OCD Flashcards
What is a “Tic”?
An abrupt, jerky, repetitive movement which involves discrete muscle groups. It mimics a normal coordinated movement, varies in intensity, and lacks rhythmicity. It may be temporarily uppressed by will power and, because of its patterned appearance, is relatively easy to imitate.
Tourette’s Sx?
Tics (occurring for > 1 yr):
- Simple & complex motor (face > head/neck >
limbs > trunk)
- Vocal (phonic)
- Onset ≤ 18-years-old
- Causing distress
What are “Obsessions”?
Constant, intrusive, unwanted thoughts that cause distressing emotions such as anxiety or disgust. The thoughts are egodystonic and the patient realizes that they are a product of his or her own mind and are excessive or unreasonable.
What is a “Compulsion”?
Urge to do something to lessen discomfort, usually discomfort caused by an obsession. Rituals are behaviors in which people engage in response to
compulsions.
Neurological Causes of OCD?
Frontotemporal Dementia
Bilateral Basal Ganglia damage:
- Encephalitis
- Traumatic brain injury
- Sydenham chorea
- CO Poisoning
- Parkinson disease
- Huntington disease
_____ is VERY common in Tourette patients
ADHD
also some overlap w/ OCD
_____ can unmask tics (often don’t worsen them)
Stimulant drugs
Which typically comes to attention first- ADHD or Tourette’s?
ADHD typically comes to attention before Tourette syndrome
Can Tourette’s Syndrome be caused by stimulants?
no. GTS is NOT caused by stimulants, just unmasked by them
Tourette’s & OCD both may improve w/ _____ (drug)?
SSRI’s
The following represents a connection between what two syndromes?
■ Suppressible
■ “Psychic itch”
■ Worse with stress
■ Repetitive scatological thoughts
■ Same prevalence of tics in 1st degree relatives
OCD & GTS
In OCD & GTS, fMRI data reveal abnormal ______ circuits
Frontal-subcortical
Name the Frontal-subcortical circuit. With what syndrome(s) is this circuit disrupted in?
Orbitofrontal / Medial Frontal / Dorsolateral Frontal
- -> Nuc. Accumbens or Caudate
- -> Globus Pallidus / Substantia Nigra
- -> Thalamus
Diagnosis?
- Dec’d caudate volume
- Inc’d dorsolateral prefrontal volume in milder cases
- Inc’d volume in worse cases (ability to control tics)
fMRI of tic suppression:
- Inc’d frontal & caudate
- Dec’d GP, SN, Thalamus
GTS
Tourette’s
fMRI of OCD (provocation) shows what?
Increased Frontal & Striatal activity
Diagnosis? Increased Frontal & Striatal activity
OCD
In OCD, _____ activity correlates inversely with severity
Orbitofrontal
OCD Psychotherapy: Improvement associated with
decreased _____ metabolism
caudate
a) Pediatric psych disorders ass’d w/ PANDAS?
b) What does PANDAS stand for?
a) GTS & OCD (tic disorders)
b) Pediatric Autoimmune Neurodegenerative Disorders After Streptococcal infection
(different from regular GTS/OCD in that onset is sudden & patients respond to steroid therapy)
PANDAS OCD/GTS: Onset & exacerbations follow _____ infections
Group-A Beta Hemolytic Strep
OCD-GTS connection: PANDAS connection?
■ Steroid-responsive OCD & GTS cases with onset after GABHS infection ■ Sydenham chorea often includes OC symptoms ■ 60% of OC children positive for antineuronal antibodies ■ High anti-basal ganglia antibodies ■ High rheumatic B cell antibodies
GTS- Tx?
Catalogue behaviors Diagnose co-morbid disorders Educate-Contact TSA Determine primary treatment goal Clonidine/Guanfacine Benzodiazepines, SSRI Neuroleptics Non-pharm treatments ? DBS bilateral thalami, accumbens
OCD- Tx?
Catalogue behaviors Diagnose co-morbid disorders Educate-Support Groups Determine primary treatment goal SSRI, anti-depressants Augmentation agents Non-pharm treatments Bilateral capsulotomies ? DBS bilateral internal capsules, accumbens
Findings in what diagnosis? Poor school performance 65% Compulsive symptoms 20-90% ADHD symptoms 30-70% Motor incoordination 50% Sleep disorders 47% Learning disabilities 30% Migraine 27% Paroxysmal aggression Stuttering, stammering, palilalia Excessive startle reactions
ADHD
