Obsessive-Compulsive Disorder Flashcards
Clopiramine
Serotonin-dopamine inhibitor of the TCA class
Effective in the treatment of OCD
Main adverse effects are sedation, anticholinergic effects, and QTc prolongation/risk of cardiac arrhythmia with high doses (overdose)
Obsessions
Recurrent and persistent thoughts, impulses, or images that cause marked anxiety or distress.
Often patients with OCD recognize that these are unreasonable.
Examples include: concerns about contamination, need for symmetry, taboo sexual or religious thoughts.
They are NOT simply excessive worries about real life problems.
Mean age of onset for OCD
20 years of age
Average duration of illness in OCD
~9 years
Diagnostic criteria for Obsessive-Compulsive Disorder
The presence of either obsessions or compulsions
The person realizes that the obsessions or compulsions are excessive and unreasonable; this requirement need not apply to children
Obsessions or compulsions cause marked distress, are time consuming, or interfere with the person’s normal routine.
If another major mental illness is present, the contens of the obsessions or compulsions are not restricted to it
Secondary obsessions and compulsions
May be seen in stimulant use, especially when stimulants are taken in high doses.
Sometimes OCD (particularly childhood OCD) may be secondary to PANDAS, and so a history of recent streptococcal infection should be taken into consideration.
Additionally, obsessive-compulsive behaviors may be secondary to psychosis, indicating a primary psychotic disorder such as schizophrenia or schizoaffective disorder.
Treatment of OCD
Can involve psychotherapy and psychopharmacology. Both have demonstrated clinical utility, and a combination is superior to either alone (particularly psychotherapy with SSRIs)
CBT with expsure/response therapy is first-line talk therapy.
SSRIs are the most effective pharmacologic treatment. Fluoxetine, sertraline, and fluvoxamine are most commonly used. Clomipramine also has demonsrtated efficacy, but its side effects make it second line.
In patients whom combiation therapy fails, another SSRI may be attempted. When SSRIs have repeatedly failed, clomipramine may be considered. For patients with severe disease that do not engage with therapy, hospitalization or therapy in residential facility may be useful.
OCD presentation in children vs adults
Children may not have the insight to realize that their obsessions and compulsions are unreasonable, unlike adults with OCD who usually have excellent clinical insight
Hoarding disorder treatment
1st line is CBT
If CBT alone fails, SSRIs can be helpful as an adjunctive therapy
