OCD Flashcards
What are obsessions in OCD?
recurrent and persistent thoughts, impulses or images that are intrusive and unwanted that cause marked anxiety or distress
Do obsessions or compulsions cause marked distress in OCD?
yes, take > 1 hour/day or cause clinically significant distress or impairment in function
What are compulsions in OCD?
Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rigidly applied rules.
Do the compulsions reduce anxiety in OCD?
no they increase it
does OCD spread?
yes
what % of general pop has OCD?
2%
what is the mean onset of OCD?
Mean onset 19.5 years, 25% start by age 14!
what is the ratio for men and women in OCD?
1:1
Do men or women have an earlier onset of OCD?
men
what are the comorbidities in OCD?
> 70% have lifetime diagnosis of an anxiety disorder such as PD, SAD, GAD, phobia
60% have lifetime diagnosis of a mood disorder MDD being the most common
Up to 30% have a lifetime Tic disorder
12% of persons with schizophrenia/ schizoaffective disorder
what is the source of repetitive behaviour in OCD?
anxiety
What are the different types of OCD?
1) Cleaning/contamination (most common) - thoughts of becoming contaminated or accidentally spreading contamination (e.g. public restrooms, shaking hands)
2) Symmetry/Order (e.g. counting steps, taps)
3) Checking (e.g. leaving door unlocked or lights on)
4) Hoarding
5) Purely obsessionals (usually neg): Sexual, harming, religious obsessions and mental rituals
- Different variants may have different etiological pathways
How does one deal with obsessions in OCD?
The person attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (i.e. compulsion)
Do compulsions disregard safety of others in OCD?
no, there is an act of responsibility of safety of others and fear they will be responsible for harm to others
Why do patients with OCD engage in compulsions?
The behaviors or acts are aimed at reducing distress or preventing some dreaded situation however these acts or behaviors are not connected in a realistic way with what they are designed to neutralize or prevent.
What is the etiology theory of OCD?
OCD patients and close relatives show under-activation of areas related to stopping habitual behaviors (e.g. lateral orbitofrontal cortex)
Brain activation in OCD patients for:
Disgust-inducing vs. neutral stimuli (right-top): insula, ACC
Threat-inducing (right-bottom) vs. neutral stimuli: mPFC, basal ganglia
Are there consistent findings for the etiology theory in OCD?
no
What is the heritability estimate for OCD?
26-47%
What are the results of the multi-site family study for OCD?
80 proband cases in 5 specialty OCD clinics and 73 control probands in the community, and their first degree relatives 343 case and 300 control)
5-fold difference in lifetime prevalence of OCD in proband relatives vs. control relatives (11.2% vs. 2.7%)
Case relatives had higher rates of both obsessions and compulsions, but a stronger association with obsessions
Early onset associated with familiality (No cases of OCD symptoms detected in the relatives of probands whose age of onset was 18 or older)
What do twins study show for OCD?
OCD symptoms are substantially greater in MZ twin pairs (80-87%) than DZ twin pairs (47-50%) (Carey & Gottesman, 1981)
What is the most likely answer for heritability in OCD?
Learning OCD actions and thoughts from parents
Arousable one will more likely model than non-arousable child
what are the biological models for OCD?
Genetics
Dysfunctional brain structures
Neurochemistry
What is problematic about the biological theories for OCD?
Mixed results
Lack of replication
Animal studies
Does NOT explain all OCD (Heterogeneities)
Are there medications to treat OCD?
no, OCD will often take SSRIS but not effective
