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OCD COMPLETE Flashcards

1
Q

What is OCD not?

A

A preference for order and rules
The patients are trapped in the cycle

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2
Q

What is OCD prevalence

A

2 percent

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3
Q

What are obsessions?

A

Recurrent and persistent
thoughts
urges
or images
that are unwanted or intrusive and in most individual cases provoke anxiety or distress

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4
Q

What are the key differences between OCD and intrusions?

A

Frequency
duration
intensity

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5
Q

What are compulsions

A

Repetitive behaviors or mental acts that the
individual does in response to an obsession or
a rigid rule

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6
Q

What are common examples of compulsions

A

Checking
Cleaning
Repeating
Counting
Ordering

They can be mental or overt behaviours

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7
Q

What is ego dystonia?

A

A consequence of OCD
Knowing the behaviours are nonsense but having no control over yourself and letting them take over your life

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8
Q

What’s the actual definition of ego dystonia?

A

A loss of connection between conscious, ie, will power, goals and common sense

and unconscious- unexplained urges to perform repetitive actions

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9
Q

What is the DSM criteria for OCD

A
  1. A presence of either or both

A. Obsessions- Recurrent and persistent thoughts, urges, or images that are
unwanted/intrusive and in most cases, provoke anxiety/distress

The individual attempts to ignore, suppress, or neutralize

AND OR

B. Compulsions- * Repetitive behaviors or mental acts that the individual does in
response to an obsession or a rigid rule

Aimed at preventing or relieving anxiety/distress or preventing
some feared consequence

Not realistic or clearly excessive

  1. Time consuming, more than one hour a day/ causes significant distress or impairment
  2. Not attributable to a substance/another mental disorder/ general medical condition
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10
Q

What are the 2 risk factors for OCD

A

Genetic factors
Environmental factors

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11
Q

What is the genetic basis of OCD

A

higher concordance for monozygotic (identical) twins - 80-87% than for dizygotic twins- 47-50%.

Prevalence increased among 1st degree relatives

Early onset OCD is more heritable
Onset age related to the risk of OCD amongst relatives

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12
Q

What are the environmental factors related to OCD

A

They’re mostly unknown
But developmental OCD can be caused by trauma, encephalitis,
streptococcal infection in children- basal ganglia

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13
Q

What is the medical treatment for OCD?

A

Selective serotonin reuptake inhibitors, ie. Prozac, Zoloft etc.

A higher dose is required than in depression

Antipsychotics can be helpful with comorbid tics

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14
Q

What are the statistics in relation to SSRI’s and OCD

A

Response: Up to 65% achieve a 20-40% in OCD symptoms but will often relapse if the drug is discontinued

Remission: Less than 25% of OCD patients achieve remission, ie. minimal symptoms

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15
Q

What is the psychological treatment for OCD

A

Cognitive behavioural therapy

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16
Q

What are the types of cognitive behavioural therapy used to treat OCD?

A

Exposure and response prevention- ExRP

Cognitive therapy

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17
Q

What is exposure and response prevention

A

Based on behavioural theories of psychopathology

Individuals confront their fears in a controlled manner while resisting the urge to perform compulsions.
Through repeated exposures and refraining from rituals, individuals learn to tolerate anxiety, leading to a reduction in obsessions and compulsions over time.

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18
Q

What are the statistics in relation to the efficacy of exposure and response prevention?

A

Its more effective than SSRIs for OCD

Up to 62-80% of patients respond
Fewer relapses
But more patients drop out mid treatment because its hard

A combination of ExRp and SSRI’s is recommended

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19
Q

What is the neurobiological analysis of OCD?

A

Hyperactivity in orbitofrontal cortex, caudate
and thalamus are commonly seen in OCD

Symptoms get worse when provoked but lessen in response to CBT and SSRIs

This data helps account for the habit part of OCD

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20
Q

What are habits?

A

Insensitive to devaluation: They are automatic stimulus response behaviour
( not good defn cuz it

Sensitive to devalutation
Better defn: Goal directed behaviours
They are actions that rely on linking actions to outcomes

21
Q

What was the test for devaluation?

A

Adams and DICKINSON
bought rats and they’re offered large amounts of food with the press of a lever so the food can be devalued

Then again offered the food, after moderate training, they will work less for the devalued food reward, press it less frequently

This illustrates that following moderate training, rats are capable of goal-directed, purposeful, control over action.

22
Q

So what is the link between the finding of Adam and Dickinson to OCD

A

Suggests that compulsions in
OCD are not necessarily
driven by thoughts/beliefs.

Fundamental tendency to
repeat old habits

23
Q

What’s the difference between DSM 4 and DSM 5 in relation to OCD?

