Obsessive Compulsive Disorder (OCD)

Question 1

What is OCD?

Answer 1

It is a condition in which an individual has uncontrollable, reoccurring obsessions and/or compulsions, which can cause significant functional impairment and/or distress

The conduction of these repetitive behaviours is to prevent an objectively, unlikely event from occurring, which the person perceives will cause harm to themselves or others. This acts to reduce their distress and enable them to gain control over the situation

Question 2

What are the five risk factors associated with OCD?

Answer 2

Young Age, 10 – 20 Years Old

Family History

Pregnancy/Post Natal Period

Childhood Trauma

Question 3

What are obsessions?

Answer 3

They are defined as unwanted intrusive thoughts, images or urges that repeatedly enter the individual’s mind

Question 4

What are the five common obsessions of OCD?

Answer 4

Fear of Contamination

Doubt & Difficulty Tolerating Uncertainty

Orderly & Symmetrical Needs

Harmful Thoughts to Themselves & Others

Unwanted Thoughts Regarding Sex & Religion

Question 5

What are compulsions?

Answer 5

They are repetitive behaviours or mental acts that the individual feels driven to perform

They can be overt and observable to others, such as checking that a door is locked, or a covert mental act that cannot be observed, such as repeating a certain phrase in one’s mind

Question 6

What are the six common compulsions of OCD?

Answer 6

Washing & Cleaning

Checking

Counting

Orderliness

Strict Routines

Demanding Reassurance

Question 7

What are the three diagnostic criteria of OCD?

Answer 7

The individual is unable to control their thoughts or behaviours, even when those thoughts or behaviours are recognised as excessive.

The obsession or compulsions should be time-consuming, taking more than one hour per day, or cause clinically significant impairment in social, occupational, or other important areas of functioning.

The individual doesn’t get pleasure when performing the compulsion, however, may feel bring relief from anxiety that the thoughts cause.

Question 8

What are the two psychological management options for OCD?

Answer 8

Psychoeducation

Cognitive Behaviour Therapy (CBT) With Exposure & Response Prevention

Question 9

What is psychoeducation?

Answer 9

It involves providing patients with information about obssessive compulsive disorder and ways in which they can control and minimise it

Question 10

What is CBT?

Answer 10

It is a talking therapy used to manage the way in which patients think, feel and behave

Question 11

What is exposure and response prevention therapy?

Answer 11

This is a technique in which the individual is exposed to an anxiety provoking situation and then stopped from engaging in their usual safety behaviour

This helps them confront their anxiety and the habituation leads to the eventual extinction of the response.

Question 12

What are the two pharmacological management options for OCD?

Answer 12

Selective Serotonin Reuptake Inhibitors (SSRIs)

Tricyclic Antidepressants (TCAs)

Question 13

What is the first line pharmacological management option for OCD?

Answer 13

SSRIs

Question 14

Name four SSRIs used to manage OCD

Answer 14

Sertraline

Citalopram

Fluoxetine

Paroxetine

Question 15

Which SSRI should be used to manage body dismorphic disorder?

Answer 15

Fluoxetine

Question 16

In comparison to depression, how do we administer SSRIs to manage OCD?

Answer 16

A higher dose and a longer duration of treatment, usually 12 weeks, is required for an initial response

Question 17

In cases where SSRI management is deemed effective, how long should administration be continued for?

Answer 17

> 12 months

Question 18

When are TCAs used to manage OCD?

Answer 18

They are the second line pharmacological management option

They should be offered when individuals prefer TCAs, have had a good previous response or if SSRIs are contraindicated

Question 19

Name a TCA used to manage OCD

Answer 19

Clomipramine

Question 20

What is the management option for mild OCD?

Answer 20

Low intensity psychological treatments, such as cognitive behaviour therapy including exposure and response prevention

Question 21

What is the management option for moderate obsessive compulsive disorder?

Answer 21

High intensity psychological treatment or pharmacological management

Question 22

What is severe OCD?

Answer 22

When individuals spend > 3 hours a day on their obsessions/compulsion

There is severe interference/distress

The individual has very little control/resistance

Question 23

What is the management option for severe OCD?

Answer 23

A referral to the secondary care mental health team for assessment

During the waiting period of this referral, they should be offered a combination of psychological and pharmacological treatment (SSRI & CBT)