symptoms as outlets for conflicting desires and drives.

Question 3

Summarise the epidemiology of OCD.

Answer 3

Associated with anankastic personality trait, comorbid depresion, schizophrenia, tics, Tourette’s. Lifetime prevalence 2-3%. Onset early 20s.

Question 4

What are signs and symptoms of obsessive compulsive disorder?

Answer 4

Obsessions AND compulsions present in most days for >2wk, not acocunted for by presence of another mental illness. These O and Cs are:

• Acknowledged as originating in the mind
• Persistent, repetitive and intrusive
• Patient tries to resist them
• Not intrinsically pleasurable
• Cause distress and interfere with functioning.

Obsessons: Persistent thoughts or ideas i.e. contamination, bodily fears, aggression, orderliness and symmetry.

Compulsions are stereotyped acts, that cause tension in patient if resisted. These include cleaning, checking, counting, hoarding.

Poor concentration if distracted by unwanted thoughts. May show increasing signs of anxiety if prevented from compulsions. Patient aware of the own and excessive thoughts.

Question 5

What are investigations for OCD?

Answer 5

FBC

U+Es

LFTs

Ca2+

TFTs

Question 6

What is the management for OCD?

Answer 6

Behavioral therapy: Exposure and response prevention. Clomipramine or SSRIs are efficacious in 50-80%. Lack of response > add antipsychotic.

Severe OCD with life disruption that is non-responsive to treatment may benefit from psychosurgery.

Question 7

What are complications associated with OCD? What is the prognosis for OCD?

Answer 7

Worse prognosis if male, early onset, severe symptoms, premorbid obsessive PD.