OCD Flashcards
Define Obsessions
recurrent and persistent thoughts, urges, or images
experienced as intrusive and unwanted
cause anxiety
Define Compulsions
repetitive behaviours or mental acts
in response to an obsession or according to rules that must be applied rigidly
prevent events or relieve distress
Epidemiology
2-3 % of population
Females slightly >males, males earlier
Onset late adolescence/young adulthood
Why is it important?
Common
Debilitating & high socioeconomic cost
Delayed help-seeking
Pathogenesis
Genetics: 25-50% in twin studies.
Neurobiology: CSTC ‘loops’: impaired control of inhibition.
Serotonin: SSRI’s improve symptoms
Dopamine: Iatrogenic (methylphenidate,cocaine)
Anatomy
“CSTC loops”
Cortico-Striatal-Thalamo-
Cortical Circuit
Cortex = GM on outer brain
A decision-making hub
Striatum = GM deep within WM
Initiates & co-ordinates motor actions
First step is to ask
Patient and their family
How?
Screening with Z-FOCS takes <60s
If identified, then a detailed enquiry
Why?
Longer untreated OCD is associated with poorer treatment outcomes
Comorbidities
Anxiety (76%) also eating disorders/alcohol
MDD (66%)
Tic disorders (up to 30%)
Children – ADHD/ASD
Suicide Risk
Z-FOCS
Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you would like to get rid of but can’t?
Do your daily activities take long time to finish?
Are you concerned about orderliness or symmetry?
DSM 5: Diagnosis
Obsessions: recurrent and persistent thoughts/urges/images experienced as intrusive/unwanted & cause anxiety/distress.
Compulsions: repetitive behaviours/mental acts that feel driven to perform in response to obsession or according to rules that must be applied rigidly. The acts aim to reduce anxiety/distress, but are not realistic/are too excessive. Wasting of time (>1hour/day)/↓functioning/distress.
DSM 5: OCD cluster symptoms
Obsessions:
Contamination concerns
Harm to self/others, sexual/religious concerns.
Symmetry, precision concerns.
Completeness concerns/ inability to discard.
Compulsions
Washing, bathing, showering.
Checking, praying, asking for reassurance.
Arranging, ordering.
Collecting/hoarding.
Mx: Pharmacological
- SSRI (e.g. Fluoxetine/Citalopram)
- Consider availability/SE’s/interactions
- General: higher doses & longer durations than MDD
Specialist Level:
- Another SSRI OR Clomipramine (TCA)
- Augment with antipsychotic
Mx: Non-pharmacological
CBT (Cognitive Behavioural Therapy)
ERP (Exposure & Response Prevention)
Mx: Other
Transcranial Magnetic Stimulation
Neurosurgical interruption of CSTC
Deep Brain Stimulation
DSM 5: Body dysmorphic disorder
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his or her appearance with that of others) in response to the appearance concerns
Causes clinically significant distress or impairment
BDD: Affects which areas
Commonly affected areas are skin, hair, nose
BDD: Prevalence & where do they often present?
0.7-2.4%
Often present to dermatologists/plastic surgeons first
BDD: Tx
High dose SSRI’s
CBT/ERP
Hoarding disorder: DSM 5
Persistent difficulty discarding or parting with possessions, regardless of their actual value
This difficulty is due to a perceived need to save the items and distress associated with discarding.
The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.
Causes clinically significant distress/impairment
HD: Prevaleve
2-6%
Females>males
HD: Tx
More resistant to treatment.
SSRI’s
Therapy (MI/CBT
Trichotillomania (hair-pulling)- DSM 5
Recurrent pulling out of one’s hair, resulting in hair loss.
Repeated attempts to decrease or stop hair pulling.
The hair pulling causes significant distress and impairment in at least one important area of functioning.
Challenging diagnosis as hair loss can be a common complaint
12 month prevalence 1-2%, females 10x more likely
Limited research
- Habit Reversal Therapy/CBT
Excoriation (skin-picking)- DSM 5
Recurrent skin picking resulting in skin lesions
Repeated attempts to decrease or stop skin picking
Causes clinically significant distress/impairment
Often follows a dermatological condition (e.g. acne/psoriasis)
Can also cause life-threatening infection
Limited research
SSRI’s = mixed results
Habit Reversal Therapy
OCD vs OCPD
OCD:
Obsessions and/or compulsions.
Marked distress and dysfunction.
OCPD:
No obsessions/compulsions
Estimated prevalence 2-8%, 2 x males
Longstanding & pervasive pattern: Orderliness/perfectionism/”in control”.
At expense of flexibility/openness/efficiency.
Diagnosed 4+/8 e.g. perfectionism that interferes with task completion.
