OCD

Question 1

What are obsessions?

Answer 1

Recurrent and persistent thoughts, impulses, images that are experiences as intrusive and inappropriate and cause marked anxiety or distress

Question 2

What are the elements of obsessions for diagnosis?

Answer 2

1. Recurrent and persistent thoughts, impulses, images that are experiences as intrusive and inappropriate and cause marked anxiety or distress
2. The thoughts are not simply excessive worries about real life problems

3 the person attempts to ignore or suppress, or to neutralise them with another thought or action.

4. The person recognises that the obsessional thoughts are a product of his or her own mind (opposed to thought insertion, like schizophrenia)

Question 3

What are compulsions?

Answer 3

Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Question 4

What are the elements of convulsions for diagnosis?

Answer 4

1. Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. The behaviours of mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation however these behaviours are not connected in a realistic way with what they are trying to prevent.
3. The compulsions cause marked distress, are time consuming (1hr+ a day) or significantly interfere re with routine, functioning or social life/relationships.
4. The person recognises the compulsions are unreasonable (may not apply to children)

Question 5

When are the two peaks of onset?

Answer 5

Childhood-adolescence - males with compulsions of symmetry, checking and tics

20-29 - females with more washing symptoms

Question 6

What is the prevalence of OCD?

Answer 6

1-3%

Question 7

Where is OCD markedly more common?

Answer 7

Nowhere: prevalence is similar across the world?

Question 8

What are examples of obsessions and compulsions?

Answer 8

Checking
Washington
Hoarding/saving
Symmetry/order

Question 9

What are the 3 complimentary modes of PANS treatment?

Answer 9

Treating symptoms (psychoactive medications, psychotherapy, supportive interventions)

Removing source of inflammation (antimicrobials)

Treating disturbances of the immune system (immunonodulator and anti-inflammatory therapies)

Question 10

What is done in the case of severe/ life threatening PANS?

Answer 10

Plasma exchange first line
IVIG, intravenous corticosteroids, rituximab

Question 11

When might steroids be prescribed for PANS?

Answer 11

Any level above moderate
Length of course or strength of dose in line with severity