OCD Flashcards
OCD - comorbidities?
another anxiety disorder mood disorder tic disorder bipolar eating tourettes MDD generalized anxiety social anxiety
OCD?
intrusive thoughts (obsessions) producing anxiety leading to REPETITIVE behaviors engaged in to reduce anxiety
OCD- pathogenesis?
neurobiology -abnormal activity in brain circuit recruitment during cognitive tasks -abnormal serotoninergic and dopaminergic signaling genetics post group a strep premenstrual postpartum stroke traumatic event TBI
OCD - sx?
obsessions:
- dirt/contamination
- hoarding/saving
- sexual content
- superstitious fears
Getting to the dx of OCD?
ask specific questions about intrusive thoughts, urges, images about repetitive behaviors and mental rituals document frequency (acute/chronic), amount of time used, extent of actions that interferes w/ADLs
Obsessive compulsive personality disorder?
very hard to tx
excessive perfectionism
rigid control that leads to ritualized behavior
OCD- DSM V dx?
obsession, compulsion, both
obsessions, compulsions are time consuming or x significant distress or impairment in social, occupation, and other fxns
OCD tx?
CBT -exposure and response prevention (expose the pt to the obsession/trigger --> replace negative compulsion w/ positive) -acceptance and commitment therapy meds -first line: SSRI -second line: TCA -third lien: SNRI
OCD - prognosis?
70-80% recovery
SSRI ADR?
sexual dysfxn
SSRI stopped abruptly?
flu like sx
TCA ADR?
dries everything - mouth, south
Hoarding disorder?
persistent difficulty discarding or parting w/ possessions REGARDLESS OF THEIR ACTUAL VALUE
Hoarding disorder - 3 components?
1) collecting too many items
2) difficulty getting rid of items
3) probs w/ organization
Hoarding-trigger?
TBI glucose metabolism neuroimaging: -executive fxning -impulse control -processing of reward value
Hoarding - regions of the brain that is affected?
frontal lobe
- orbitofrontal cortex
- ventromedial prefrontal cortex
- anterior cingulate cortex
“this bottle cap is the only one ive seen”
hoarding
“if i throw bottle cap away - something bad will happen”
ocd
Hoarding sx?
inability to throw away possession
anxiety when tempted to discard items
cannot categorize
indecisive whether to keep or where to put things
suspicions of other people touching items
Hoarding - DSM V?
persistent difficulty discarding or parting w/ personal possession - even though its not important
effects: social, occupational, other imp areas - not safe
sx are NOT d/t brain injury, CV dz
Hoarding - comorbidites?
MDD General anxiety disorder social phobia PTSD ADHD grooming disorder dementia
Hoarding tx?
CBT -motivation interviewing \+/- meds -SSRI/SNRI TCA
Trichotillomania?
pulling hair - ANYWHERE THAT HAS HAIR
Trichotillomania - warning signs?
wearing hats wearing excessive eye make up or glasses continually playing w/ one's hair preoccupation, anxiety, depression avoidance of windy/wet situations career or academic decline
Trichotillomania - DSM 5?
irresistible hair pulling and has hair loss
repeated attempts to decrease or stop hair pulling
hair pulling cxs clinically significant distress or impairment in social, occupational, or other areas of fxning
hair pulling/loss is NOT d/t o another attribute
unconscious; emotionally driven
Trichotillomania tx?
education: hair pulling barriers
1) CBT
2) meds: SSRI
3) alternative therapies: N-acetylcysteine
support groups
Dematillomania?
skin and hair pulling
Dermatophagia?
scab eating
Dermaphagia?
eating hair
Excoriation (SPD)?
skin picking by recurrent skin picking resulting in SKIN LESION
- repetitively touch
- rub
- scratching
- pick
- dig into skin
- belief that bug is under skin
Excoriation cx?
1) injury or disease of the skin
2) stressful life experience (outlet of the emotions)
Excoriation- dx?
- repeated attempts to decrease or stop the skin picking
- cx clinically significant distress or impairment in social, occupational or other important areas of fxning
- sx must not be better explained by sx of another mental or medical disorder
Excoriation investigation?
labs:
-CBC (cancer, anemia)
-Chemistry panel
-TSH
-FBG (diabetes)
-ANA (autoimmune)
-ESR (autoimmune)
Imaging:
-CXR (lymphoma)
Excoration DDx?
dermatological disorder autoimmune probs BDD OCD substance abuse (opiate withdrawal) autism psychosis
Excoriatiotn tx?
CBT
meds:
-oral, topical (lidocaine)
-barriers (una sleeves)
Interviewing the pt?
SOLER
OARS
SOLER?
Smile and sit squarely Open body posture Lean slightly Eye contact Relax
OARS?
Open-ended questions
Affirmations
Reflective listening
Summaries
