Obsessive Compulsive Disorder

Question 1

What is meant by obsessions?

Answer 1

Stereotypical, purposeless, unwanted intrusive thoughts, images or urges that repeatedly enter the person’s mind.

Question 2

What is meant by compulsions?

Answer 2

Senseless, repeated rituals/behaviours/mental acts that a person feels is driven to perform. May be overt (observable by others) or covert (not observable by others e.g. repeating something in their mind).

Question 3

What are obsessions and compulsions perceived as?

Answer 3

INTRUSIVE, NONSENSICAL and although out of character aware that they originate from themselves.

Question 4

What are risk factors for OCD?

Answer 4

• Genetic predisposition
• Developmental factors e.g. abuse, neglect, social isolation
• Personality traits exaggerating/maintaining pathology
• Stressors/triggers e.g. pregnancy or postnatal period
• Neurological conditions e.g. tumour, frontotemporal dementia or trauma to brain.

Question 5

What are the ICD-10 diagnostic criteria?

Answer 5

• Either obsessions or compulsions (or both) must be present on most days for a period of at least two weeks.
• They are acknowledged as originating in the mind of the patient and are not imposed by outside persons or influences.
• They are repetitive and unpleasant and at least one obsession or compulsion must
be present that is acknowledged as excessive or unreasonable.
• The subject tries to resist them (but if very long-standing, resistance to some obsessions or compulsions may be minimal). At least one obsession or compulsion must be present which is unsuccessfully resisted.
• Carrying out the obsessive thought or compulsive act is not in itself pleasurable.
• The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.

Question 6

What is the pathophysiology of OCD?

Answer 6

CNS imaging implicates the orbitofrontal cortex and caudate nucleus, and in treatment it is noted that this is less so.

Question 7

Management of OCD?

Answer 7

Psychological:
•	CBT  first line treatment
•	Exposure and response prevention (ERP)
Pharmacological:
•	Can give SSRI e.g. fluoxetine or can give Clomipramine