Anxiety: OCD

Question 1

What are the features of disordered aversive functioning? (11)

Answer 1

-enhanced identification of aversive or threat stimuli
in arousal- hyper vigilance
inability to relax/sleep
reduced contact with prev rewarding stimuli
tense, anxious mood
prev neutral stimuli become aversive and avoidance of prev neutral environments
avoidance
inc use of anxiety management techniques
rehearsal & over-rehearsal of safety behaviours
intolerant of frustration

Question 2

OCD

• what is it?
• poorer prognosis?
• what is seen on neuroimaging?

Answer 2

OCD is a common, chronic and disabling disorder, marked by obsessions and/or compulsions that are ‘egodystonic’ [viewed as repugnant or inconsistent with the personality, values and moral perspective] and cause significant distress for patients and their families

-early onset, male tics and multiple symptoms

-inc metabolism and blood flow in orbitofrontal cortex , caudate nucleus and cingulate cortex
Also a genetic component

-

Question 3

Obsessions

-definition?

Answer 3

recurrent, intrusive and distressing thoughts, ideas, images, memories, impulses
unwanted
usually resisted
recognised as originating from own mind
associated with the emergence or increase of anxiety

Question 4

Compulsions

-definition?

Answer 4

repetitive, seemingly purposeful behaviours that individual feels driven to perform.
can include physical and mental rituals
carrying out compulsions tends to reduce anxiety – e.g. handwashing
resistance to performing a compulsion increases anxiety
usually recognised as ‘irrational’

Question 5

OCD comorbidity

-what are the differentials?

Answer 5

-OC personality disorder

-autism spectrum
schizophrenia
Hypochondriasis
BDD

Question 6

OC personality disorder

-features? (8)

Answer 6

preoccupation with rules, lists, order, schedules
perfectionism interfering with task completion
devotion to work
overconscientious & inflexible
unable to discard worthless objects
reluctance to delegate, need to be in control
miserliness
rigidity and stubbornness

Question 7

Treatment? (4)

-name the 3 domains of dysfunctional belief that OCD patients exhibit?

Answer 7

-Start with an SSRI or CBT
basically keep changing SSRI until they respond to one
clomipramine/SSRI after 2 SSRIs
Exposure and response prevention

-Overestimation of threat / Inflated sense of responsibility
Beliefs about the importance of, and need to control, intrusive thoughts
Perfectionism and intolerance of uncertainty

Question 8

What are the 5 screening Qs to help identify OCD?

Answer 8

1. Do you wash or clean a lot?
2. Do you check things a lot?
3. Is there any thought that keeps bothering you that you would like to get rid of but can’t?
4. Do your daily activities take along time to finish?
5. Are you concerned about orderliness or symmetry?