Obsessive-compulsive disorder: OCD Flashcards
What is OCD and how many people does it affect?
obsessive compulsive disorder-
form of anxiety. Compelled to repeat activities. Affects anyone regardless of ethnicity and socio- economic background.once considered rare but not anymore.- 1-3% prevelance.
What are the characteristics of OCD ?
compulsive acts – their function is to prevent an irrational event
What are the symptoms of OCD?
the magnitude of Psychosocial imparement is so high that that co- morbidies are common:depression,anxiety ,social phobias,bi-polar may be seen also.
What can be used to diagnose OCD?
recurrent obsessional thoughts – ideas and images – constantly repeated. Y Bocs is the rating scale that is usedand indicated the severity and evaluates effical of the pharmaceutical treatment at hand.
What are the 2 treatment pathways for OCD?
SSRI and clomipramine.(those high risk of suicide a limited amount of meds should be supplied.frequent contact with HCPs – crisi procedure in place also.
What is the first-line treatment and what are the given doses?
SSRI – Citalopran (20- 40 daily),escitoplram 10-20 mg daily,sertraline(50-200mg daily),fluotetine 20-60 mg nightly.
What is the mechanism of action SSRI?
selective inhibition of the re- uptake of serotonin at the pre- synaptic membrane results in aan increased synaptic concentration of serotonin in the cns.The serotonin response at 5ht1a and 5ht2a receptors is enhanced causing enhanced serotonergic neurotransmission – therapeutic effect of an ssri = may not be seen for 4-6 weeks.
What are the side effects?
drowsiness, nausea,drymouth,akathsia- restlessness,insomnia,diarohhea,sexual dysfunction,fluoxetine- long washout period of 4-5 weeks – risk of serotonin syndrome is high
What are the interactions ssri
are substrated of cyp450 3a4 metobolic enzymes – drugs metabolised by 3a4 should not be given with ssri because = adverse effects increased.Nsaid and ssri – increased risk of bleeding.
What are discontinuation side- effects?
Flu like symptoms, sleep disorder,nausea,poor balance,anxiety,sensory issues.- ssri nearly twice as likely as placebo to produce an effect
What is the second line and what is the given dose for it?
Clomipramine- used when a trial of one SSRI has failed in efficacy and tolerability or acceptability or side effects super bad . 25mg Daily – then increased to 100-150 daily.
What is its mechanism of action and how does it work?
Inhibition of the reuptake of serotonin and norepinephrine- leads to an increase in the synaptic concentration of serotonin and norepinephrine – increases th ecynapic concentration of serotonin nad norepinephrine, it has additional activity at histamine and acetyl choline receptors which produces adverse effets.
What are the side effects?
Dry mouth and eyes,poor taste in the mouth constipation,urinary issues.
What would you do in the case of an overdose?
Dose less than 20mg less likely to be fatal – sinus tachycardia in overdose, prolonge QRS, ANTI cholinergic action dry mouth and blurred vsison which is so bad.
What is monitoring put in place for OCD?
Remission is where a meaningful response has been given and efined as 25-355 improvement in baseline Y-BCOS or a scole of greater than 7 , worsening of baseline yboc by 50% = replase. If no response is seen then compliance should be challenged and ensure no substance missue issues present – trtration of dose at its best – decision to continue treatment reviewed every 12 months and severity and duration of illness looked at – no previous epsiodes or more symptoms.
