Obsessive compulsive disorder (OCD) Flashcards

1
Q

What is OCD? What is the difference between obsessions and compulsions?

A

This disorder is characterised by the presence of obsessions and compulsions which causes distress

  • Obsessions = recurrent, unwanted and intrusive thoughts/ images/ impulses in one’s mind, despite attempts to resist them; patient aware that this is a product of their own mind
  • Compulsions = repeated and seemingly purposeful rituals that are carried out to neutralise an obsession and reduce anxiety
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2
Q

How common is OCD? Who is it more common in?

A
  • 1-2%
  • F = M
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3
Q

What is the aetiology of OCD?

A

Aetiology is multifactorial.

Biological:

  • Basal ganglia defects
  • Frontal lobe abnormalities
  • FH - MZ:DZ is 50-80% concordance, 35% of first degree relatives
  • Other metal health conditions

Psychosocial:

  • Personality traits: anankastic
  • Psychological trauma
  • Stress
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4
Q

List 3 conditions which OCD is associted with.

A
  • depression (30%)
  • schizophrenia (3%)
  • Sydenham’s chorea
  • Tourette’s syndrome
  • anorexia nervosa
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5
Q

How often must symptoms be present to diagnose OCD?

A
  1. symptoms must be present on most days for >1hr/day for at least 2 weeks
  2. AND must be the source of distress or interference with activities.
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6
Q

Are the thoughts in OCD the patient’s own?

A

Yes they are the patient’s own thoughts. They are recognised to be irrational but cause intense discomfort. Anxiety increases as compulsive acts are resisted.

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7
Q

What are the most common themes in OCD?

A

In order:

  • checking compulsions 63 %
  • washing 50 %
  • fears of contamination 45 %
  • obsessive doubts 42 %
  • bodily fears 36 %
  • counting 36 %
  • insistence on symmetry 31 %
  • aggressive thoughts 28 %
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8
Q

What are the two categories of compulsions?

A

Overt - and observable by others, such as checking that a door is locked,

Covert - mental act that cannot be observed, such as repeating a certain phrase in one’s mind.

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9
Q

Give 3 common examples of obsessions and compulsions.

A

Obsessions e.g.

  • doubts (not closing windows, door)
  • ruminations,
  • believing they are always dirty
  • impulse to do something dangerous

Compulsions e.g.

  • hand-washing,
  • checking,
  • arranging objects in a certain wa
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10
Q

What is the management of OCD?

A

1st line:

  • Low intensity psychological treatment - CBT with ERP* - up to 10 hours
  • +/-SSRI (fluoxetine)

2nd line:

  • SSRI (fluoxetine)
    • Continue for 12 months after remission
  • +/- more intense CBT + ERP

3rd line:

  • After 12 weeks: clomipramine (TCA) or alternative SSRI
    • CBT + ERP

Resistant: - psychosurgery (rare) - anterior cingulotomy

ERP = exposure and response prevention

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11
Q

What is the SSRI of choice in OCD? What happens if it is not effective? How long should it be continued?

A
  • Fluoxetine
  • Continue for 12 months after remission
  • It after 12 weeks no effect - different SSRI or clomipramine (highly serotonergic TCA)
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12
Q

What does ERP involve?

A
  • Compulsions are analogous to escape in phobias
  • CBT aims to prevent compulsive behaviour, allowing the tolerated anxiety to habituate
    • E.g. someone with obsessions about contamination is supported to touch something dirty and instead of immediately washing their hands, they are encouraged to experience anxiety and discuss it with the therapist
  • A hierarchy of feared situations is used
  • Effective in well-motivated patients
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13
Q

Give examples of low-intensity psychological therapies that can be used for OCD.

A
  • Brief individual CBT (including ERP) using structured self-help materials
  • Brief individual CBT (including ERP) by telephone
  • Group CBT (including ERP)
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14
Q

What are overvalued ideas in OCD?

A

Describes thought content: a reasonable belief that is pursued excessively, dominates the person’s life and causes distress to self/others e.g. beliefs about body shape. They are not unusual or bizzare beliefs and are socially acceptable.

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15
Q

What must you show has been excluded when documenting presence of overvalued ideas?

A

Must exclude delusions

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16
Q

What questions should you ask about OCD in a history?

A

Obsessions:

  • Do you have any unpleasant thoughts that don’t go away however hard you try to ignore them?
  • Do you worry about cleanliness, not having checked something, bad religious thoughts, doing something bad to someone?
  • Where do these thoughts come from?
  • Do you believe them?
  • How do they make you feel?
  • How do you manage these feelings?

Compulsions:

  • Do you have to do any rituals to manage your anxiety?
  • How long do you have to spend?
  • How mnay times a day do you have to…
  • How do you feel if you can’t do that ritual?
17
Q

What is the prognosis with OCD?

A
  • Often chronic course with symptoms worse at times of stress
    • 70% respond to rx but can be chronic
    • Precipitated/perpetuated by stress
  • Associated with other mental illnesses, e.g. depression
  • Better if mild symptoms / short duration
  • Comorbid depression is common