Obsessive compulsive disorder Flashcards
What is OCD?
common, chronic, disabling disorder marked by obsession/compulsions that are egodystonic and causing distress for patients and families
What are some common obsessions for OCD?
- contamination
- fear of harm
- excessive concern over order/symmetry
- obsession with body/physical symptoms
- religious/sacrireligious/blasphemy thoughts
- sexual thoughts e.g. being a paedophile
- urge to hoard
- thoughts of violence/agression e.g. stabbing a baby
What are some common compulsions for OCD?
- checking
- cleaning/washing
- repeating acts
- mental compulsions
- ordering/symmetry/exactness
- hoarding/collecting
- counting
What are obsessions?
Obsessions are recurrent, intrusive and distressing thoughts/ideas/memories/impulses.
They are unwanted.
They are usually resisted
They originate from own mind
They are associated with emergence or of increase in anxiety
What are compulsions?
- repetitive and seemingly purposeful behaviors that individual feels driven to perform
- physical/mental rituals
- tends to reduce anxiety (resisting tends to increase anxiety)
- irrational
Epidemiology of OCD: lifetime prevalence? 1 year prevalence? F:M? Mean age? Age onset? Peak incidence males/females? assoc. with comorbidities? FH relevant?
Lifetime prevalence - 2.3% (higher in general hosp. population) 1 year prevalence - 1.2% F:M - 1.5:1 Mean age - 20yrs Age onset - any Peak incidence - males 13-15, females 24-35 90% have comorbidities FH increases the chance
What co-morbidities are associated with OCD?
- obsessive compulsive personality disorder
- autism spectrum
- schizophrenia
- hypochondriasis
- body dysmorphic disorder
What is obsessive compulsive personality disorder?
- pre-occupation with rules/lists/schedules
- perfectionism hinders fast completion
- excessive devotion to work
- unable to discard worthless objects
- miserliness
- rigidity and stubbonness
- reluctance to dedicate (need to be in control)
what is the prognosis for OCD?
- 58% qualitative symptom change
- 20% recovered
- 28% mild symptoms
- 48% affected for over 30years
- worse prognosis if male/early onset/tics
Describe the aetiology of OCD with regard to genetics/autoimmunity/neuroimaging?
genetics - MZ vs DZ twins: 63-87% vs 15-45%
autoimmunity - beta haemolytic strep. infection and autoantibodies to basal ganglian
neuroimaging - increase in metabolism and blood flowo in orbitofrontal cortex, caudate nucleus and cingulate cortex
What is the cognitive theory in OCD?
80-90% people experience intrusive thoughts that are:
- less frequent
- shorter duration/intensity
- less stress/distress
- less urge to neutralise
- more easily dismissed
- less egodystonic
what the the three domains of dysfunctional beliefs in OCD?
1 - overestimation of threat/inflated sense of responsibility
2 - belief about importance of, and need to control, intrusive thoughts
3 - perfectionism and intolerance of uncertainty
what is the psychotherapy for OCD called and what does it involve?
Exposure and response prevention - ERP
-deliberate exposure to obsessional stimuli and the prevention of compulsions acts to lessen the distress assoc. with stimuli
= repeated exposure to obsessional cues whilst employing strict response prevention leads to habituation (as the amount of times pt. doesnt check increases, the anxiety decreases)
describe the family/systemic factors of OCD
- heritability of OCD is high, modelling by parents = powerful
- OCD often emerges in childhood/early youth = impacts social development
- there can be family accomodation
- changing behavior/entrenched lifestyle for patient = enormous challenges and potential distress for the family
What are the five screening questions for OCD?
1 - do you wash/clean alot?
2 - Do you check things alot?
3 - Is there any thought that keeps bothering you that you would like to get rid of but cant?
4 - do your dailt activities take a long time to finish?
5 - are you concerned about orderliness or symmetry?
