Obsessive compulsive disorder

Question 1

Definition of obsession

Answer 1

Unwanted intrusive thoughts, images or urges (ego dystonic)

Recurrent and distressing

Question 2

Definition of compulsions

Answer 2

Neutralising behaviours that a person feels driven to do to manage anxiety from obsession

Question 3

Types of compulsion

Answer 3

Overt - others can see

Covert - mental acts

Question 4

Relate OCD to the cognitive behavioural model

Answer 4

Obsession 
Over evaluation of threat 
Negative appraisal = anxiety and avoidance
Compulsion
Focus on obsession maintains cycle

Question 5

ICD10 criteria for OCD

Answer 5

Obsessions or compulsions on most days for >2 weeks
Obsessions or compulsions cause distress or interfere with functioning
Obsessions or compulsions:
Recognised as from own mind
Can’t resist
Repetitive and distressing
Are not pleasurable

Question 6

Common obsessions

Answer 6

Contamination
Need for order or symmetry
Sexual or violent imagery
Fear of harm e.g door looked, gas switched off
Blasphemy

Question 7

Diagnostic questionnaire

Answer 7

Y-BOCS

Question 8

What is ERP

Answer 8

Exposure and response prevention (CBT subtype) - exposure to anxiety trigger and not allowed to perform compulsion

Question 9

Management for mild, moderate and severe OCD

Answer 9

Mild: low intensity psychotherapy e.g self help and group therapy
Moderate: SSRI or ERP
Severe: SSRI and ERP

Question 10

Pharmacological management of OCD

Answer 10

1st line is SSRI
2nd line is clomipramine (TCA)

For severe OCD, combine clomipramine with citalopram