OCD Flashcards
What 3 things need to occur before OCD diagnosis is made as per ICD-10?
- Obsessional symptoms or compulsive acts, or both, must be present on most days for at least 2 successive weeks
- interferes with daily life
- Can be diagnosed with OCD by having primarily one over the other
What should the characteristics of the OCD symptoms be?
- Must be recognized as the individual’s own thoughts or impulses
- must be at least one thought or act that is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists
- thought of carrying out the act must not in itself be pleasurable
- the thoughts, images, or impulses must be unpleasantly repetitive.
Define what is characterised as obsessions
- Idea, image or impulse
- These are repetitive or intrusive
- Distressing
- Egodystonic (out of character)
Describe characteristics of compulsions
- Behavior, thought or image which is designed to reduce or prevent the anxiety of the obsessive thought
- Recognised as useless or at least excessive by patient
- Drive to complete the action recognized as the patient’s own and they are aware of it
- Can resist the act at the cost of increasing anxiety
- Anxiolytic – Done to relieve anxiety
What are the most common obsessions?
- Contamination fears – 45%
- Doubting – 42%
- Body fears – 36%
- Symmetry – 31%
- Aggressive thoughts – 28%
- Perfectionism
What are some common compulsions?
- Washing – 50%
- Counting – 36%
- Checking
What is epidemiology for OCD?
- Prevalence: 0.5-2%
- 0.25% in children and adolescents aged 5 to 15 years
- Mean age of onset: 20 years
- 70% have onset before age of 25
- More common in males than females
- Can rarely be presenting features of Sydenham’s chorea and basal ganglia disorders
What is aetiology of OCD?
- More common in monozygotic twins that dizygotic twins - 50-80%: 25%
- 3-7% 1st degree relatives
-Some abnormalities on imaging – reduced caudate size, hypermetabolism in orbitofrontal gyrus and basal ganglia
Why do people with OCD fail to disclose their symptoms and what is the consequence of this?
- fear stigmatization
- low rates of Recognition
- Undertreatment
What other mental health disorders are provided as part of the differential diagnosis for OCD?
- Anxiety
- substance use
- psychotic
- Delusional
- organic
What is the diagnostic criteria for OCD?
- Screen out other mental health conditions such as depression, anxiety and alcohol disorder
- Exclude other conditions which can be misdiagnosed as OCD - autism, eating disorder and illness anxiety disorder
- Assessing severity of functional impairment as mild, moderate or severe to find best management
- Assess risk of suicide and self harm
What is difference between DSM and ICD-10 definitions for OCD?
- dsm lacks specificity with use of “functional impairment” -american criteria
- ICD-10 refers to “interference with activities”
Consequence of having oCD win everyday life?
- May not be able to go work, constantly checking if doors locked
- may not be able to live independently
- can impact health - can’t go hospital cos germs
- relationships - raising children, being attached to children
What does management of OCD depend upon?
- Level of functional development
What are 3 management options for OCD?
- CBT. including exposure response therapy
- SSRI, should only be prescribed to under 18s after assessment and diagnosis by child and adolescent psychiatrist
- Specialist referral
Who is urgent referral reserved for?
- People who are high risk for suicide or self harm
What is first line of treatment for OCD?
- SSRI - High dose
- eg clomipramine
What is alternative to SSRIs?
-Low dose dopamine blockers (antipsychotic medication)
What psychology treatment used for OCD?
- CBT
- specifically ERT
- involves prolonged graded exposure to feared situation with self-imposed prevention response
What does CBT consist of?
- Behaviours
- Emotions
- Thoughts
What does ERP involve?
- Gradual exposure to situations designed to provoke a person’s obsessions
- Hierachy of increasingly anxiety producing situations - resist compulsions.
- Homework
Example of ERP
- Day 1:Watched friend scoop up dog mess
- Day 2:Asked friend to touch hand and arm after they scooped and put dog mess in bin
- Day 3:Asked friend to scoop and carry dog mess bag to the bin, but at the bin placed bag in the bin myself(without hand washing)
- Day 4:Asked friend to scoop, but carried the dog mess bag all the way to the bin and placed it in the bin myself
- Day 5:I scooped up dog mess, but using petrol station gloves in addition to the dog mess bag and then carried it to the bin to dispose of
- Day 6:I scooped up dog mess with the dog mess bag only and carried it to the bin to dispose of
What is ERP based upon?
- Joseph Wolpe 1958
- Reciprocal Inhibition
What is reciprocal inhibition?
- The principle that different physiological responses are incompatible with each other (eg anxiety and relaxation)§
What is OCD commonly confused with?
-Anakastic Personality Disorder
What is anankastic personality disorder?
-A severe disturbance in the characterological constitution and behavioural tendencies of the individual and nearly always associated with considerable personal and social disruption
What is prognosis for OCD?
- Chronic course
- Last for years, decades
- Symptoms may wax and wane
- With a combination of pharmacotherapy and behaviour therapy, up to 90% expected to have a moderate/marked improvement
What are good prognosis factors?
- there is clear presence of a precipitating factor, so can be found quicker and removed
- Good social/occupational functioning
- episodic symptoms
What are poor prognosis factors?
- Childhood onset
- Presence of personality disorders
