OCD

Question 1

What is OCD characterized by?

Answer 1

• recurrent obsessions/compulsions
• causing significant distress/impairment

Question 2

Terminology

• obsessions
• compulsions

Answer 2

• recurrent and unwanted intrusive thoughts (ilness, contamination, security etc)
• repetitive behaviors or mental acts performed to reduce anxiety caused by obsessions. Rigid rules in application of compulsion

Question 3

Outline the biological aetiology of OCD

Answer 3

Biological:
- 48% heritability
- molecular mechanism (dopaminergic/glutaminergic genes)
- neurobio abnormalities
- neurotransmitter networks (SRIs)

Question 4

Outline the Psychological aetiology of OCD

Answer 4

1. CBT model: -
   - maladaptive beliefs ->compulsions to cope with anx
2. Functional relation btwn obsession and compulsion:
   - C reduces stress, avoidance which reinforces fear via negative reinforcement (instant relief)
   - C limits opportunity to become accustomed to feared objects and events
3. Overestimation of threat
4. Intolerance of uncertainty

Question 5

Outline the environmental aetiology of OCD

Answer 5

• stressful and traumatic life events (trigger symptoms
• infections

Question 6

Outline the social aetiology of OCD

Answer 6

• early childhood exposure to fear/anx
• family/parental dynamics (excessive control, rigidity, restriction of autonomy)

Question 7

What are the broad diagnostic criteria?

Answer 7

• Obs and Comps that cause distress and discomfort
• time consuming or impairment in other area of functions
• not attributable to physiological causes
• disturbance not better explained by another MD

Question 8

Outline the Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5)

Answer 8

• designed to diagnose anxiety disorder (ocd included)
• useful in differentiating OCD from other anxiety disorders
• structured interviews with modules for various anxiety disorders

Question 9

What is the rough course of treatment for OCD

Answer 9

• build therapeutic relationship
• psychoeducation
• psychological or pharmacological approaches

Question 10

Outline the psychoeducation, psychotherapy and pharmacotherapy treatment for OCD

Answer 10

1. Psychoeducation
   - explain/normalize
   - coping strategies
   - treatments
   - stigma and family maintenance
   - involved family
2. Psychotherapy
   - CBT with Exposed and response prevention (ERP)
3. Pharmacotherapy
   - SSRIs

Question 11

50% of OCD sufferers….

Answer 11

fail to respond to first line pharmacotherapy treatment.

• need a combination of psychological and pharmacological approaches

Question 12

What are some of the controversial factors in OCD?

Answer 12

1. Overlap of symptoms
   - GAD, BDD, Dep Ds., Anx Ds with ritualistic behaviour
2. Alternative treatments
   - psilocybin, cannabis, nicotine, morphine
3. Environmental vs biological role
   - overemphasis of genetic
   - quantifying environmental factors
4. Stigma and Misunderstanding
   - confusion with perfectionism
   - misunderstanding of comps and obs

Question 13

What are some of the cognitive distortions associated with OCD?

Answer 13

• catastrophic thinking
• overestimating risks and probabilities
• black and white thinking
• excessive importance placed on thoughts

Question 14

What are some self-help strategies for OCD?

Answer 14

• mindfulness and relaxation techniques
• challenging and reframing thoughts
• setting achievable goals, gradual exposure
• creating structured daily routine