Obsessive Compulsive Disorder (OCD) Flashcards
What is obesseive-compulsive disorder (OCD)?
Obsessive– compulsive disorder (OCD) is characterised by recurrent obsessional thoughts or compulsive acts, or commonly both. It is ranked by the WHO as one of the top ten most disabling illnesses in terms of impact upon quality of life.
What are obsessions?
Obsessions: unwanted intrusive thoughts , images or urges that repeatedly enter the individual’s mind. They are distressing for the individual who attempts to resist them and recognizes them as absurd (egodystonic) and a product of their own mind.
What are compulsions?
Compulsions: repetitive, stereotyped behaviours or mental acts that a person feels driven into performing. They are overt (observable by others) or covert (mental acts not observable).
Briefly describe the pathophysiology/ aetiology of OCD
Biological
- Related to ↓ serotonin and abnormalities of the frontal cortex and basal ganglia.
- Twin and family studies suggest a genetic contribution to OCD particularly with paediatric onset.
- Childhood group A beta-haemolytic streptococcal infection may have a role in causing OCD symptoms by setting up an autoimmune reaction which damages the basal ganglia (this is called PANDAS).
Psychoanalytic
- Filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering consciousness.
Behavioural
- Compulsive behaviour is learned and maintained by operant conditioning. The anxiety created by the obsession is reduced by performing the compulsion, and subsequently the need to perform the compulsion is increased.
What other psychiatric conditions is OCD linked to?
OCD has strong associations with other psychiatric disorders:
- Depression (30%)
- Schizophrenia (3%)
- Sydenham’s chorea
- Tourette’s syndrome
- Anorexia nervosa
How common is OCD?
The prevalence of OCD ranges from 0.8– 3%.
Who is commonly affected by OCD?
It is most common in early adulthood and is equally common in ♂ and ♀ .
OCD is more common in the relatives of OCD patients than it is in the general population.
What factors may contribute to development of OCD?
Carrying out the compulsive act (e.g. washing) is likely to exacerbate the obsession and is thus a maintaining factor.
Developmental factors such as neglect, abuse, bullying and social isolation may have a role.
Briefly descrieb the ICD-10 Criteria for the diagnosis of OCD
A. Either obsessions or compulsions (or both) present on most days for a period of at least 2 weeks.
B. Obsessions (thoughts, ideas or images) or compulsions (acts) share a number of features (see Clinical features ), all of which must be present.
C. The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.
Note: the diagnosis can be specified as ‘predominantly obsessional thoughts or ruminations’, ‘predominantly compulsive acts’, or ‘mixed obsessional thoughts and acts’.
Give examples of obsessions and compulsions
Obsessions
- Contamination (e.g. from dirt, viruses, germs, bodily fluids)
- Fear of harm (e.g. door locks not safe)
- Excessive concern with order or symmetry
- Others: sex, violence, blasphemy, doubt
Compulsions
- Checking e.g. gas taps, water taps, doors (O)
- Cleaning, washing (O)
- Repeating acts e.g. counting (C), arranging objects (O)
- Mental compulsions e.g. special words repeated in a set manner (C)
- Hoarding (O)
Note: C= covert; O= overt
What is the most common obbsession and compulsion?
The most common obsession is that of being contaminated (38%) and the most common compulsion is checking (29%) followed closely by washing/ cleaning (27%).
What 4 features must obsessions and compulsions follow?
Note: FORD Car
Obsessions or compulsions must share all of the following features (FORD Car):
- Failure to resist: at least one obsession or compulsion is present which is unsuccessfully resisted.
- Originate from patient’s mind: acknowledged that the obsessions or compulsions originate from their own mind, and are not imposed by outside persons or influences.
- Repetitive and Distressing: at least one obsession or compulsion must be present which is acknowledged by the patient as excessive or unreasonable.
- Carrying out the obsessive thought (or compulsive act) is not in itself pleasurable, but reduces anxiety levels.
Briefly describe the OCD cycle
Obsessions create anxiety which continues to build until a compulsion is carried out in order to provide relief . This vicious cycle is known as the OCD cycle.
Briefly describe the MSE for OCD
Patient may be on edge (easily startled). May look visibly worried or lost in thought. May be constantly checking doors or fidgety with hands (as they can’t wash them).
May demonstrate increasing levels of anxiety if unable to succumb to compulsion.
Thoughts are unwanted, intrusive and uncomfortable for the patient.
Obsessions can be distracting and lead to poor concentration.
Insight is usually very good (as they recognise the thoughts are a product of their own mind).
What questionnaires can be used to assess OCD?
Yale-Brown obsessive-compulsive scale (Y-BOCS).
10-item questionnaire with each item graded from 0– 4; e.g. Time occupied by obsessive thoughts (0 = none, 4 = extreme, >8 hours/day).
