Obsessive Compulsive Disorder

Question 1

What are the symptoms of OCD?

Answer 1

> Obsessional thoughts
> Obsessional imagery 
> Doubting 
> Obsessional impulses
> Contamination
> Phobias

Question 2

What are compulsions?

Answer 2

An almost irresistible need to perform certain acts or thoughts in an effort to reduce anxiety

Question 3

What are some common examples of compulsions?

Answer 3

> Checking rituals
Cleaning rituals
Obsessional slowness
~55% of normal population acknowledges compulsive behaviours

Question 4

What is the OCD cycle?

Answer 4

> Obsessions
> Anxiety
> Compulsions
> Relief
> Repeat

Question 5

During assessment of OCD what must clinicians be aware of?

Answer 5

> Conceal symptoms
Comorbid with Tourette’s
Children may develop OCD after streptococcal infection
Pregnant women may develop or increase symptoms

Question 6

What information is used when making an OCD assessment?

Answer 6

> General medical history
> Yale-Brown obsessive-compulsive scale
> Patient's own thoughts/theories
> Family history
> Brain imaging

Question 7

What are the different proposed aetiologies for OCD?

Answer 7

> Psychological disorder
Social disorder
Biological disorder

Question 8

What are the different dimensions of OCD onset?

Answer 8

> Biological dimension
Psychological dimension
Social dimension
Sociocultural dimension

Question 9

What are the features of the biological dimension of OCD onset?

Answer 9

> Dysregulation of orbital frontal caudate circuit
Lower activation of cingulate cortex
Subgroups differ on genetic and biological involvement

Question 10

What are the features of the psychological dimension of OCD onset?

Answer 10

> Lack of trust in own performance
Impulse control conflicts
Anxiety reduction
Immoral thoughts equivalent to behaviour

Question 11

What are the features of the social dimension of OCD onset?

Answer 11

Social vulnerabilities (divorce, separation, unemployment)

Question 12

What are the features of the sociocultural dimension of OCD onset?

Answer 12

> No gender differences
Childhood onset more common in males
Children do not usually request help

Question 13

What are the psychological theories of OCD?

Answer 13

> Psychodynamic theory

> Personality (axis I v axis II)

Question 14

What does the psychodynamic theory of OCD propose?

Answer 14

That OCD is a regression to anal phase

Question 15

What does the personality theory of OCD propose?

Answer 15

> OCD likelihood is dependant on personality type

> ~ 25% with OCD have OCPD

Question 16

What does the behavioural theory of OCD propose?

Answer 16

> Classical conditioning (innocuous stimulus to stress responses)
Operant conditioning (Compulsions develop through anxiety reduction)

Question 17

What did Beck’s Schemata propose?

Answer 17

> Indiv diff in operation of schemata underlies vulnerability to mood disorders
Emotional material requires more processing (biased attention)

Question 18

What are the types of core belief present in depression?

Answer 18

> Helpless core beliefs
Unlovable core beliefs
Worthless core beliefs

Question 19

What are the types of core beliefs present in anxiety?

Answer 19

> Self core beliefs
Others core beliefs
Future core beliefs

Question 20

What is Beck’s Cognitive Specificity Hypothesis?

Answer 20

The main cognitive explanation for OCD

Question 21

What are the features of Beck’s Cognitive Specificity Hypothesis?

Answer 21

> Depression (views and core believes)

> Anxiety (overestimation of threats, lack of control)

Question 22

What are the cognitive biases underlying OCD?

Answer 22

> Amnesiac deficit hypothesis
Overestimation of threat / Inflated responsibility
Beliefs about the importance of, and need to control, intrusive thoughts

Question 23

What are the biological explanations for OCD?

Answer 23

> Serotonin and Dopamine Hypotheses
Neuroimmunology
Genetics
Structural abnormalities

Question 24

What does the neuropathological framework of OCD propose?

Answer 24

OCD is a result of abnormalities in:
> Serotonin systems (hypofunction in basal ganglia)
> Dopamine systems (hyperfunction in prefrontal cortex)
> Glutamate systems

Question 25

What evidence is there of a genetic component to OCD?

Answer 25

> Bolton et al (2007)
Comorbidity with tic and anxiety disorders
29-47% heritability
No gender differences
Complex pattern of inheritance
Neurotransmitter gene systems
Environmental factors also transmit within families

Question 26

What differences have been observed between OCD populations and ‘healthy’ controls?

Answer 26

> Problems in pathways between frontal lobe and deep brain structures
>OCD have increased activity in:
   -> Orbitofrontal cortex
   -> Cingulate cortex
   -> Caudate nucleus
   -> Thalamus

Question 27

What did Bannich and Compton demonstrate?

Answer 27

In OCD prefrontal ganglia loops are overactive

Question 28

What are the treatments for OCD?

Answer 28

> Behaviour therapy
CBT
Medication (SSRIs)
Surgery

Question 29

What are the different types of behaviour treatment for OCD?

Answer 29

> Exposure

> Flooding

Question 30

What are the limitations of the biological treatments of OCD?

Answer 30

> Side effects

> High rate of relapse

Question 31

What are the different types of neurosurgery used to treat OCD?

Answer 31

> Capsulotomy
Cingulatomy
Deep brain stimulation