OCD

Question 1

List the etiologies of OCD

Answer 1

• positive family history
• childhood - trauma, abuse, separation anxiety
• group A strep infection (PANDAS)
• cortical striatal thalamic cortical circuit dysfunction (CSTC)

Question 2

What are Obsessions?

Answer 2

• Doubt, impulse/image, Rumination, Thought
• persistent, recurrent
• intrusive, unwanted, distressing

Question 3

What are Compulsions?

Answer 3

• repetitive behaviors / mental acts
• that are unrealistic / excessive
• in resp to obsession / according to rigidly applied rules
• aim = px / decr distress, anxiety or something dread

Question 4

List the DSM-V criteria for OCD

Answer 4

• obsession / compulsion / both
• time consuming
• significantly distressing
• causing severe dysfunction
• not due to MMS

Specifiers

• insight (good, poor, absent/delusion)
• tics

Question 5

What are the related behaviors of OCD?

Answer 5

• avoidance
• time consuming
• injury, damage (self, property)

Question 6

How do you manage OCD?

Answer 6

• challenging, need MDT
• risk assessment (self + others)
• psychoeducation

psychosocial
- CBT, ERT (gradual)

pharmacological

• SSRI (1st line) - dose + duration > depression
• Venlafaxine - resistant cases
• low dose Risperidone if psychosis

Question 7

What is Body Dysmorphic Disorder?

Answer 7

• preoccupation
• 1 or more perceived physical flaws
• not observed by others
• causing repetitive behav / mental acts related to appearance
• result in distress + dysfunction
• Not due to eating disorders

Specifiers

• insight (good, poor, absent/delusion)
• muscle dysmorphia (almost excl in men)

Question 8

How do you Mx Body Dysmorphic disorder?

Answer 8

• MDT
• risk assessment (self, px unnecessary surgeries)

Psychoeducation

• surgery does not = satisfaction
• encourage active life despite condition

Psychological
- CBT, BT

Pharms
- SSRI (chronic)

Question 9

What is Hoarding Disorder?

Answer 9

• persistent, recurrent
• difficult discarding items -> distress
• regardless of value
• causing clutter + compromised living areas
• incr distress + dysfxn

Question 10

How do you mx Hoarding disorder?

Answer 10

• challenging
• CBT, BT
• SSRI
  but less valuable than for OCD

Question 11

What is Trichotillomania?

Answer 11

• persistent, irresistible
• urge to pull out own body hair
• if consumes it = with/without pica

Question 12

What is Excoriation disorder?

Answer 12

• related to OCD
• repeated picking own skin -> lesions
• causes significant life disruption