Obsessive Compulsive Disorder Flashcards
Define obsessive compulsive disorder
Recurrent obsessional thoughts or compulsive acts, or commonly both, which may cause significant functional impairment and/or distress
Define obsession
unwanted, intrusive thought, image, or urge that repeatedly enters the person’s mind, and usually causes marked anxiety or distress
Define compulsion
Repetitive behaviours or mental acts that the person feels driven by their obsession(s) to perform. A compulsions can be either overt and observable, or a mental act that cannot be observed
What are the risk factors for OCD
FHx of OCD (First-degree relatives)
Age: peak ages are 10 years and 21 years, rare over 30
Past events:
Emotional, physical, sexual abuse
Neglect
Social isolation
Bullying
Pregnancy*
Give examples of common obsessions in OCD
Contamination from dirt, germs, viruses (e.g. HIV), bodily fluids or faeces, chemicals, sticky substances, dangerous materials (e.g. asbestos).
Fear of harm.
Excessive concern with order or symmetry.
Superstition, fear of ‘bad’ numbers ‘magical’ thinking, religious obsessions.
‘Forbidden’ thoughts or images (such as being a paedophile, blasphemy, violence, sexual or criminal acts, harm to others, harming own baby).
Give some examples of common compulsions in OCD
Repetitive hand washing — due to fear of contamination.
Checking (e.g. that doors are locked, electrical items unplugged, gas taps are off) — due to fear of harm to self or others.
Ordering, arranging, and/or repeating — due to excessive concern with order or symmetry.
Mental compulsions (e.g. special words or prayers repeated in a set manner, asking for forgiveness, excessive counting) — due to religious beliefs, ‘magical’ thinking, superstitions.
Memory checking and avoidance of triggers — due to concerns about ‘forbidden’ thoughts or images.
What are the features of OCD in children and young people
Young children’s obsessional thoughts are more likely to include ‘magical’ or superstitious thinking (e.g. If I don’t count up to 20, my parents will die).
Members of the family are almost always involved in a young person’s compulsive rituals.
What are some physical symptoms that may occur due to OCD
Dermatological symptoms e.g. from excessive washing
Genital or anal symptoms e.g. from excessive checking or washing
General stress e.g. losing a job due to repeated lateness or issues with interpersonal relationships
Doubts about contracting HIV
What questions should you ask to assess OCD
Is there any thought that keeps bothering you that you would like to get rid of, but cannot?
Do you wash or clean a lot?
Do you check things a lot?
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 is the effect of these behaviours on work, school, relationships, social life, and quality of life
What are the differentials for OCD
Obsessive compulsive personality disorder
Body dysmorphic disorder
Somatic symptom disorder
Hypochondriasis
Delusional disorder
Autism spectrum disorder
What investigations are done for OCD
Clinical diagnosis using ICD-10 or DSM-5
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess severity
What is the management for mild, moderate and severe OCD
Mild: Education and refer to IAPT
Moderate: education, refer directly for CBT/ERP OR offer SSRI
Severe: Refer to secondary care mental health team for assessment and offer SSRI and CBT/ERP while waiting
What is the biological management for OCD
First line: SSRIs e.g. fluoxetine, fluvoxamine, paroxetine, sertraline
Second line: Clompiramine
AND 1 week follow up due to risk of suicidal thinking/self-harm <30yo
If low risk → review drug and side effects every 2-4 weeks in the first 3 months and every 3 months thereafter
Usually requires a long treatment of at least 12 weeks
What is the psychological treatment for OCD
Refer or recommend self-referral to IAPT
→ Low intensity CBT AND Exposure and response prevention (ERP)
What is the social management for OCD
Education - offer leaflets e.g. MIND, Royal college of psychiatrists
