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Psychiatry > OCD > Flashcards

OCD Flashcards

1
Q

What is a “Tic”?

A

An abrupt, jerky, repetitive movement which involves discrete muscle groups. It mimics a normal coordinated movement, varies in intensity, and lacks rhythmicity. It may be temporarily uppressed by will power and, because of its patterned appearance, is relatively easy to imitate.

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2
Q

Tourette’s Sx?

A

Tics (occurring for > 1 yr):
- Simple & complex motor (face > head/neck >
limbs > trunk)
- Vocal (phonic)

  • Onset ≤ 18-years-old
  • Causing distress
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3
Q

What are “Obsessions”?

A

Constant, intrusive, unwanted thoughts that cause distressing emotions such as anxiety or disgust. The thoughts are egodystonic and the patient realizes that they are a product of his or her own mind and are excessive or unreasonable.

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4
Q

What is a “Compulsion”?

A

Urge to do something to lessen discomfort, usually discomfort caused by an obsession. Rituals are behaviors in which people engage in response to
compulsions.

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5
Q

Neurological Causes of OCD?

A

Frontotemporal Dementia

Bilateral Basal Ganglia damage:

  • Encephalitis
  • Traumatic brain injury
  • Sydenham chorea
  • CO Poisoning
  • Parkinson disease
  • Huntington disease
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6
Q

_____ is VERY common in Tourette patients

A

ADHD

also some overlap w/ OCD

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7
Q

_____ can unmask tics (often don’t worsen them)

A

Stimulant drugs

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8
Q

Which typically comes to attention first- ADHD or Tourette’s?

A

ADHD typically comes to attention before Tourette syndrome

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9
Q

Can Tourette’s Syndrome be caused by stimulants?

A

no. GTS is NOT caused by stimulants, just unmasked by them

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10
Q

Tourette’s & OCD both may improve w/ _____ (drug)?

A

SSRI’s

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11
Q

The following represents a connection between what two syndromes?
■ Suppressible
■ “Psychic itch”
■ Worse with stress
■ Repetitive scatological thoughts
■ Same prevalence of tics in 1st degree relatives

A

OCD & GTS

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12
Q

In OCD & GTS, fMRI data reveal abnormal ______ circuits

A

Frontal-subcortical

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13
Q

Name the Frontal-subcortical circuit. With what syndrome(s) is this circuit disrupted in?

A

Orbitofrontal / Medial Frontal / Dorsolateral Frontal

  • -> Nuc. Accumbens or Caudate
  • -> Globus Pallidus / Substantia Nigra
  • -> Thalamus
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14
Q

Diagnosis?

  • Dec’d caudate volume
  • Inc’d dorsolateral prefrontal volume in milder cases
  • Inc’d volume in worse cases (ability to control tics)

fMRI of tic suppression:

  • Inc’d frontal & caudate
  • Dec’d GP, SN, Thalamus
A

GTS

Tourette’s

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15
Q

fMRI of OCD (provocation) shows what?

A

Increased Frontal & Striatal activity

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16
Q

Diagnosis? Increased Frontal & Striatal activity

A

OCD

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17
Q

In OCD, _____ activity correlates inversely with severity

A

Orbitofrontal

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18
Q

OCD Psychotherapy: Improvement associated with

decreased _____ metabolism

A

caudate

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19
Q

a) Pediatric psych disorders ass’d w/ PANDAS?

b) What does PANDAS stand for?

A

a) GTS & OCD (tic disorders)
b) Pediatric Autoimmune Neurodegenerative Disorders After Streptococcal infection

(different from regular GTS/OCD in that onset is sudden & patients respond to steroid therapy)

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20
Q

PANDAS OCD/GTS: Onset & exacerbations follow _____ infections

A

Group-A Beta Hemolytic Strep

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21
Q

OCD-GTS connection: PANDAS connection?

A 
■ Steroid-responsive OCD & GTS cases with
onset after GABHS infection
■ Sydenham chorea often includes OC
symptoms
■ 60% of OC children positive for antineuronal
antibodies
■ High anti-basal ganglia antibodies
■ High rheumatic B cell antibodies
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22
Q

GTS- Tx?

A 
Catalogue behaviors
Diagnose co-morbid disorders
Educate-Contact TSA
Determine primary treatment goal
Clonidine/Guanfacine
Benzodiazepines, SSRI
Neuroleptics
Non-pharm treatments
? DBS bilateral thalami, accumbens
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23
Q

OCD- Tx?

A 
Catalogue behaviors
Diagnose co-morbid disorders
Educate-Support Groups
Determine primary treatment goal
SSRI, anti-depressants
Augmentation agents
Non-pharm treatments
Bilateral capsulotomies
? DBS bilateral internal capsules, accumbens
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24
Q 
Findings in what diagnosis?
Poor school performance 65%
Compulsive symptoms 20-90%
ADHD symptoms 30-70%
Motor incoordination 50%
Sleep disorders 47%
Learning disabilities 30%
Migraine 27%
Paroxysmal aggression
Stuttering, stammering, palilalia
Excessive startle reactions
A

ADHD

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25
Q

What is “Coprolalia”?

A

Shouting out words that are “frowned upon” in society

Tourette’s Syndrome - swear words

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26
Q

Knuckle cracking- complex or simple motor tic?

A

Complex

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27
Q

Touching oneself- complex or simple motor tic?

A

Complex

28
Q

Facial grimace- complex or simple motor tic?

A

Simple

29
Q

Eye blink- complex or simple motor tic?

A

Simple

30
Q

Hand/foot twitch- complex or simple motor tic?

A

Simple

31
Q

Smelling- complex or simple motor tic?

