Exam 3 Flashcards
National Comorbidity Survey-replication found ? % of population met criteria for OCD during their lifetime
Worldwide prevalence is ?%
Does it occur equally in all ethnic groups?
1.6%
1-3%
Yes
How does DSM-5 classify OCD differently vs. DSM-4? Why did the DSM committee decide to change classifiation?
DSM-4 as anxiety
New category “Compulsive and related disorders” “OCD and related disorders”. Still next to anxiety though
Treatment options different anxiety vs. OCD. Different subcategories. Differences in DSM-5 vs. DSM-4.
Fear not central to OCD. Repetitive thoughts and actions. Other things different too, like response to medication.
Serotonin helps more people with anxiety. Different neural circuits and response to pharmacological treatment.
Differs from anxiety disorders in course of illness, comorbidity, genetic risk/biomarkers, personality correlates, cognitive-emotional processing, treatment response.
Repetitive behaviors (cognition or body-focused actions)
DSM-5 OCD criteria (including 2 specifiers)
A. Obsessions, Compulsions or Both
B. O/C are time consuming (1 hour+) OR cause lots of distress/impair social/occupations/other functioning
C. not attributable to substance or medical condtion
D. not better explained by symptoms of another mental disorder
Specifiers: 1) insight 2) tics (those with tics have more severe symptoms)
? % of those with OCD have poor insight which is related to worse severity and poorer treatment outcomes
2-4%
Obsessions and their compulsions (7)
- Fear contaimintion (clean/wash)
- Pathological doubt (repetitive checking)
- Sexual/violent (repetitive undoing thoughts)
- Fear cause harm (repeated checking)
- Symmetry/exactness (ordering and arranging things)
- Religious obsessions (religious rituals/excessive praying)
- Superstitious obsessions (Superstitious rituals e.g., repeating activities a certain number of times)
Body Dysmorphic Disorder
(Criteria, clinical features, preferred treatment)
Preoccuption with perceived defects or flaws in physical appearance that leads to repetitive behaviors or mental acts in response to the apparent concerns
Poor insight, dermatologists/cosmetic surgeons to address defects, symptom onset during teens, waxing/waning course
CBT and SSRIs
Excoriation (skin-picking)
(Criteria, clinical features, preferred treatment)
Recurrent skin picking leads to lesions. Repeated attempts to decrease or stop skin picking.
More common in females. Symptom onset at beginning of puberty.
Habit reversal therapy. Limited studies on pharmacotherapy
Hoarding Disorder
(Criteria, clinical features, preferred treatment
Persistent difficulty discarding or parting with possessions because of urge to save/not discard. Accumulation where space not used as intended.
75% patients comorbid mood/anxiety
Sig. distress or impariment
Symptom onset 11-15
Hoarding progressively worsens
Behavior thearpy (remove hoarded items, reduce accumulation new things), no data support pharmacotherapy.
Trichotillomania (hair-pulling disorder)
(Criteria, clinical features, preferred treatment)
Recurrent pulling of hair from any part of the body resulting in hair loss. Repeated attempts to decrease or stop hair pulling
More common in females. Onset puberty.
Habit reversal therapy. Mixed/poor response to SSRIs.
Treatment Resistant OCD
DBS, psychosurgery for this
Types of Assessment for OCD(4 types)
Diagnostic Interview (SCID)
Clinician Administered Interview (Y-BOCS)
Family Report
Self-report questionnaire
Describe the Yale-Brown OCD scale
(2 advantages)
Most widely used OCD scale, measure of severity
First generate target symptoms list with patient, allows clinician and patient to agree on symptoms rated. Follow up with specific questions about obsessions/compulsions.
- Used to select target symptoms for treatments.
- You can measure Improvement not just if they have symptoms or not
In controled trials of YBOCS, a decrease of ?% or greater is accepted as indicating clinically meaningful response (global improvement indicating much or very much improved)
35%
Neural Circutry of OCD
Cortico-striatal-thalamic-cortical loops (CSTC)
for cognitive and other associated features of OCD we are still learning about how constructs such as error monitoring is related to circuitry
OFC, prefrontal cortex, caudate/putamen, striatal/striatum, thalamus.
