OCD

Question 1

OCD
-risk factors

Answer 1

Equal sex distribution
Mean onset - 20 but can occur at any age
Premorbid anxious/dependent on others/obsessional traits
-perfectionist
Often a triggering event

Question 2

Good and poor prognostic factors

Answer 2

Good prognosis
- good premorbid functioning with work and social life
- precipitating event
- episodic symptoms

Poor prognosis
- giving into compulsions
- long duration
- early onset
- comorbid mental illness (anxiety, depression , tic, personality disorder)

Question 3

Presentation of obsessions
Presentation of compulsions
Diagnosis

Answer 3

Obsessions - distressing thoughts that cause anxiety
- know they are illogical
- feeling of impending doom
- results in rumination or compulsions

Compulsions - urges to peform safety behaviours
- temporary relief, resistance increases anxiety
- impact on social, ADLs

Common obsessions/compulsions
- hand washing, cleaning
- checking, counting, placing in order

Obessions, compulsions present on most days for 2wks

Question 4

Differential diagnoses

Answer 4

GAD - excessive worry over various life domains instead of specific obsessive themes

Body dysmorphic disorder - preoccupation with perceived body flaws => repetitive behaviours

Hoarding disorder - accumulation of possessions due to perceived need to difficulty discarding items, no obsessions or compulsions

Trichotillomania, excoriation disorder - resulting in noticeable hair loss or skin lesions

Question 5

OCD management

Answer 5

Mild - CBT and ERP
-can add SSRI/intensive CBT with ERP
Moderate - SSRI/intensive CBT with ERP
Severe - SSRI + CBT with ERP
-refer to CMHT, can start SSRI whilst waiting

ERP - expose patient to anxiety provoking situation and stop them engaging in their safety behaviour

If SSRI effective => continue for 1 year
SSRI ineffective => different SSRI or clomipramine

Use fluoxetine for BDD