Trastorno Obsesivo Compulsivo Flashcards
9.1.
Which of the following types of obsessions is most commonly
associated with obsessive–compulsive disorder (OCD)?
A. Contamination fears
B. Counting
C. Pathologic doubt
D. Sexual acts
E. Suicidal thoughts
9.1. A. Contamination fears
The most common pattern in OCD is an obsession of contamination,
which is often followed by washing or compulsive avoidance of the
contaminated object. Pathologic doubt is the second most common
obsession seen in OCD, often followed by checking compulsions. The
third most common pattern in OCD is intrusive obsessional thoughts
without compulsions
9.2.
Which pattern of body concern is most often associated with
body dysmorphic disorder?
A. Concern about multiple different areas of the body
B. Emphasis on the thighs and stomach
C. Focus on body symmetry
D. Intense preoccupation with weight and shape concerns
E. Possessing good insight about their actual versus desired
appearance
9.2. A. Concern about multiple different areas of the body
The most common concern in patients with body dysmorphic
disorder involves the face and head and can also include the skin,
nose, and hair. Most patients with body dysmorphic disorder worry
about five to seven different body areas. Only about a quarter of
patients are concerned with symmetry of their appearance, and only
about a quarter of patients have reasonable insight. Weight- and
shape-related concerns of other body areas, such as the thighs and
stomach are more consistent with body dysmorphia from an eating
disorder.
9.3.
A child presents to the hospital with severe emaciation and
parents report significant restricting behaviors. This child
denies body image concerns though parents report that she has
visible mealtime anxiety. She refuses to talk more when asked
about her eating and just stares blankly ahead. She reports
some school worries though parents confirm she sleeps and
focuses well. Physical examination is noteworthy for a palpable
abdominal mass. She ends up being transferred to the intensive
care unit (ICU) for extremely low hemoglobin and hematocrit
and there is a concern that she is bleeding out. Which of the
following is most likely the underlying diagnosis?
A. Anorexia nervosa
B. Generalized anxiety disorder
C. Major depressive disorder-
D. Trichotillomania
E. Unspecified psychotic disorder
9.3. D. Trichotillomania
While the patient above presents with some features of anorexia, the
physical examination findings of a palpable abdominal mass point
toward a bezoar. Most likely she is pulling and eating her hair
(trichophagia) after pulling it out (trichotillomania), which is leading
to an intestinal obstruction. Medical complications of trichophagy
include trichobezoars, intestinal obstruction, and malnutrition.
9.4.
The most common demographic group to be affected by
olfactory reference syndrome includes which of the following?
A. Elderly, single females
B. Married, middle-aged males
C. Married, middle-aged females
D. Middle-aged, single females
E. Young, single males
9.4. E. Young, single males
Olfactory-reference syndrome involves the preoccupation of having
the false belief that one has an offensive body odor. It is most
commonly found in young, single males, with an average age of onset
of 25 years old.
9.5.
Obsessive–compulsive disorder (OCD) symptoms from a
neurologic cause, such as basal ganglia disease, are more likely
to have which type of onset in which demographic group?
A. Insidious onset in a middle-aged person
B. Insidious onset in an elderly person
C. Insidious onset in younger individuals
D. New-onset symptoms in middle-aged individuals
E. New-onset symptoms in older individuals
9.5. E. New-onset symptoms in older individuals
When OCD develops before the age of 30 years and new-onset
symptoms in older individuals occur, concern should be raised for a
potential neurologic disease. This can include disorders such as
Sydenham chorea and Huntington disease.
9.6.
Damage to which brain region can cause excessive hoarding?
A. Cingulate cortex
B. Frontal lobe
C. Hippocampal lobe
D. Parietal cortex
E. Temporal lobe
9.6. A. Cingulate cortex
Hoarding can be common with certain genetic conditions including
Prader–Willi syndrome and Alzheimer disease. Damage to the
anterior ventromedial prefrontal cortex along with the cingulate
cortex can lead to heavy hoarding behaviors.
9.7.
Which of the following criterion is required for making a
diagnosis of trichotillomania, or hair-pulling disorder,
according to International Classification of Diseases, Tenth
Revision (ICD-10), but is not a part of the DSM-5 criteria?
A. Anxiety that precedes and is relieved by the hairpulling
B. Hairpulling despite repeated attempts to change
C. Impairment in social functioning
D. Pulling out hair from more than one site of the body
E. Recurrent pulling resulting in hair loss
9.7. A. Anxiety that precedes and is relieved by the
hairpulling
Per ICD-10 criteria for trichotillomania, all that is required for a
diagnosis is the notice of hair loss due to hair-pulling behavior and
hair-pulling behavior that is preceded by increased anxiety that is
relieved by the hairpulling. For the DSM-5 criteria, there must also
be recurrent hairpulling resulting in hair loss, along with repeated
attempts to change the behavior, an impairment in functioning, or
the behavior leading to significant distress
9.8.
A patient chooses to wear a wig after repeatedly pulling their
hair out. The patient is unable to stop, as it is reported to
alleviate significant anxiety at the moment. Which of the
following psychiatric disorders is most commonly comorbid
with this condition?
A. Attention deficit hyperactivity disorder
B. Anorexia nervosa
C. Excoriation disorder
D. Schizophrenia
E. Substance use disorder
9.8. C. Excoriation disorder
The patient described in the vignette has hair-pulling disorder, or
trichotillomania. The most common comorbidity with it is
excoriation disorder. Other common comorbidities include
obsessive–compulsive disorder (OCD). More than half of those with
excoriation disorder have another psychiatric disorder, most
commonly a mood or anxiety disorder
9.9.
A patient presents with struggles falling asleep due to constant
checking of the locks in the home and having to tap on all of the
windows 10 times in multiples of 10. Examination is notable for
frequent eye blinking and throat clearing. The patient is still
struggling after being on sertraline 200 mg PO daily for 3
months. In this scenario, there is the most evidence base to
support the use of which of the following psychiatric
medications as adjunctive treatment for this disorder?
A. Aripiprazole
B. Clomipramine
C. Lamotrigine
D. Memantine
E. Olanzapine
9.9. A. Aripiprazole
Both risperidone and aripiprazole are best supported as adjunctive
treatment for obsessive–compulsive disorder (OCD) when patients
fail to respond fully to selective serotonin reuptake inhibitors (SSRI)
trials. High doses of SSRIs for at least 12 weeks should be utilized
first. Though conflicting data, some show that the atypical
antipsychotics are particularly useful when tics are comorbid with
the OCD. Response to the atypical antipsychotics is typically quick
(i.e., 4 weeks). Memantine and lamotrigine are experimental agents
that might be promising in the future, along with other meds such as
riluzole, ketamine, and NAC
9.10.
Both therapy and medication for obsessive–compulsive
disorder (OCD) can correct abnormalities in functioning in
which of the following brain pathways?
A. Corpus callosum
B. Corticospinal and corticobulbar tracts
C. Cortico-striatal-thalamic-cortical
D. Dorsal column–medial lemniscus pathway
E. Retinohypothalmic tract
9.10. C. Cortico-striatal-thalamic-cortical (CSTC)
It is thought that CSTC pathway plays a role in contributing to the
cognitive–affective impairments in OCD, with abnormal activation
and inhibition. These impairments result in cognitive inflexibility
and alteration in the habit system and contribute to motor
impulsivity. Medication treatment and cognitive behaivoral therapy
(CBT) have been shown on imaging studies to normalize the
functional alterations in the CSTC pathway in OCD