Basal Ganglia in OCD: the parts
Caudate Nucleus, Putamen, Globus Pallidus, subthalamic nucleus, substantia nigra
Striatum
Caudate nucleus and putamen
Ventral striatum
Nucleus accumbens, ventral part of caudate and putamen, olfactory tubercle
Basal Ganglia 5 Functions
- Movement Regulation: initaiton, execution, termination voluntary/involuntary movements
- Learning and memory: procedural memory
- Reward learning: link certain behaviors with positive outcomes
- Emotional processing: context of reward and motivation
- Cognitive control: cognitive control, including ability to inhibit unwanted thoughts and behaviors and to shift attention between tasks and stimuli
CSTC loops in OCD specifics you need to know
Basal ganglia and frontal cotex operate together to learn optimal behaviors and execute goal-directed behaviors
Motivation and emotional drive is coupled with planning and congitive components to plan an action, and then the movement itself are reflected in the organization, physiology, and connections between areas of frontal cortex and projections to striatum
Direct vs. Indirect Pathways: bridging collaterals between these pathways may permit modulation of what?
information transmission
OCD treatment
first line evidence based or something idk there are stars on the slide
- CBT (exposure and response prevention(ERT)#)
- Pharmacotherapy (SSRI: fluoxetine,paroxetine, sertraline#) (also: Clomipramine (tricyclics) and antipsychotics(risperidone/aripiprazole))
- TMS
- DBS
- Psychosurgery
ERT: most effective if you stick with it
How does ERT work?
Start with YBOCS, then treatment planning, psychoeducation about OCD
Systematic repeated and prolonged exposure to feared stimlui in vivo and imaginal
* In vivo: exposure in real life (in the session)
* Imaginal: ask patient to imagine in detail the distressing thoughts/situation (homework)
* Subjective units of distress (SUDS) ratings
Elimiation of rituals: abstain from ritual, patient learns that feared consequence does not occur
12-16 weeks. 50% report continued symptoms
Sympathetic nervous system up, but can only spike for so long.
Effective but high drop out rates
DBS for OCD
Electrode in brain, pulse generator under clavicale (computer and batter, lead wire all implanted)
The DBS lead goes through the putamen and caudate nucleus down to the nucleus accumbens.
rDoC in OCD (gillian paper- error related negativity). Why is it useful?
Error related negativity and error monitoring as constructs “performance monitoring”.
Functional sig of ERN seems to be priming defense responses and encouraging avoidance behavior.
ERN enhancement is not specific to OCD, social anxiety disorder and depression.
ERN good cognitive transdiagnostic marker for treatment predictions rather than neuroimaging (expensive and impractical) for most clinics to use diagnostically (at least for now)
rDoC in OCD: what are other constructs/paradigms in OCD? How do you measure them?
Goal selection, updating, representation, maintenance.
Measure by devaluation task. (an association with feared outcome is no longer present yet individuals with OCD have been show to continue behavior)
Larger response when they make an error relative to those that don’t. EEG signal. OCD = greater error related negativities.
Press button, don’t change when the rules switch
Test question: rDoC experiment for OCD rDoC?
Something related to a circuit.
Game where the rules switch.
Congitive systems, cognitive control, goals updating selection and maintenance. Circuit: CSTC.
different diagnoses
Rats and OCD
Basal ganglia similar to animals
Frontal cortex inactivated, more checking behavior
Light = food. Check more often. in this case, checking wastes time
Monkeys and OCD
Closer resembalance to human brain. Cortex of human not covered by rat. Rat 28% human brain volume, monkey 60-70% depending on species
Humans only correlation of activity. Monkey gets drug effect on brain and changes.
Juice reward. Normally get the new rule, but not if OFC is inactivated. Then more repetitive behaviors. Learn, but hard to switch back. Go on responding to behavior even if not rewarded anymore. Some patients with OCD see change in OFC and first degree relatives.
