OCD

Question 1

Px

Answer 1

-intrusive obsessional thoughts-
Ideas, images or impulses that repeatedly enter mind. Distressing and often resisted. Or interfere with function.
Conditional stimuli associated with fear or anx.
-compulsive acts or rituals-
Repeated behavs to relieve stress, not enjoable. Neutralising behavsto reduce anx that become fixated.
-present most days for at least 2 wk.
-75% have obsessions and compulsions.
-common obessions are contamination, and doubt then checking. Also symmetry, religious, hoarding, bodily fears, counting, aggressive thoughts.

Question 2

Mx

Answer 2

-bio- SSRI 1st line eg escitalopram, fluoxetine, sertraline, paroxetine. Clomipramine second line. Risperidone, haloperidol if psychotic feats. 
ECT and psychosyrgery if suicidal or sev incapacitated. 
?DBS. 
-psycho- 
CBT- exposure and response prevention. 
Behavioural and cognitive therapy. 
Supportive psychotherapy
Family therapy. 
Psychoanalytical.

Question 3

Prevalence

Answer 3

Mean age onset 20.
70% onset before 25, 15% after 35.
Equal male and female.
0.5-3% of popn.

Question 4

Aetiology

Answer 4

• bio- Dysregulation 5HT system. Cell mediated AI factors. Reduced caudate size. Basal ganglia hypermetabolism. Genetic.
• psycho- defective arousal system, inabilty to control unpleasant internal state.

Question 5

Comorbidity

Answer 5

• associations- avoidnt, dependant, histrionic, anankastic traits before. Schizophrenia. Sydenhams chorea and other basal ganglia disorder eg tourettes.
• comorbidity- dep, subtance, social or other phobia, panic disoder, ED, PTSD, tourettes.

Question 6

Diffs

Answer 6

Normal worries or habits
Anankastic PD
Schizo
Phobia
Dep
Hypochondriasis
Body dysmorphic disorder.

Question 7

Prognosis

Answer 7

25% sig improve.
50% moderate improvement.
30% chronic or worsening.
Relapse high after stop meds.
Suicide high esp if dep too.
-good facs- good social and occupational adjustment before, having a precipitating event, episodic symps, less avoidance.
-poor facs- giving in to compulsions, LT, early onset, male, tics, strange compulsions, dep too, delusions, PD.