OCD

Question 1

What are obsessions?

Answer 1

 Thoughts, images or impulses
 Repetitive, intrusive, uncontrollable
 Not just excessive worries about real life problems
 Cause anxiety or distress
 Compel the person to ignore, suppress or neutralize the obsessions in some way

Question 2

Forms of obsessions?

Answer 2

Thoughts
 Ideas experienced as unacceptable or unwanted
(e.g., idea of stabbing my child)
Images
 Mental visualizations that are experienced as troubling or distressing (e.g., one’s elderly grandparents having sex)
Impulses
 Unwanted urges or notions to behave in inappropriate ways (e.g., to yell obscenities)

Question 3

What are some typical obsessions?

Answer 3

 Violence
 Impulse: to attack a helpless person
 Image: loves one’s being dismembered
 Impulse to reach for a police officer’s gun
 Sex
 Impulse: to stare at peoples’ genitals  Thought: what if I am a pedophile
 Blasphemy and sacrilege
 Image: sexual images of a religious deity
 Thought: God is dead

Question 4

What are compulsions?

Answer 4

 Repetitive overt behaviors (handwashing, ordering, checking) or covert mental acts (praying, counting, repeating words)

Question 5

What are goals of compulsions?

Answer 5

• Goals are usually to “undo” obsession, to prevent harm associated with obsession, or to alleviate anxiety.
• Obsessions are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

Question 6

Distinguish between mental rituals and obsessions

Answer 6

o Obsessions are intrusive, unwanted thoughts that evoke anxiety or distress
o Mental rituals are deliberate mental acts designed to neutralize or reduce anxiety or distress

Question 7

DSM-5 criteria for OCD?

Answer 7

 Either obsessions, compulsions, or both
 Obsessions or compulsions cause distress, are time
consuming (>1 hour/day), or significantly interfere
 Content of obsession or compulsion is not restricted to another Axis I disorder (e.g., food obsession in an eating disorder)
 Not due to a substance or medical condition
 Specify if with good or fair insight, with poor insight, with absent insight/delusional beliefs

Question 8

Prevalence of OCD?

Answer 8

about 1% 12 month prevalence
2-3% lifetime
prevalence
F=M

Question 9

Onset of OCD typically in

Answer 9

Childhood, teenage years

Question 10

Course of OCD?

Answer 10

 chronic, constant or waxing/waning
 only 15% describe periods of > 3 months symptom
free

Question 11

Symptom dimensions of OCD?

Answer 11

Heterogenous:
 obsessions and checking
 symmetry and ordering
 cleanliness and washing

Question 12

Neurochemical theory suggests _____ plays a central tole in development of OCD

Answer 12

Serotonin

Question 13

Biological Model of OCD

Answer 13

Biological Model of OCD Found in the cortical-stratal-thalamic circuit (prefrontal cortex, thalamus, basal ganglia)

This is the area related to filtering out irrelevant info and preservation of behaviour.

Question 14

Cortical-stratal-thalamic circuit (prefrontal cortex, thalamus, basal ganglia) involved in…

Answer 14

filtering out irrelevant info and preservation of behaviour.

Question 15

Efficacy of SSRIs

Answer 15

• Such as fluvoxamine, sterling, fluoxetine, etc.
• Significant avg symptom reduction of approx. 40% in 50-60% subjects
• Majority relapse after discontinuation of SSRIs - addition of behaviour therapy is important.

Question 16

Foa and Kozac stated there are TWO requirements for anxiety treatment:

Answer 16

1. Anxiety must be experienced or aroused

2. New information must be provided and emotionally processed. (Extinction)

Question 17

Efficacy of Exposure and Response Prevention

Answer 17

• Effective and potentially curative treatment for OCD

- 70-85% of those completing treatment maintain gains over 2+ yr follow ups