OCD Flashcards
OCD
-risk factors
Equal sex distribution
Mean onset - 20 but can occur at any age
Premorbid anxious/dependent on others/obsessional traits
-perfectionist
Often a triggering event
Good and poor prognostic factors
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)
Presentation of obsessions
Presentation of compulsions
Diagnosis
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
Differential diagnoses
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
OCD management
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