Trouble obsessionnel-compulsif Flashcards
what is the mean age of onset of OCD
about 20 years old
–symptoms can occur before age 10
–few new cases after early 30s
what % of people with OCD seek treatment
estimated around 14-56% of patients–> OCD may be udner recognizes and under treated
name 3 risk factors for developing OCD
social isolation
hx physical abuse
negative emotionality
what % of people with OCD have attempted suicide
up to 25%
what % of people with OCD have attempted suicide
up to 25%
what % of people with OCD have a comorbid disorder
60-90%–> basically, MOST if not almost ALL
how does CBT compare to pharmacotherapy for OCD treatment?
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
how does CBT compare to pharmacotherapy for OCD treatment?
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
what type of CBT was found to be more efficacious than CBT-ERP for OCD with fears of contamination with infectious agents
cognitive intervention that had NO direct exposure called DIRT–> “danger ideation reduction therapy”
in which patients with OCD might cognitive interventions be more important to treatment
patients who do not have overt compulsions (because this makes ERP more difficult)
other than CBT, what other psychological interventions may be useful for OCD treatment
acceptance and committment therapy (ACT)
modular cognitive therapy (CT) addressing OCD beliefs
CT addressing obsessional doubt
organizational training
mindfulness training
are therapist guided or self guided exposures more effective in OCD treatment?
both showed significant symptom reduction but THERAPIST-LED exposures were more effective in reducing symptoms
name a factor that has been associated with poorer response to both behavioural and pharmacological treatments for OCD
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
what type of psychological treatment has been shown to improve symptoms of hoarding disorder
group CBT
“significantly reduced hoarding and depression symptoms”
(bibliotherapy alone did not)
what is best for OCD treatment: pharmacotherapy alone, CBT alone, or the combo
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
adding what medication may hasten onset of improvements with ERP?
d-cycloserine
are the benefits of CBT maintained over time after used for treatment of OCD
yes–> studies show lasting benefits at 1 and 5 years
list the first line medications for treatment of OCD
Every Fixed Fear Panics Sometime
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
name the two first line adjunctive agents for treatment of OCD
abilify
risperidone
list the 3 second line adjunctive agents for treatment of OCD
memantine
quetiapine
topiramate
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
abilify
first line ADJUNCTIVE
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
fluoxetine
first line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
clonazepam
not recommended
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
escitalopram
first line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
citalopam
second line
(and third line adjunctive)
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
memantine
second line adjunctive
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
risperidone
first line adjunctive
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
fluvoxamine
first line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
sertraline
first line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
clomipramine
second line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
phenelzine
third line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
paroxetine
first line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
mirtazapine
second line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
venlafaxine XR
second line
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
quetiapine
second line adjunctive
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
topiramate
second line adjunctive
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
lithium
not recommended
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
buspirone
not recommended
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
clonidine
not recommended
where does the following medication fall in terms of treatment for OCD according to the canadian practice guidelines for OCD:
desipramine
not recommended
what is the response rate to SSRIs in OCD
40-60%
what types of OCD symptoms may be associated with poorer response to SSRIs
symmetry/hoarding symptoms
what types of OCD symptoms may be associated with a BETTER response to SSRIs
aggressive, sexual, and religious symptoms
why is clomipramine second line for OCD
similar efficacy to SSRIs but not as well tolerated
compared to abilify, risperidone may better target which: obsessions or compulsions
obsessions
does topiramate seem to help more with compulsions or obsessions
compulsions
what invasive procedure may be effective in reducing symptoms in patients with severe, treatment refractory OCD
capsulotomy or cingulotomy
*usually considered last resorts
what neurostim interventions may be beneficial in treatment of OCD but require more data
rTMS
deep brain stimulation
what lifestyle intervention may improve OCD symptoms
moderate intensity aerobic exercise
