OCD

Question 1

25 y.o. bank teller visits your GP surgery having received a verbal warning at his work. he gives a year long hx of worries that his receipts will not balance each day to the extent that he has to check each transaction at least 6 times. customers have complained about his excessive slowness.

(a) what are these sx?

Answer 1

compulsions

Question 2

(b) list 5 characteristic features of such sx

Answer 2

1. repetitive behavioural or mental acts
2. neutralise anxiety
3. not inherently enjoyable
4. attempts made to resist typically fail
5. self-reinforcing
6. pt sees compulsions as a way of preventing an unlikely occurrence
7. compulsions are egodystonic (i.e. pt recognises them as unreasonable)

Question 3

(c) name 2 possible dxs

Answer 3

1. OCD (sees obsessions as a bad thing)
2. OCD PD (personality disorder; sees obsession as a good thing)

Question 4

(d) what neurotransmitter system is thought to be most relevant in the genesis of these sx?

Answer 4

5-HT

Question 5

(e) what drug rx is most effective?

Answer 5

SSRIs e.g. escitalopram (1st-line)

TCAs e.g. clomipramine (most effective)