OCD

Question 1

Different underlying neurocircuitry

Anxiety disorders vs OCD

Answer 1

Anxiety Disorders: Weakened amygdala-cortical connectivity - underactivity
OCD: over-active fronto-striatal circuitry - overactivity

Question 2

Why did OCD separate from anxiety?

Answer 2

Different neurocircuit, symptom patters, comorbidity with ocd spectrum

Question 3

Obsessions

Answer 3

Recurrent and persistent thoughts, impulses or urges
intrusive and unwanted
Attempts to ignore and suppress, or to neutralize with other thoughts or with actions

Question 4

Compulsions

Answer 4

Repetitive behaviors or mental acts
That the person feels driven to perform
In response to an obsession or according to rigid rules

Question 5

OCD epidemiology

Answer 5

1.2% a year - 12-month prevalence in general pop
Culture: Similarities across culture
Gender - Boys 2:1 Girls. But in adults it is more common in women.

Question 6

Clinical course ocd

Answer 6

Onset 20
Chronic waxing and waning
15% display deterioration (worsening)
Most Delay seeking treatment

Question 7

Comorbidity of ocd

Answer 7

49% anxiety disorder

27% MDD - Depression as a response to OCD

Question 8

Biological factors ocd

Answer 8

Genetics: nonspecific heritable component
Dysregulation (overactivation) of brain circuit is associated with OCD
Orbitofrontal cortex -> anterior circulate cortex > caudate nucleus > thalamus

Question 9

Surgical techniques ocd

Answer 9

Ablation Techniques - effective Ablate sections of OCD- circuit
Deep Brain Stimulation
Craniotomy followed by implantation of electrodes

Question 10

Two factor learning model of ocd

Answer 10

Obsession: conditioned fear to neutral stimulus
Compulsions: temporary reduction in anxiety-negative reinforcement

Question 11

Behavioral treatments

Answer 11

ERP - Exposure (of obsession triggers) and ritual preventions - effective especially with meds

Question 12

What OCD people have that others do not?

Answer 12

Over Importance of thought + Inflated sense of responsibility + Thought-action fusion (if I think about it, it will happen)

Question 13

Cognitive Behavioral Therapy ocd

Answer 13

Lower drop-out rate 10%
Same reduction in symptom severity as ERP
Fewer studies
Done by testing beliefs

Question 14

Body dysmorphic Disorder

Answer 14

Preoccupation with a perceived defect in physical appearance that is not observable or appears slight to others
+ At some point, the patient has performed repetitive behaviors. 3-8 hrs per day
+ Significant distress or impairment

Question 15

Treatment for body dismorph Dis

Answer 15

Seldom sought - take mirrors away, etc
SSRIs aid
Cognitive behavioral therapy - ERP

Question 16

Hoarding disord

Answer 16

Persistent difficulty discarding possessions regardless of actual value
Perceived need to save items and distress associated with discarding them
For diagnosis: Accumulation of possessions that clutter living areas and compromise their intended use

Question 17

Insight

Answer 17

is important in ocd spectrum disorders

Question 18

Clinical picture hoarding disorder

Answer 18

Substantial impairment - Danger to self, Danger to others
5%
hard to treat

Question 19

hoarding is not on Ocd spectrum?

Answer 19

Beliefs are Ego syntonic (delusion) vs. dystonic (in OCD - they don’t want the thoughts)
No rituals
Acquisition associated with positive emotions
no distress

Question 20

Treatment hoarding

Answer 20

Specialized CBT more effective (not very good though)
Education about hoarding
Cognitive therapy for dysfunctional beliefs
Skills training for organizing, decision-making
Reducing acquisition