Obsessive Compulsive Disorder (OCD) Flashcards
Obsession definition
Recurrent intrusive though/feeling/idea/image/sensation
Compulsion definition
A conscious, standardized recurrent behavior intended to create a feeling of safety or mitigate anxiety
DSM-5 for OCD
1) Presence of obsession/compulsions or both
2) The obsessions or compulsions are time-consuming (>1 hr per day) or cause clinically significant distress or impaired social/occupation functioning
Also shows ego-dystonic behaviors in compulsions
- behavior that is not congruent with ones beliefs and attitudes
- this is opposite OC personality disorder, where the actions are ego-syntonic*
Types of obsessions
Harm:
- feeling that you are going to some unintended harm, so need to always recheck to make sure
Contamination:
- feeling that you accidentally are infecting people or contaminating objects
Doubt:
- feeling that you are forgetting to dos one thing so having to recheck
Sexual/violent:
- ego-dystonic feelings of unwarranted sexual or violent conduct. The compulsions are to mitigate doing these actions
Order and symmetry:
- ego-syntonic feelings of ensuring you and others are doing the right things
Religious:
- obsession of making sure you are in good graces of the religious power
Self-control:
“Just right”:
- patient feels that everything is done “almost, built not quite right” so needs to keep redoing things.
How to tell a compulsion from a behavior?
Ask the patient what happens if they dont do the action.
- if they say nothing and its okay = behavior
- if they say anxiety or somatic symptoms develop = compulsion
When to screen for OCD
When there is any evidence of an obsession or compulsion
When you are treating someone for depression or anxiety that just isnt getting better
Anytime a patient keeps making visits/ asking over and over again “am i okay” or”is anything wrong with me”?
Specifiers in OCD diagnosis
Good/fair/poor/absent insight
- in order to determine this, ask “how likely do you think (“”) is true?”
OCD w/ tics or without tics
note while not a specifier, new mothers with postpartum psychosis often show with OCD
How to ask for OCD?
“Is there anything that you have to do repeatedly every day in order to feel safe and comfortable?”
“Do you have intrusive, unwanted thoughts that cause you anxiety or distress?”
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or the Florida Obsessive-Compulsive Inventory (FOCI) can be helpful if the questions aren’t enough to determine if they have OCD
Treatment for OCD
- Prognosis is great as long as the treatment is compliant*
- suicide does have an increased risk in OCD patients however, so be careful
First line therapy:
- psychotherapy
- Exposure and response prevention therapy is first-line (start gradually to challenge the principles of their anxiety to start habitation of their anxiety)*
First line Meds:
SSRIs and SNRIs
- fluoxetine and fluvoxamine are most common
Others:
- atypical antipsychotics (only as augmentation if needed)
- clomipramine (failed first-line only)
- benzos (short-term only, cannot be a true therapy thou)
What is the most likely neurotransmitter responsible for OCD?
Serotonin In the Orbito-prefrontal cortex
Misconceptions of OCD
is NOT adaptive
Psychotherapy can be harmful if not administered by a trained therapist for OCD
- other therapies that is not exposure/response DOESNT WORK AND IS HARMFUL (can develop new compulsions)
General treatment for other OCD-related disorders
BDD , hoarding disorder, tricholotillomania
CBT therapy and SSRIs
- need to refer to specialist though
Obsessive-compulsive personality disorder DSM-5 (OCPD)
Pervasive patterns of preoccupation with order, perfection and interpersonal control at the expensive of Flexibility and efficiency As indicated by at least 4 of the following:
- preoccupied with details/rules/lists and schedules to the point where the major activity is lost
- shows perfectionism that interferes with task completion (doesnt ever actually get the project done since the standards are too strict)
- excessively devoted to work and productively of friendship and relationships
- inflexibility to morality, ethics and values (not religious based)
- unable to discard worn-out or worthless objects even when no sentimental value is present
- reluctant to delegate tasks or to work with others unless they are 100% submitted to the persons way of doing things
- hoards money for “future catastrophes” and refuses to spend money unless there is a reason behind it
- shows rigidity and stubbornness
- usually no compulsions and are generally stable* (difference from “just right” OCD)
- also is ego-syntonic
What is the most common syndrome outside of MDD that OCD is associated with?
Tourette’s syndrome