A

In DSM-4
OCD was considered an anxiety disorder
Bad because anxiety wasn’t the core diagnoses, it was obsessions and compulsions

In DSM 5
New umbrella called Obsessive compulsive and related disorders

All related disorders share the common feature of the presence of repetitive thoughts and behaviours

24
Q

What are the DSM 5 categories of Obsessive compulsive and related disorders?

A
  1. Obsessive Compulsive Disorder (OCD)
  2. Body Dysmorphic Disorder (BDD)
  3. Hoarding Disorder (HD)
  4. Trichotillomania (Hair-Pulling Disorder)
  5. Excoriation (Skin-Picking) Disorder
25
What is Body Dysmorphic disorder?
A preoccupation with imagined or exaggerated flaws in physical appearance Some patients carry out plastic surgery
26
What is the DSM 5 criteria for BDD
1. Preoccupation with appearance: Preoccupation with one or more perceived defects or flaws in physical appearance Believe they look ugly, unattractive or deformed- these are not observable or are very slight to others 2. Repetitive Behaviours or Mental Acts: e.g., mirror checking, excessive grooming, skin picking, reassurance seeking, disguising/covering areas, comparing appearance with others 3. Not better explained by another medical or psychiatric condition
27
What are examples of BDD concerns?
Defects with skin, ie. acne, wrinkles, scars MOST COMMON: Facial deformities, large nose, long chin HAir, thinning or balding excessive facial or body hair Other parts of body- protruding stomach Muscle dysphoria( Mostly in men)
28
What is the prevalence of BDD
Man- 2.2% Women: 2.5%
29
What are the risk factors of BDD
Genetics Environmental factors
30
What is the generic basis for BDD
* 44% heritable on the basis of twin study * 4X higher prevalence in 1st degree relatives of BDD patients
31
What are the environmental risk factors of BDD
History of childhood abuse or neglect Past history of teasing/bullying at school that is appearance related Cultural: Eyelid concerns more common in Japan Early Childhood temperament: * Shyness/ inhibition * Perfectionism * Anxiety & depression
32
What is the medical treatment for BDD
Selective Serotonin Reuptake Inhibitors There's fewer trials than OCD, mostly open label instead of randomised control trials Better than placebo pills or non-SSRi anti depressants
33
What are the statistics in relation to the efficacy of SSRIs and BDD
Up to 63% achieve a clinically significant improvement But like in OCD, the person will often relapse when the drug is discontinued
34
What are the psychological treatements for BDD
Cognitive therapy Exposure response prevention therapy
35
Describe cognitive therapy for BDD
Identify and question the meaning of the defectiveness (not the defect) Example: “If my appearance is defective then I am worthless” Collect info that is inconsistent with these beliefs: * Patients may normally ignore or distort this evidence * Challenge values placed on appearance
36
Describe the behavioural/ exposure response prevention therapy for BDD
Exposure to avoided situations (e.g. social situations) Response prevention (preventing compulsive behaviors: use of concealers, skin grooming, mirror checking)
37
Give an example of ExRP for BDD
Patient who is focused on having dark circles under their eyes 1. Go out with 30 minutes mirror time 2. Go out with 30 mins mirror time but no glasses 3. Go out with friends with 30 minute mirror timw 4. Go out with friends with no makeup 5. Dating
38
What's the prevalence of hoarding disorder?
1.5%
39
What's the DSM 5 criteria for hoarding disorder
1. Persistent difficulty discarding or parting with possessions, regardless of their actual value. 2. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. 3. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use 4. Not better explained by another medical or psychiatric condition
40
What are the specifiers for hoarding disorder DSM 5
Excessive acquisition Lack Insight
41
What are the risk factors for Hoarding disorder?
They're poorly understood as they were previously bundled with OCD
42
What is the treatement for hoarding disorder
* Cognitive Behavioral Therapy - individual or group Medication- stimulate ot SRIs Services- learning and removal services etc
43
What's trichotillomania disorder
Hair pulling disorder
44
What is excoriation disorder
Skin picking disorder
45
What is the medical treatment for trichotillomania and excoriation
Clomipramine- trcyclic anti depressant better than placebo SSRIs are also not more effective than placebo HRT is superior to medication for trichotillomania
46
What is the psychological treatment for trichotillomania and excoriation
Habit reversal training- HRT 1. Monitor pulling to identify situational antecedents 2. Increase awareness of behaviour and high risk situations 3. Identify a “competing response” that is incompatible with hair pulling (clenching fist) 4. Stimulus control. decrease opportunities to pull hair or to interfere with or prevent pulling (i.e., wearing gloves in high-risk situations).
47
Why are trichotillomania and excoriation considered together
Comorbid- they commonly co-occur- shared genetic risk factors Neurobiological overlap- Hyperactivity in orbitofrontal cortex, caudate and thalamus during symptom provocation Similarities in symptom presentation. Repetitive, compulsive behaviors are core to all. Treatments are similar
48

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