Anxiety disorders - OCD Flashcards
(12 cards)
What are the risk factors for OCD? GAPSS
Family history
Age 10-20
Pregnancy / postnatal period
History of abuse/neglect/bullying
G -GENETICS
A - AGE
P - PREGNANCY POST NATAL
S - STREP INFECTION
S - SOCIALS
Other conditions which affect the basal ganglia can also increase the risk of OCD ‘OCD SET’
Neurological conditions that can increase the risk of OCD?
Sydenham’s chorea (in children after strep throat)
Encephalitis lethargica (sleeping sickness)
Tourette’s syndrome
All are basal ganglia implicated
what scores on the Yale brown screening for OCD indicate mild moderate severe and extremely severe OCD?
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
· 8-15 = Mild
· 16-23 = Moderate
· 24-31 = Severe
· 32-40 = Extremely severe
What is 3rd line for OCD is all else is not working?
Clomipramine / alternative SSRI to flouxetine
Clomipramine is in a group of medications called tricyclic antidepressants
if at any point with OCD ther is severe function impairment: to secondary care mental health team for assessment. Whilst awaiting assessment start SSRI + CBT.
[1st line = cbt with ERP]
[2nd line = SSRI fluxoetine]
What is OCD?
Obsessional thoughts / compulsive activities, present on most days for 2+ weeks that impact normal functioning
These acts take up 1+ hr / day
Whats the difference in obsessions and compulsions?
Obsession: Repetitive, unwanted intrusive thought. Images and impulses, these thoughts are not pleasurable.
Compulsions: Reptitive behaviours or mental acts that the person feels driven to perform, caused by the obsession.
Often performed to reduce anxiety through the irrational belief that this will prevent a dreaded event
Examples of common obsessions? (OCD)
Obsession: Repetitive, unwanted intrusive thought. Images and impulses, these thoughts are not pleasurable.
Contamination, aggression, infection, sex, religion
Egodystonic (themes/ideas against that which the person associates with their ego)
What is 2nd line for OCD that is causing functional impairment
If mild has become moderate / or 1st line doesnt work:
SSRI = flouxetine (larger dose than for depression)
12 months after remission of symptoms too
If <12 weeks and ineffective, try increasing dose. Only move onto 3rd line after 12 weeks.
If someone has mild OCD what is 1st line management?
Low intensity psychological therapies
-> CBT with ERP (exposure and response prevention)
ERP is rooted in the concept of habituation: by exposing an individual to the trigger of their obsessive thoughts or behaviours without permitting the ensuing compulsion, the anxiety or urge usually diminishes over time.
Which scale to use for OCD classification?
Yale-brown OCD scale
Can be mild, moderate, severe
OCD and insight?
Patient is aware of their thoughts and actions - have intact insight
Why may sertraline be preferred over flouxetine?
IF a patient has comorbidites such as previous MI
