OCD Flashcards
What is the ICD definition of OCD
Reccurent obsessional thoughts OR/AND complusive acts
Must be a source of stress and intefere with ADLS
what are defined as obsessions-involuntary thoughts, imagied, implulses
Self recognised as product of own mind
>1 thought cannot be resisted
Throughts of carrying the act arent pleasurable
Thoughts must be pleasently repetive
Themed - contamination, agression (self or other), infectioin, sex, religion
Edodystonic-themes agaisnt what person consider themselve
compulsions- repetitve mental/physcal acts
compelled to perform in response to obessions/irrationally defined rules
Performed to reduce anxiety though IRRATIONAL beliefs
ddx- body dysmoprhia, anakastic persolality disorder
if obsession - depressive (becks triad -50% OCD have depression), other anxietty , hypocondria, schizophrenia (delusion)
complusions - habit/impulse disorders
if depression - if sx develop toegether-prioritise first one. if unkown-focus on depression
What are the aetiology and RF of OCD
Aetiology - 1% of pop, M>F (only anxiety to affect men more than women), 70% <25
bio - genetics -3x risk Fhx
Neuro-Basal ganglia implicated and complicated by (eg- syndehams chorea, ecenphelitis, tourettes), Infection
psych- personality -25% have premorbid anakastic personality (rigid)
sx of ocd
Obesssional thougts and compulsions (repeated rituals) tensions/discomfort neutralised by compulsions (but the acts arent enjyable in themselves) =find out how many ytimes a day and etc anxiety sx
Ix and key Q of OCD
Ix -bloods =FBC, TSH
Rating scale - yale brown ocd scale
key q/screening q do you wash/clean a lot check time a lot thought that bother you youd want to get rid off daily activities take long to finish> concerned about putting things in special order? corncened with mess? do these issues trouble you?
Mx of OCD
Mild impairement -
CBT and ERP
CBT–
relabel- eg- tell hands are not dirty even if they are
Reatribute -“the ocd is causing me to feel this way, my hands are not actually dirty”
Refocus - indulge in other behaviours to distract from OCD thoughts
Revalue - told to not give importance to OCD thoughts -“its just my stupid ocd ignore it”
Moderate impairment- Intensive CBT with ERP SSRI - continue 12m -Fluoxetine > sertraline depression 20mg, anxiety 40mg OCD 60/80mg -taper after 12m 2nd -SNRI (off label=specialist only) 3rd line --TCA or SSRI (clominapramine) (or off label, specialist only - atypical antipsychotics
Severe -reffer to psych
Prog – 25% significant improve,
50% moderate improve
25 get worse