OCD Flashcards
Different underlying neurocircuitry
Anxiety disorders vs OCD
Anxiety Disorders: Weakened amygdala-cortical connectivity - underactivity
OCD: over-active fronto-striatal circuitry - overactivity
Why did OCD separate from anxiety?
Different neurocircuit, symptom patters, comorbidity with ocd spectrum
Obsessions
Recurrent and persistent thoughts, impulses or urges
intrusive and unwanted
Attempts to ignore and suppress, or to neutralize with other thoughts or with actions
Compulsions
Repetitive behaviors or mental acts
That the person feels driven to perform
In response to an obsession or according to rigid rules
OCD epidemiology
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.
Clinical course ocd
Onset 20
Chronic waxing and waning
15% display deterioration (worsening)
Most Delay seeking treatment
Comorbidity of ocd
49% anxiety disorder
27% MDD - Depression as a response to OCD
Biological factors ocd
Genetics: nonspecific heritable component
Dysregulation (overactivation) of brain circuit is associated with OCD
Orbitofrontal cortex -> anterior circulate cortex > caudate nucleus > thalamus
Surgical techniques ocd
Ablation Techniques - effective Ablate sections of OCD- circuit
Deep Brain Stimulation
Craniotomy followed by implantation of electrodes
Two factor learning model of ocd
Obsession: conditioned fear to neutral stimulus
Compulsions: temporary reduction in anxiety-negative reinforcement
Behavioral treatments
ERP - Exposure (of obsession triggers) and ritual preventions - effective especially with meds
What OCD people have that others do not?
Over Importance of thought + Inflated sense of responsibility + Thought-action fusion (if I think about it, it will happen)
Cognitive Behavioral Therapy ocd
Lower drop-out rate 10%
Same reduction in symptom severity as ERP
Fewer studies
Done by testing beliefs
Body dysmorphic Disorder
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
Treatment for body dismorph Dis
Seldom sought - take mirrors away, etc
SSRIs aid
Cognitive behavioral therapy - ERP
Hoarding disord
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
Insight
is important in ocd spectrum disorders
Clinical picture hoarding disorder
Substantial impairment - Danger to self, Danger to others
5%
hard to treat
hoarding is not on Ocd spectrum?
Beliefs are Ego syntonic (delusion) vs. dystonic (in OCD - they don’t want the thoughts)
No rituals
Acquisition associated with positive emotions
no distress
Treatment hoarding
Specialized CBT more effective (not very good though)
Education about hoarding
Cognitive therapy for dysfunctional beliefs
Skills training for organizing, decision-making
Reducing acquisition
