Obsessive compulsive disorder (OCD) Flashcards
What is OCD? What is the difference between obsessions and compulsions?
This disorder is characterised by the presence of obsessions and compulsions which causes distress
- Obsessions = recurrent, unwanted and intrusive thoughts/ images/ impulses in one’s mind, despite attempts to resist them; patient aware that this is a product of their own mind
- Compulsions = repeated and seemingly purposeful rituals that are carried out to neutralise an obsession and reduce anxiety
How common is OCD? Who is it more common in?
- 1-2%
- F = M
What is the aetiology of OCD?
Aetiology is multifactorial.
Biological:
- Basal ganglia defects
- Frontal lobe abnormalities
- FH - MZ:DZ is 50-80% concordance, 35% of first degree relatives
- Other metal health conditions
Psychosocial:
- Personality traits: anankastic
- Psychological trauma
- Stress
List 3 conditions which OCD is associted with.
- depression (30%)
- schizophrenia (3%)
- Sydenham’s chorea
- Tourette’s syndrome
- anorexia nervosa
How often must symptoms be present to diagnose OCD?
- symptoms must be present on most days for >1hr/day for at least 2 weeks
- AND must be the source of distress or interference with activities.
Are the thoughts in OCD the patient’s own?
Yes they are the patient’s own thoughts. They are recognised to be irrational but cause intense discomfort. Anxiety increases as compulsive acts are resisted.
What are the most common themes in OCD?
In order:
- checking compulsions 63 %
- washing 50 %
- fears of contamination 45 %
- obsessive doubts 42 %
- bodily fears 36 %
- counting 36 %
- insistence on symmetry 31 %
- aggressive thoughts 28 %
What are the two categories of compulsions?
Overt - and observable by others, such as checking that a door is locked,
Covert - mental act that cannot be observed, such as repeating a certain phrase in one’s mind.
Give 3 common examples of obsessions and compulsions.
Obsessions e.g.
- doubts (not closing windows, door)
- ruminations,
- believing they are always dirty
- impulse to do something dangerous
Compulsions e.g.
- hand-washing,
- checking,
- arranging objects in a certain wa
What is the management of OCD?
1st line:
- Low intensity psychological treatment - CBT with ERP* - up to 10 hours
- +/-SSRI (fluoxetine)
2nd line:
-
SSRI (fluoxetine)
- Continue for 12 months after remission
- +/- more intense CBT + ERP
3rd line:
- After 12 weeks: clomipramine (TCA) or alternative SSRI
- CBT + ERP
Resistant: - psychosurgery (rare) - anterior cingulotomy
ERP = exposure and response prevention
What is the SSRI of choice in OCD? What happens if it is not effective? How long should it be continued?
- Fluoxetine
- Continue for 12 months after remission
- It after 12 weeks no effect - different SSRI or clomipramine (highly serotonergic TCA)
What does ERP involve?
- Compulsions are analogous to escape in phobias
- CBT aims to prevent compulsive behaviour, allowing the tolerated anxiety to habituate
- E.g. someone with obsessions about contamination is supported to touch something dirty and instead of immediately washing their hands, they are encouraged to experience anxiety and discuss it with the therapist
- A hierarchy of feared situations is used
- Effective in well-motivated patients
Give examples of low-intensity psychological therapies that can be used for OCD.
- Brief individual CBT (including ERP) using structured self-help materials
- Brief individual CBT (including ERP) by telephone
- Group CBT (including ERP)
What are overvalued ideas in OCD?
Describes thought content: a reasonable belief that is pursued excessively, dominates the person’s life and causes distress to self/others e.g. beliefs about body shape. They are not unusual or bizzare beliefs and are socially acceptable.
What must you show has been excluded when documenting presence of overvalued ideas?
Must exclude delusions
