OCD COMPLETE Flashcards
What is OCD not?
A preference for order and rules
The patients are trapped in the cycle
What is OCD prevalence
2 percent
What are obsessions?
Recurrent and persistent
thoughts
urges
or images
that are unwanted or intrusive and in most individual cases provoke anxiety or distress
What are the key differences between OCD and intrusions?
Frequency
duration
intensity
What are compulsions
Repetitive behaviors or mental acts that the
individual does in response to an obsession or
a rigid rule
What are common examples of compulsions
Checking
Cleaning
Repeating
Counting
Ordering
They can be mental or overt behaviours
What is ego dystonia?
A consequence of OCD
Knowing the behaviours are nonsense but having no control over yourself and letting them take over your life
What’s the actual definition of ego dystonia?
A loss of connection between conscious, ie, will power, goals and common sense
and unconscious- unexplained urges to perform repetitive actions
What is the DSM criteria for OCD
- 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
- Time consuming, more than one hour a day/ causes significant distress or impairment
- Not attributable to a substance/another mental disorder/ general medical condition
What are the 2 risk factors for OCD
Genetic factors
Environmental factors
What is the genetic basis of OCD
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
What are the environmental factors related to OCD
They’re mostly unknown
But developmental OCD can be caused by trauma, encephalitis,
streptococcal infection in children- basal ganglia
What is the medical treatment for OCD?
Selective serotonin reuptake inhibitors, ie. Prozac, Zoloft etc.
A higher dose is required than in depression
Antipsychotics can be helpful with comorbid tics
What are the statistics in relation to SSRI’s and OCD
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
What is the psychological treatment for OCD
Cognitive behavioural therapy
What are the types of cognitive behavioural therapy used to treat OCD?
Exposure and response prevention- ExRP
Cognitive therapy
What is exposure and response prevention
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.
What are the statistics in relation to the efficacy of exposure and response prevention?
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
What is the neurobiological analysis of OCD?
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
What are habits?
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
What was the test for devaluation?
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.
So what is the link between the finding of Adam and Dickinson to OCD
Suggests that compulsions in
OCD are not necessarily
driven by thoughts/beliefs.
Fundamental tendency to
repeat old habits
What’s the difference between DSM 4 and DSM 5 in relation to OCD?
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
What are the DSM 5 categories of Obsessive compulsive and related disorders?
- Obsessive Compulsive Disorder (OCD)
- Body Dysmorphic Disorder (BDD)
- Hoarding Disorder (HD)
- Trichotillomania (Hair-Pulling Disorder)
- Excoriation (Skin-Picking) Disorder
What is Body Dysmorphic disorder?
A preoccupation with
imagined or
exaggerated flaws in
physical appearance
Some patients carry
out plastic surgery
What is the DSM 5 criteria for BDD
- 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 - Repetitive Behaviours or Mental Acts: e.g., mirror checking,
excessive grooming, skin picking, reassurance seeking,
disguising/covering areas, comparing appearance with others - Not better explained by another medical or psychiatric condition
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)
What is the prevalence of BDD
Man- 2.2%
Women: 2.5%
What are the risk factors of BDD
Genetics
Environmental factors
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
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
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
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
What are the psychological treatements for BDD
Cognitive therapy
Exposure response prevention therapy
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
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)
Give an example of ExRP for BDD
Patient who is focused on having dark circles under their eyes
- Go out with 30 minutes mirror time
- Go out with 30 mins mirror time but no glasses
- Go out with friends with 30 minute mirror timw
- Go out with friends with no makeup
- Dating
What’s the prevalence of hoarding disorder?
1.5%
What’s the DSM 5 criteria for hoarding disorder
- Persistent difficulty discarding or parting with possessions,
regardless of their actual value. - This difficulty is due to a perceived need to save the items and
to distress associated with discarding them. - The difficulty discarding possessions results in the
accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use - Not better explained by another medical or psychiatric condition
What are the specifiers for hoarding disorder DSM 5
Excessive acquisition
Lack Insight
What are the risk factors for Hoarding disorder?
They’re poorly understood as they were previously bundled with OCD
What is the treatement for hoarding disorder
- Cognitive Behavioral Therapy - individual or group
Medication- stimulate ot SRIs
Services- learning and removal services etc
What’s trichotillomania disorder
Hair pulling disorder
What is excoriation disorder
Skin picking disorder
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
What is the psychological treatment for trichotillomania and excoriation
Habit reversal training- HRT
- Monitor pulling to identify situational
antecedents - Increase awareness of behaviour and high risk
situations - Identify a “competing response” that is
incompatible with hair pulling (clenching fist) - Stimulus control. decrease opportunities to
pull hair or to interfere with or prevent pulling
(i.e., wearing gloves in high-risk situations).
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
