Obsessive compulsive disorder Flashcards
Define OCD.
presence of either obsessions or compulsions, but commonly both. Sx cause significant functional impairment +/ or distress.
What are obsessions and compulsions?
Obsessions: Recurrent unwanted intrusive thoughts, images, or urges, causing anxiety/ distress
Compulsions: repetitive behaviors/ mental acts the person feels driven to perform. Overt + observable or covert mental act that can’t be observed
What are 3 risk factors for OCD?
Genetic
Psychological trauma
Paediatric AI neuropsychiatric disorder a/w group A streptococcal infection (PANDAS)
OCD is associated with which other conditions?
Anankastic personality disorder
Depression
Schizophrenia
Sydenham’s chorea
Tourette’s syndrome
Anorexia nervosa
What characterises obsessions in OCD
SUTURE:
- Self-recognised as a product of own mind
- Unpleasantly repetitive
- Themed
- Unpleasurable to think about
- Resisted unsuccessfully at least once
- Egodystonic
What are examples of obsessions and compulsions?
O’s: contamination, bodily fluids, harm, forbidden thoughts, orderliness + symmetry.
C’s: cleaning, checking, counting, hoarding.
Time consuming >1h/ day or interfere substantially with functioning
What 6 screening questions can be used in OCD?
Do you wash or 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 cannot?
Do your daily activities take a long time to finish?
Are you concerned about putting things in a special order, or are you upset by mess?
Do these problems trouble you?
What formal screening tool can be used for OCD?
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
How can severity of OCD be assessed?
Ask about the effects on work or school, relationships, social life, + QoL
What is the management for mild OCD?
Low-intensity psychological Tx via IAPT:
CBT inc. exposure + response prevention (ERP)
If insufficient, offer SSRI or more intensive CBT (inc. ERP)
What is the management for moderate OCD?
SSRI (or clomipramine, TCA) or more intensive CBT (including ERP)
Clomipramine or SSRIs are efficacious in 50-80%.
Which SSRI is specifically indicated in body dysmorphic disorder?
Fluoxetine
What is the management for severe OCD?
Refer to secondary care mental health team for assessment
Whilst awaiting appointment: offer combined Tx with an SSRI/ Clomipramine + CBT (inc. ERP)
What formal screening tool can be used for OCD?
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
