OCD

Question 1

Characteristic features of OCD

Answer 1

• presence of either obsessions or compulsions, but commonly both.
• The symptoms can cause significant functional impairment and/ or distress.

Question 2

Definition of an obsession

Answer 2

an unwanted intrusive thought, image or urge that repeatedly enters the person’s mind.

Question 3

Definition of a compulsion

Answer 3

repetitive behaviours or mental acts that the person feels driven to perform.

Question 4

Give examples of an observable and unobservable compulsion

Answer 4

observable: checking that a door is locked

unobservable mental act: repeating a certain phrase in one’s mind.

Question 5

Risk factors for OCD

Answer 5

family history
teenage
pregnancy/postnatal period
history of abuse, bullying, neglect

Question 6

Peak age of incidence of OCD

Answer 6

10-20 years

Question 7

NICE recommend classifying functional impairment caused by OCD into Mild, Moderate or Severe using the Y-BOCS scale. Give an example of Severe OCD.

Answer 7

• someone who spends > 3 hours a day on their obsessions/compulsions
• very little control/resistance

Question 8

What treatment is offered to those with OCD causing Mild functional impairment?

Answer 8

• CBT
• Exposure and response prevention (ERP)

If insufficient or can’t engage in psychological therapy, then can try a course of SSRI

Question 9

What treatment is offered to those with OCD causing Moderate functional impairment?

Answer 9

• course of SSRI or CBT with ERP
• clomipramine if SSRI is contraindicated

Question 10

What treatment is offered to those with OCD causing Severe functional impairment?

Answer 10

• refer to secondary care
• whilst awaiting assessment - CBT + ERP and SSRI
• again consider clomipramine if SSRI contraindicated

Question 11

Describe the methods used during Exposure and Response Prevention (ERP)

Answer 11

• exposing a patient to an anxiety provoking situation (e.g. having dirty hands)
• stopping them engaging in their usual safety behaviour (e.g. washing their hands)
• leads to extinction of the habitual response

Question 12

If treatment of OCD with an SSRI is effective, for how long must it be continued to prevent relapse?

Answer 12

for at least 12 months

Question 13

How does the dosage and duration of treatment with an SSRI differ between depression and OCD?

Answer 13

SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response in OCD