OCD

Question 1

What is the ICD definition of OCD

Answer 1

Reccurent obsessional thoughts OR/AND complusive acts
Must be a source of stress and intefere with ADLS

what are defined as obsessions-involuntary thoughts, imagied, implulses
Self recognised as product of own mind
>1 thought cannot be resisted
Throughts of carrying the act arent pleasurable
Thoughts must be pleasently repetive
Themed - contamination, agression (self or other), infectioin, sex, religion
Edodystonic-themes agaisnt what person consider themselve

compulsions- repetitve mental/physcal acts
compelled to perform in response to obessions/irrationally defined rules
Performed to reduce anxiety though IRRATIONAL beliefs

ddx- body dysmoprhia, anakastic persolality disorder
if obsession - depressive (becks triad -50% OCD have depression), other anxietty , hypocondria, schizophrenia (delusion)
complusions - habit/impulse disorders

if depression - if sx develop toegether-prioritise first one. if unkown-focus on depression

Question 2

What are the aetiology and RF of OCD

Answer 2

Aetiology - 1% of pop, M>F (only anxiety to affect men more than women), 70% <25

bio - genetics -3x risk Fhx
Neuro-Basal ganglia implicated and complicated by (eg- syndehams chorea, ecenphelitis, tourettes), Infection
psych- personality -25% have premorbid anakastic personality (rigid)

Question 3

sx of ocd

Answer 3

Obesssional thougts and
compulsions (repeated rituals)
tensions/discomfort neutralised by compulsions (but the acts arent enjyable in themselves)
=find out how many ytimes a day and etc
anxiety sx

Question 4

Ix and key Q of OCD

Answer 4

Ix -bloods =FBC, TSH
Rating scale - yale brown ocd scale

key q/screening q
do you wash/clean a lot
check time a lot
thought that bother you youd want to get rid off
daily activities take long to finish>
concerned about putting things in special order?
corncened with mess?
do these issues trouble you?

Question 5

Mx of OCD

Answer 5

Mild impairement -
CBT and ERP
CBT–
relabel- eg- tell hands are not dirty even if they are
Reatribute -“the ocd is causing me to feel this way, my hands are not actually dirty”
Refocus - indulge in other behaviours to distract from OCD thoughts
Revalue - told to not give importance to OCD thoughts -“its just my stupid ocd ignore it”

Moderate impairment-
Intensive CBT with ERP
SSRI - continue 12m -Fluoxetine > sertraline
depression 20mg, anxiety 40mg
OCD 60/80mg -taper after 12m
2nd -SNRI (off label=specialist only)
3rd line --TCA or SSRI (clominapramine)
(or off label, specialist only - atypical antipsychotics

Severe -reffer to psych

Prog – 25% significant improve,
50% moderate improve
25 get worse