Obsessive Compulsive Disorder Flashcards
Michael has for years been afraid that electrical appliances, if not switched off, could cause a fire and harm his family or neighbours. He spends four hours a day checking that they are switched off. How would you assess and manage?
Impression
Given the obsessions around fire etc, and compulsive checking behaviours in response which are impairing function given the four hours daily of checking, this most likely represents a presentation of OCD.
DDX
- Anxiety: hypochondriasis, GAD
- Personality: OCPD
- psychotic disorder - could represent delusional
- Comorbids: ED, depression, SUD
Priorities
- complete psych assessment (H/E/I)
OCD - History
History
- sx: OCD diagnostic criteria: 1 - obsessions, and/or 2 compulsions, significantly distressing or impairing function, egodystonic (the patient is distressed by them)
- screen for patients personality
- other anxiety symptoms,
- screen suicide, mania, depression, SUD, violence, personality
- rest of
OCD - Examination
Examination
- MSE
- signs related to compulsions: eczematous eruptions due to excessive washing, hair loss related to compulsive pulling, excoriation’s due to compulsive skin picking)
- Case formulation
OCD - Investigations
Investigations
- nil required for diagnosis of OCD
- only for ruling out organic causes, investigating co-morbid conditions
- Severity scale: Y-BOCS scale, establishes a baseline of patients symptoms and assess their severity
OCD - Management
Management
First line treatment is CBT +/- SSRIs. the illness tends to be chronic and refractory, higher doses of SSRI’s required to treat
Psychological
- CBT
- gradual exposure and response prevention therapy: over time get exposed and desensitised to them. Start with least threatening fear regarding obsession and get them to work through, create strategies for dealing with compulsions.
Biological
- SSRI, start at 1/2 dose to MDD, but end dose tends to be higher
- TCA if no response to SSRI
Social
