Obsessive Compulsive Disorder Flashcards

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1
Q

Michael has for years been afraid that electrical appliances, if not switched off, could cause a fire and harm his family or neighbours. He spends four hours a day checking that they are switched off. How would you assess and manage?

A

Impression
Given the obsessions around fire etc, and compulsive checking behaviours in response which are impairing function given the four hours daily of checking, this most likely represents a presentation of OCD.

DDX

  • Anxiety: hypochondriasis, GAD
  • Personality: OCPD
  • psychotic disorder - could represent delusional
  • Comorbids: ED, depression, SUD

Priorities
- complete psych assessment (H/E/I)

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2
Q

OCD - History

A

History

  • sx: OCD diagnostic criteria: 1 - obsessions, and/or 2 compulsions, significantly distressing or impairing function, egodystonic (the patient is distressed by them)
  • screen for patients personality
  • other anxiety symptoms,
  • screen suicide, mania, depression, SUD, violence, personality
  • rest of
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3
Q

OCD - Examination

A

Examination

  • MSE
  • signs related to compulsions: eczematous eruptions due to excessive washing, hair loss related to compulsive pulling, excoriation’s due to compulsive skin picking)
  • Case formulation
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4
Q

OCD - Investigations

A

Investigations

  • nil required for diagnosis of OCD
  • only for ruling out organic causes, investigating co-morbid conditions
  • Severity scale: Y-BOCS scale, establishes a baseline of patients symptoms and assess their severity
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5
Q

OCD - Management

A

Management
First line treatment is CBT +/- SSRIs. the illness tends to be chronic and refractory, higher doses of SSRI’s required to treat

Psychological

  • CBT
  • gradual exposure and response prevention therapy: over time get exposed and desensitised to them. Start with least threatening fear regarding obsession and get them to work through, create strategies for dealing with compulsions.

Biological
- SSRI, start at 1/2 dose to MDD, but end dose tends to be higher
- TCA if no response to SSRI
Social

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