A

Complex

32
Q

What is “Palilalia”?

A

Repeating the last syllable your heard

deteriorates as you go forward

33
Q

Tourette’s:

What parts of body are simple/complex motor tics most often seen?

A

Face > Head & neck > Limbs > Trunk

34
Q

In order to diagnose a disorder (in psychiatry or any other medical field), you always need what characteristic?

A

The disorder must cause some level of distress

from OCD lecture

35
Q

How long to vocal tics (complex & simple) last in order for them to be classified as Tourette’s?

A

> 1 year

Also, w/ onset before 18 yrs. old
& as always, distress causing

36
Q

Categorize from highest to lowest frequency seen in Tourette’s:
Coprolalia, Copropraxia, Echolalia, Echopraxia

A

Echolalia > Echopraxia > Copropraxia > Coprolalia

37
Q

What is “Copropraxia”?

A

Tic consisting of involuntarily performing obscene or forbidden gestures, or inappropriate touching

38
Q

Post-strep infection can result in what movement disorder?

A

Chorea

called Sydenham Chorea

39
Q

One of the signs of _____ toxicity is developing tics

A

dopaminergic

eg. excessive L-Dopa

40
Q

Benzodiazepines or Barbiturates would tend to _____ tics.

A

decrease

b/c they’re relaxants, whereas stimulants would tend to increase tics

41
Q

What are obsessions vs. compulsions?

A

Obsession = Unwanted, egodystonic thoughts that you cannot get out of head

Compulsion = Urge to do something physically to lessen discomfort caused by obsession

(Rituals are behaviors in which ppl engage in response to obsessions)

42
Q

Contamination: Obsession or Compulsion?

A

Obsession

43
Q

Self-injury/Violence: Obsession or Compulsion?

A

Obsession

44
Q

Symmetry, just right: Obsession or Compulsion?

A

Obsession

45
Q

Cleaning: Obsession or Compulsion?

A

Compulsion

46
Q

Checking locks over & over: Obsession or Compulsion?

A

Compulsion

47
Q

Counting: Obsession or Compulsion?

A

Compulsion

48
Q

Repeating: Obsession or Compulsion?

A

Compulsion

49
Q

Hoarding: Obsession or Compulsion?

A

Compulsion

50
Q

Self-doubt: Obsession or Compulsion?

A

Obsession

51
Q

Fear of loss: Obsession or Compulsion?

A

Obsession

52
Q

OCD can have neurological causes, which is either _____ or _____.

A

Frontotemporal Dementia
or
Bilateral Basal Ganglia Damage

(though usually just unexplained)

53
Q

______ is a neurological cause of repetitive behaviors in many animal models

A

Bilateral Basal Ganglia Damage

Encephalitis, TBI, Sydenham chorea, CO poisoning, Huntington’s, Parkinson’s

54
Q

A large number of ppl w/ Tourette’s may also have what other 2 syndromes?

A

ADHD & OCD

55
Q

T or F?

Stimulants (ritalin, adderall) may cause or exacerbate tics in children w/ Tourette’s.

A

False.

Stimulants tend to unmask these tics, however do not cause or make them worse.

56
Q

Trichotilomania- what is it?

A

When ppl mindlessly play w/ their hair to the point that they get bald spots.
– Goodwin

(treated w/ same drugs as OCD)

57
Q

Some similarities btwn OCD & GTS?

A
  • temporarily suppressible
  • “psychic itch” precedes it
  • better w/ relaxation
  • repetitive scatological thoughts
  • same prevalence of tics in 1st degree relatives
  • Both improve w/ SSRIs
58
Q

GTS & OCD – both improve w/ _____ (pharmacological)

A

SSRIs

also, w/ relaxation

59
Q

GTS: Common structural changes in brain?

A
  • dec’d Caudate volume

Mild cases – inc’d Dorsolateral Prefrontal volume

Severe cases - dec’d Dorsolateral Prefrontal volume

(dorsolateral = part of brain suppresses movement)

60
Q

What part of your brain is the part that suppresses tics/movement (in GTS)?

A

Dorsolateral Prefrontal cortex & Caudate

(hence inc’d DL-volume = milder cases,
whereas dec’d volume = severe cases)

61
Q

Describe brain activity during fMRI of tic suppression (in GTS)

A

inc’d activity = Dorsolateral Prefrontal & Caudate

dec’d activity = Basal Ganglia & Thalamus
Basal Ganglia = GP & SN

62
Q

Describe brain activity during OCD provocation fMRI

A

inc’d Frontal & Striatal activity

63
Q

OCD: increased _____ activity correlates with LESS severity of disorder.

A

Orbitofrontal

this probably keeps behavior “in line” w/ societal expectations

64
Q

GTS seems to be a disorder of the __(a)__ circuit, whereas OCD seems to be a disorder of the __(b)__ circuit.

A

a) Dorsolateral - Frontal

b) Orbitofrontal - Medial

65
Q

Famous OCD study:

Subjects that IMPROVED, showed decreased _____ metabolism, regardless of which Tx they received.

A

Caudate

66
Q

Describe the pharmacological Tx for GTS, if you decide to do pharm Tx at all.

A

start w/:
- Clonidine/Guanfacine

if that doesn’t work…
- Benzodiazepines / SSRIs

if those don’t work…
- Neuroleptics

still not working…
- Non-pharm Txs (DBS, etc.)

67
Q

Describe the pharmacological Tx for OCD, if you decide to do pharm Tx at all.

A

start w/:
- SSRIs / anti-depressants

if not working…
- Augmentation agents (like in depression)

still not working…
- Non-pharm Txs

still not working…
- Bilateral capsulotomies

Psychiatry (7 decks)

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