Obsessive Compulsive Disorder Flashcards
What are the symptoms of OCD?
> Obsessional thoughts > Obsessional imagery > Doubting > Obsessional impulses > Contamination > Phobias
What are compulsions?
An almost irresistible need to perform certain acts or thoughts in an effort to reduce anxiety
What are some common examples of compulsions?
> Checking rituals
Cleaning rituals
Obsessional slowness
~55% of normal population acknowledges compulsive behaviours
What is the OCD cycle?
> Obsessions > Anxiety > Compulsions > Relief > Repeat
During assessment of OCD what must clinicians be aware of?
> Conceal symptoms
Comorbid with Tourette’s
Children may develop OCD after streptococcal infection
Pregnant women may develop or increase symptoms
What information is used when making an OCD assessment?
> General medical history > Yale-Brown obsessive-compulsive scale > Patient's own thoughts/theories > Family history > Brain imaging
What are the different proposed aetiologies for OCD?
> Psychological disorder
Social disorder
Biological disorder
What are the different dimensions of OCD onset?
> Biological dimension
Psychological dimension
Social dimension
Sociocultural dimension
What are the features of the biological dimension of OCD onset?
> Dysregulation of orbital frontal caudate circuit
Lower activation of cingulate cortex
Subgroups differ on genetic and biological involvement
What are the features of the psychological dimension of OCD onset?
> Lack of trust in own performance
Impulse control conflicts
Anxiety reduction
Immoral thoughts equivalent to behaviour
What are the features of the social dimension of OCD onset?
Social vulnerabilities (divorce, separation, unemployment)
What are the features of the sociocultural dimension of OCD onset?
> No gender differences
Childhood onset more common in males
Children do not usually request help
What are the psychological theories of OCD?
> Psychodynamic theory
> Personality (axis I v axis II)
What does the psychodynamic theory of OCD propose?
That OCD is a regression to anal phase
What does the personality theory of OCD propose?
> OCD likelihood is dependant on personality type
> ~ 25% with OCD have OCPD
What does the behavioural theory of OCD propose?
> Classical conditioning (innocuous stimulus to stress responses)
Operant conditioning (Compulsions develop through anxiety reduction)
What did Beck’s Schemata propose?
> Indiv diff in operation of schemata underlies vulnerability to mood disorders
Emotional material requires more processing (biased attention)
What are the types of core belief present in depression?
> Helpless core beliefs
Unlovable core beliefs
Worthless core beliefs
What are the types of core beliefs present in anxiety?
> Self core beliefs
Others core beliefs
Future core beliefs
What is Beck’s Cognitive Specificity Hypothesis?
The main cognitive explanation for OCD
What are the features of Beck’s Cognitive Specificity Hypothesis?
> Depression (views and core believes)
> Anxiety (overestimation of threats, lack of control)
What are the cognitive biases underlying OCD?
> Amnesiac deficit hypothesis
Overestimation of threat / Inflated responsibility
Beliefs about the importance of, and need to control, intrusive thoughts
What are the biological explanations for OCD?
> Serotonin and Dopamine Hypotheses
Neuroimmunology
Genetics
Structural abnormalities
What does the neuropathological framework of OCD propose?
OCD is a result of abnormalities in:
> Serotonin systems (hypofunction in basal ganglia)
> Dopamine systems (hyperfunction in prefrontal cortex)
> Glutamate systems
What evidence is there of a genetic component to OCD?
> 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
What differences have been observed between OCD populations and ‘healthy’ controls?
> Problems in pathways between frontal lobe and deep brain structures >OCD have increased activity in: -> Orbitofrontal cortex -> Cingulate cortex -> Caudate nucleus -> Thalamus
What did Bannich and Compton demonstrate?
In OCD prefrontal ganglia loops are overactive
What are the treatments for OCD?
> Behaviour therapy
CBT
Medication (SSRIs)
Surgery
What are the different types of behaviour treatment for OCD?
> Exposure
> Flooding
What are the limitations of the biological treatments of OCD?
> Side effects
> High rate of relapse
What are the different types of neurosurgery used to treat OCD?
> Capsulotomy
Cingulatomy
Deep brain stimulation
