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Psychiatry > Obsessive Compulsive Disorders > Flashcards

Obsessive Compulsive Disorders Flashcards

1
Q

What are obsessions?

A
  • 1) Unwelcome, persistent, recurrent, intrusive thoughts distressing to the invididual,
  • 2) not excess worries about real life problems
  • 3) ind attempts to suppress or neutralise them and
  • 4) recognises them as absurd (egodystonic) and product of own mind (i.e. not thought insertion)
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2
Q

What are compulsions

A
  • Repetitive, purposeful, physical or mental behaviours performed with reluctance in response to an obsession.
  • Carried out according to certain rules in a stereotyped fashion,
  • designed to neutralise or prevent discomfort or a dreaded event.
  • excessive and not connected to obsession
  • individual realises behaviour is unreasonable
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3
Q

What are examples of compulsions?

A
  • hand washing, cleaning
  • counting, checking
  • touching and rearrangement of objects to achieve symmetry
  • mental compulsions
  • hoarding
  • arithmomania
  • onomatomania
  • folie du pourquoi
  • excessive tidiness
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4
Q

What is arithmomania

A

Compulsive counting

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5
Q

What is onomatomania?

A

Compulsion to utter forbidden word

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6
Q

what is folie du pourquoi?

A

Compulsion to seek explanations for commonplace facts by asking endless questions

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7
Q

What happens if compulsions are resisted?

A

Anxiety builds until compulsion completed

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8
Q

What characterises OCD?

A 
A. Obsession +/- compulsions
B. Recognised as unreaosnable
C. Cause marked distress and are time consuming / interfere significantly with routine
D. Other Axis I excluded
E. Exclusion of GMC
  • Time consuming (>1h/d) obsessions / compulsions
  • Present most days for at least two weeks
  • Distressing and interfere with activities
  • avoidance of triggers
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9
Q

Onset of OCD?

A

Adolescence

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10
Q

OCD subtypes?

A
    1. O&Cs: concerned with contamination (most common)
    1. Checking compulsions in response to obsessional thoughts about potential harm (e.g. leaving gas on)
    1. Obsessions without overt compulsive acts
    1. Hoarding
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11
Q

Complications of OCD?

A

-Depression
-Anxiolytic abuse
-EtOH abuse
Distress and functional impairment similar to psychotic d/os

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12
Q

OCD prevalence?

A

2-3%

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13
Q

Medical illness a/w OCD?

A

Streptococcal infection (PANDAS subtype)

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14
Q

Aetiology OCD?

A
  • FHx: 50% of OCD, tics, Tourette’s
  • Parental overprotection
  • Biochem: 5HT esp
  • Cortico-striatal-thalamic circuit (mediates social behaviour)
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15
Q

Psychoanalytic theory of OCD?

A

Defences against cruel and aggressive fantasies (filling the mind with obsessional thoughts prevents undesirable ideas entering consciousness) and defensive regression to anal stage of development

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16
Q

Behavioural theory of OCD?

A

-Compulsive behaviour is learned and maintained by OPERANT conditioning: anxiety reduction following compulsive behaviour strengthens/increases need to perform compulsion following obsession.

17
Q

What is PANDAS?

A

Paediatric autoimmune neuropsychiatric disorders associated with streptococci

18
Q

What is BDD?

A
  • Preoccupation with imagined defect in appearance or markedly excessive concern with a slight physical anomaly
  • Time consuming behaviours: mirror gazing, comparing features, excessive camouflaging, skin picking
19
Q

Management OC disorders (OCD, BDD)?

A
  • CBT (psychoeducation; graded exposure therapy; relaxation)
  • Drug: SSRIs or clomipramine
  • Regular review of mental state and risk
  • Exclude medical causes
  • Liase with work / study
20
Q

Response to drugs and CBT?

A

~75%

placebo 5%

21
Q

What is anakanistic personality disorder?

A 
(aka OCD personality d/o)
Characteristics:
-rigid thinking
-perfectionism interfering with task completion
-Moralistic rule preoccupation
-excessive cleanliness
-high standards seldom achieved
-tendency to hoard
-emotional coldness
22
Q

Medication used in OCD?

A

-SSRI e.g.
==>fluoxetine 20-80mg/d
==>sertraline 50 - 200mg
==> fluvoxamine 25mg nocte

Psychiatry (16 decks)

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