OCD

Question 1

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

Answer 1

obsessions

Question 2

repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Answer 2

Compulsions

Question 3

Obsessive-Compulsive disorder

Presence of obsessions, compulsion, OR both

Answer 3

Obsessions: MUST HAVE THE FOLLOWING: recurrent/persistent thoughts/urges/images that are intrusive and unwanted that cause anxiety and attempts to ignore or suppress these with another thought or action

Compulsions: MUST HAVE THE FOLLOWING repetitive behaviors or mental acts done in response to an obsession or according to rules and acts aimed at preventing or reducing anxiety/distress; behaviors not realistically connected to prevent this or are excessive

Question 4

For OCD, specify

good/fair insight,

poor insight, or

absent insight/delusional

Answer 4

Good/fair = individual recognizes OCD beliefs are probably/definitely NOT true

Poor = individual thinks OCD beliefs are PROBABLY true

Question 5

Characteristic feature is the presence of obsessions and compulsions (but only one is needed)

Answer 5

Obsessive-Compulsive disorder

Question 6

OCD Individuals tend to have

Answer 6

dysfunctional beliefs

inflated sense of responsibility

overestimate threats

be perfectionists

need to control thoughts

(Up to 30% have a tic disorder in their lifetime)

Question 7

Most common in males

Suicide risk: SI for up to 1/2 of these patients; attempts by 1/4th of these patients

Answer 7

OCD

Question 8

Non-pharmacologic:
Systematic desensitization
Cognitive behavioral therapy

Answer 8

Tx for OCD

Question 9

SSRIs; may need longer than a typical course of depression to see results

Clomipramine (TCA)

Answer 9

Pharmacologic tx for OCD

W/ clomipramine (TCA) use caution if considering serotenergic meds

Question 10

SSRIs; may need longer than a typical course of depression to see results

Clomipramine (TCA)

Answer 10

Pharmacologic tx for OCD

W/ clomipramine (TCA) use caution if considering serotenergic meds

Question 11

Preoccupation with perceived defects in physical appearance not observable to others

Patients has performed repetitive behaviors or mental acts in response to the concerns

Answer 11

Body Dysmorphic Disorder

Clinically significant
Not better explained

Question 12

Like OCD, with body dysmorphic disorder… specify level of insight…

For example

Answer 12

With muscle dysmorphia: insufficient musculature

Good/fair insight: think thoughts are not/probably not true

Poor insight: probably true

Absent insight/delusional: convinced they are true

Question 13

Essential feature is preoccupation with perceived flaws that make them look ugly or deformed BUT are not obvious to others

Answer 13

Body Dysmorphic Disorder

Question 14

Skin, hair, and nose are most common areas, but any body part can be the nidus of concern

Common repetitive behaviors include comparing themselves to others, checking mirrors, excessive grooming, camouflaging, or seeking reassurance

Muscle dysmorphia occurs almost exclusively in males

Suicide Risk: High in adults and adolescents

Answer 14

Body Dysmorphic Disorder

Question 15

Non-pharmacologic
Psychotherapy

Pharmacologic = SSRIs
Clomipramine (TCA)

(Treatment towards a perceived organic issue (i.e. Dermatology referral/surgery) rarely successful…so use these referrals very cautiously )

Answer 15

Body dysmorphic disorder

but we have to get to the core of the fact they’re not having this disfigurement that they feel they’re having

Question 16

A dx for body dysmorphic disorder is depression… but with depression they need?

Answer 16

Endorsed depressive mood

Question 17

Difficulty discarding possessions
Perceived need to save item and distress with discarding it
Accumulation of possessions that congests and clutters active living areas

Answer 17

Hoarding Disorder

if not cluttered, ONLY because of 3rd party involvement

Question 18

Essential feature is long standing difficulty discarding items regardless of value

Not a transient issue (i.e. inheriting property)

Answer 18

Hoarding Disorder

Question 19

Many display excessive acquisition from buying or getting free items

Stealing is less common

Experience distress at the prospect of discarding the items

Answer 19

Hoarding Disorder

Question 20

Very difficult to treat

Cognitive behavioral therapies show the best effectiveness

Mixed results with medications such as SSRIs

Answer 20

Hoarding Disorder

Question 21

*Pulling out one’s hair with *hair loss and *repeated attempts to stop or decrease the activity

Clinically significant

Answer 21

Trichotillomania

Question 22

Essential feature is pulling out one’s hair despite trying to stop

Can be any body region, but scalp, eyebrows, and eyelids are the most common areas

Answer 22

Trichotillomania

Question 23

Non-pharmacologic tx =
Biofeedback
Desensitization
Habit reversal

Answer 23

Trichotillomania

Question 24

Pharmacologic interventions for trichotillomania include?

Answer 24

topical steroids
hydroxyzine
antidepressants
antipsychotics

(behavioral therapy is best)

Question 25

Picking at one’s skin with skin lesions and repeated attempts to stop or decrease the activity

Clinically significant

Answer 25

Excoriation

Question 26

The essential feature of excoriation disorder is recurrent picking at one’s own skin

most commonly picked sites are the face, arms, and hands but any site is possible

Answer 26

Excoriation

Question 27

Excoriation tx?

difficult to treat

Answer 27

*CBT and habit reversal may help

Some support for fluoxetine or naltrexone