Trouble obsessionnel-compulsif

Question 1

what is the mean age of onset of OCD

Answer 1

about 20 years old
–symptoms can occur before age 10
–few new cases after early 30s

Question 2

what % of people with OCD seek treatment

Answer 2

estimated around 14-56% of patients–> OCD may be udner recognizes and under treated

Question 3

name 3 risk factors for developing OCD

Answer 3

social isolation

hx physical abuse

negative emotionality

Question 4

what % of people with OCD have attempted suicide

Answer 4

up to 25%

Question 5

what % of people with OCD have attempted suicide

Answer 5

up to 25%

Question 6

what % of people with OCD have a comorbid disorder

Answer 6

60-90%–> basically, MOST if not almost ALL

Question 7

how does CBT compare to pharmacotherapy for OCD treatment?

Answer 7

CBT is equivalent or superior to pharmacotherapy

*results with CBT were generally similar in comparisons of interventions with an emphasis on ERP and those with an emphasis on cognitive elements

Question 8

how does CBT compare to pharmacotherapy for OCD treatment?

Answer 8

CBT is equivalent or superior to pharmacotherapy

*results with CBT were generally similar in comparisons of interventions with an emphasis on ERP and those with an emphasis on cognitive elements

Question 9

what type of CBT was found to be more efficacious than CBT-ERP for OCD with fears of contamination with infectious agents

Answer 9

cognitive intervention that had NO direct exposure called DIRT–> “danger ideation reduction therapy”

Question 10

in which patients with OCD might cognitive interventions be more important to treatment

Answer 10

patients who do not have overt compulsions (because this makes ERP more difficult)

Question 11

other than CBT, what other psychological interventions may be useful for OCD treatment

Answer 11

acceptance and committment therapy (ACT)

modular cognitive therapy (CT) addressing OCD beliefs

CT addressing obsessional doubt

organizational training

mindfulness training

Question 12

are therapist guided or self guided exposures more effective in OCD treatment?

Answer 12

both showed significant symptom reduction but THERAPIST-LED exposures were more effective in reducing symptoms

Question 13

name a factor that has been associated with poorer response to both behavioural and pharmacological treatments for OCD

Answer 13

family accommodation
(family members taking part in performance of rituals, avoidance of anxiety provoking situations, or modification of daily routines to assist relative with OCD)

*may want to target family accommodation in order to improve treatment outcomes for some patients

Question 14

what type of psychological treatment has been shown to improve symptoms of hoarding disorder

Answer 14

group CBT

“significantly reduced hoarding and depression symptoms”

(bibliotherapy alone did not)

Question 15

what is best for OCD treatment: pharmacotherapy alone, CBT alone, or the combo

Answer 15

combo treatment is better than meds alone, but not better than CBT alone

therefore, if meds are required or preferred, adding CBT to meds may enhance response rates and reduce relapse rates

Question 16

adding what medication may hasten onset of improvements with ERP?

Answer 16

d-cycloserine

Question 17

are the benefits of CBT maintained over time after used for treatment of OCD

Answer 17

yes–> studies show lasting benefits at 1 and 5 years

Question 18

list the first line medications for treatment of OCD

Answer 18

Every Fixed Fear Panics Sometime

Escitalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

Question 19

name the two first line adjunctive agents for treatment of OCD

Answer 19

abilify

risperidone

Question 20

list the 3 second line adjunctive agents for treatment of OCD

Answer 20

memantine

quetiapine

topiramate

Question 21

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

abilify

Answer 21

first line ADJUNCTIVE

Question 22

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

fluoxetine

Answer 22

first line

Question 23

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clonazepam

Answer 23

not recommended

Question 24

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

escitalopram

Answer 24

first line

Question 25

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

citalopam

Answer 25

second line

(and third line adjunctive)

Question 26

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

memantine

Answer 26

second line adjunctive

Question 27

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

risperidone

Answer 27

first line adjunctive

Question 28

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

fluvoxamine

Answer 28

first line

Question 29

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

sertraline

Answer 29

first line

Question 30

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clomipramine

Answer 30

second line

Question 31

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

phenelzine

Answer 31

third line

Question 32

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

paroxetine

Answer 32

first line

Question 33

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

mirtazapine

Answer 33

second line

Question 34

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

venlafaxine XR

Answer 34

second line

Question 35

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

quetiapine

Answer 35

second line adjunctive

Question 36

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

topiramate

Answer 36

second line adjunctive

Question 37

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

lithium

Answer 37

not recommended

Question 38

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

buspirone

Answer 38

not recommended

Question 39

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

clonidine

Answer 39

not recommended

Question 40

where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:

desipramine

Answer 40

not recommended

Question 41

what is the response rate to SSRIs in OCD

Answer 41

40-60%

Question 42

what types of OCD symptoms may be associated with poorer response to SSRIs

Answer 42

symmetry/hoarding symptoms

Question 43

what types of OCD symptoms may be associated with a BETTER response to SSRIs

Answer 43

aggressive, sexual, and religious symptoms

Question 44

why is clomipramine second line for OCD

Answer 44

similar efficacy to SSRIs but not as well tolerated

Question 45

compared to abilify, risperidone may better target which: obsessions or compulsions

Answer 45

obsessions

Question 46

does topiramate seem to help more with compulsions or obsessions

Answer 46

compulsions

Question 47

what invasive procedure may be effective in reducing symptoms in patients with severe, treatment refractory OCD

Answer 47

capsulotomy or cingulotomy

*usually considered last resorts

Question 48

what neurostim interventions may be beneficial in treatment of OCD but require more data

Answer 48

rTMS

deep brain stimulation

Question 49

what lifestyle intervention may improve OCD symptoms

Answer 49

moderate intensity aerobic exercise