Obsessive Compulsive Disorder

Question 1

What are obsessions?

Answer 1

These are recurrent and persistent thoughts, urges or images that are experienced as intrusive or unwanted and cause marked distress
The patient usually attempts to ignore the obsessions by performing a compulsion

Question 2

What are compulsions?

Answer 2

These are repetitive behaviours like handwashing, ordering, checking or mental acts (like praying, counting, repeating words silently) that the person feels driven top perform in order to control the obsession

Question 3

What is the DSM V Diagnosis of OCD?

Answer 3

1. The presence of obsessions or compulsions or both
2. The obsessions or compulsions are time consuming and take more than 1 hour per day or causes impairment in important areas of functioning or in social or occupational areas
3. The obsessive compulsive symptoms are not due to another another medical condition or the physiological effects of substances
4. The disturbance is not better explained by another mental disorder

Question 4

What is the treatment of OCD?

Answer 4

1. SRI’ like clomipramine
2. SSRI’s
3. CBT-we use techniques which exposes the patient to the fear like placing hands in dirt to desensitize them. Involving family is also particularly helpful

Question 5

What doses do we give of the meds and why?

Answer 5

We need higher doses for us to see effects in OCD

• We can give fluoxetine-60mg daily
• paroxetine 60mg daily
• sertraline 200mg daily
• TCA(clomipramine) up to 250mg daily

Question 6

What percentage of patients with OCD cannot handle the subsequent side effects?

Answer 6

60% and these patients can try rTMS(Repetitive transcranial stimulation) and deep brain stimulation (DBS)

• RTMS is non-invasive and is usually more effective in patients with depression than OCD
• Deep brain stimulation is a surgical procedure that involves inserting a brain pacemaker that sends electrical impulses to specific parts in the brain