OCD

Question 1

Prevalence

Answer 1

1%

Question 2

Onset

Answer 2

Typically childhood: 8 to 11

more common in boys until adolescents

Question 3

Treatment

Answer 3

CBT and SSRI

Question 4

Obsession

Answer 4

• Recurrent thoughts, images, or impulses that are ego-dystonic, intrusive, and acknowledged as senseless.
• Generally accompanied by negative affect, such as fear, disgust, doubt, or a feeling of incompleteness, and so, are distressing to the affected individual.

Question 5

Compulsions

Answer 5

• Way of reducing or neutralizing negative affect by performing compulsions, which are repetitive, intentional, and purposeful behaviors performed in response to an observable, repetitive behaviors, such as washing or checking, but they can also be covert mental acts, such as counting or replacing an intrusive thought with a “good” thought.
• Negative reinforcement

Question 6

Most common obsessions in children

Answer 6

fears of harm or other negative outcomes to self and others and concerns with germs, contamination and illness.

Question 7

Most common compulsions in children

Answer 7

Excessive washing, cleaning, and checking are the most commonly seen compulsions, although excessive or ritualized repeating, arranging and ordering, confessing and seeking reassurance are also common.

Question 8

Comorbdity

Answer 8

anxiety, mood disorder, OC spectrum, and externalizing disorders

tic

Question 9

Natural Course

Answer 9

40% of youngsters with OCD meet criteria when 15 years old.

Question 10

Asssesment

Answer 10

• Comprehensive
• Survey history of OCD symptoms and current OCD symptom severity (Children’s yale brown obsessive compulsive scale checklist and severity scale)
• Review Medical Reccords (could be tic or PANDAS)

Question 11

Relatedness to PANDAS

Answer 11

• Two prospectively documented episodes of exacerbations in OCD and tic symptoms associated with streptococcal infection.
• Proves that OCD is a neurobehavioral disorder likely to have various biological precipitants and underpinnings, and is certainly not the result of bad parenting, stubborn children, etc.

Question 12

Evidenced Based Treatments

Answer 12

CBT
- Effective for individual and group and it’s durable
- CBT may prevent relapse to medication discontinuation
- Poorer response to CBT was associated with a higher baseline CY-BOCS
- Controlled outcome trials
o Individual cognitive therapy more effective than group
o CBT and psychosocial comparison condition
o CBT more efficacious than clomipramine (no placebo or control group?)
o Pediatric OCD Treatment Study (POTS)\
study CBT effective with or without medication

Exposure and Ritual Prevention (EX/RP)
• Exposure reducing phobic anxiety
• Response prevention reducing rituals
• So you expose the person to their fears slowly then prevent them from committing the ritual tasks

Question 13

Abromowitz et al., (2005)

Answer 13

used 28 studies in metaanalysis of SRI and ERP…both very effective (large effect size .99)

Question 14

Natural course of OCD

Answer 14

waxing and waning presentation.