OCD

Question 1

If you were to say “Chris is obsessed with making flash cards,” would that be correct?

Answer 1

No, I actually enjoy this (depending on the lecture). Obsessions are always negative and unwanted.

Question 2

What are 2 main types of compulsions? What is their purpose?

Answer 2

Physical behaviors and mental exercises.

Their purpose is to neutralize the obsession.

Question 3

Examples of mental compulsions?

Answer 3

Words, images. Prayers. Mental counting, list-making, reviewing, etc.

Question 4

3 different clinical courses of OCD?

Answer 4

Unremitting and chronic.
Phasic with periods of complete remission.
Episodic with incomplete remission.

Question 5

6 disorders with which OCD is often co-morbid?

Answer 5

Mood disorders
Other anxiety disorders
Tic disorders
Eating disorders
Psychotic disorders
Personality disorders

Question 6

Big picture of this whole lecture?

Answer 6

Don’t feed the beast. Compulsions reinforce obsessions.

Question 7

Prevalence of OCD?

Answer 7

About 1 in 50, slightly more common in women in most areas.

Question 8

How heritable is OCD?

Answer 8

It seems to be pretty high… MZ concordance is 53-87% (vs. 22-46% DZ)… but hard to separate out influence of upbringing.

Question 9

2 areas of brain overactive in OCD?

Answer 9

Head of caudate, orbital cortex.

Question 10

What’s trichotillomania? Why is it not a sign of OCD (usually, I suppose)?

Answer 10

Hair pulling / skin picking. People actually enjoy the act - it’s not a compulsion.

Question 11

6 diseases that are said to be on the “OCD spectrum” …but that aren’t really that much like OCD?

Answer 11

Trichotillomania (hair pulling / skin picking)
Pathologic gambling
Body dysmorphic disorder <- actually a lot like OCD
Hypochondriasis
Binge eating disorder
Autistic disorders

Question 12

4 steps in the obsessive compulsive cycle? What sort of learning takes place?

Answer 12

Obessions -> distress -> compulsion -> relief.

The relief from compulsions causes negative reinforcement that strengthens the obsession.

Question 13

Which part of the obsessive compulsive cycle does treatment target?

Answer 13

The carrying out of the compulsion, so as to stop the negative reinforcement.
Note that the goal isn’t to get them to reason away their obsessions.

Question 14

4 techniques for CBT in OCD?

Answer 14

Exposure in vivo. (touch the dumpster)
Imaginal exposure.
Ritual prevention. (practice not washing your hands)
Cognitive interventions. (confront idea that anxiety will never decrease without compulsion)

Question 15

What’s the standardized metric of OCD-ness? What do the numbers mean?

Answer 15

Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

Range is 0-40. Minimum for treatment is about 16 (pre-treatment mean is in mid 20s).

Question 16

How well do SRIs work for OCD? What’s the average Y-BOCS score reduction?

Answer 16

“Partial symptom reduction is the norm”
65-70% have moderate improvement.
Avg reduction of 6-10 points on Y-BOCS.

Question 17

4 downsides of treating OCD with SRIs?

Answer 17

Often doesn’t fully treat. (residual impairment)
Relapse upon stopping SRIs.
Side effects.
Black box warning.

Question 18

What’s the average Y-BOCS score reduction with CBT? Do the effects last after discontinuation?

Answer 18

10-15 points.

Yes, the effects last.

Question 19

2 downsides to CBT for OCD?

Answer 19

Initial distress.

Not readily available. (not everybody is a crazy badass like Dr. Franklin)

Question 20

Do SRIs make CBT more effective? Do they make it less effective?

Answer 20

Depends on what data you look at.
Some show combination therapy as being more effective.
CBT alone at Penn has worked better than CBT + SRIs… but not so at Duke.
(overall, there’s no evidence that combination impairs monotherapy)

Question 21

Take away point from CBT working at better at Penn than at Duke?

Answer 21

CBT, unlike the effects of an SRI, can vary greatly between practitioners.
Hopefully Dr. Franklin can teach everybody to be as awesome as he is.

Question 22

How do you start off CBT for OCD?

Answer 22

Begin with only moderately distressing things.
Encourage abstinence from rituals.
Troubleshoot, discuss future exposures to do.

Question 23

What do you do in intermediate CBT for OCD?

Answer 23

Praise progress.

Allow pt to choose from among several options for exposures.

Question 24

Aspects of advanced stage CBT for OCD?

Answer 24

Praise
Modeling
Cognitive exercises: acceptable vs. unacceptable risk. (don’t make false guarantees of safety)
Repeated, prolonged exposures.
Vary context in which fears are confronted.

Question 25

Aspects of wrapping up OCD treatment and preventing relapse?

Answer 25

Laud progress.
Talk about general ability to confront OCD outside of the specific obsessions/compulsions confronted.
Talk about lapse vs. relapse.
Relationship between OCD and stress.
Do booster sessions if necessary.