OCD Flashcards
(25 cards)
Define OCD
- OCD: recurrent obsessional thoughts or compulsive acts, or commonly both
- Obsessions: Unwanted intrusive thoughts, images or urges that repeatedly enter the individuals mind. Distressing for the individual who attempts to resist them + recognises them as absurd + product of own mind
- Compulsions: repetitive, stereotyped behaviours or mental acts that a person feels driven into performing. They are overt (observable by others) or covert (mental acts that are not observable)
RFs OCD
- Developmental factors → neglect, bullying, abuse, social isolation
Biological pathophysiology of OCD
• Neurochemical: ↓ serotonin
• Abnormalities in frontal cortex + basal ganglia
o Childhood infection w/ group A beta haemolytic streptococci → autoimmune reaction → damage to basal ganglia
• Genetic contribution
Behavioural/ psychological causes of OCD
- Compulsive behaviour is learned + maintained by operant conditioning → the anxiety created by the obsession is reduced by performing the compulsion (therefore the need to perform the compulsion is ^)
- Obsessions are conditioned stimuli (stimulated by an anxiety provoking event)
- Compulsions = learned + reinforced (anxiety-reducing avoidance)
CFs and most common compulsion and obsession
- SYMPTOMS OF ANXIETY
- Most common compulsion: checking > washing/cleaning
- Most common obsession: being contaminated
OCD cycle: 1: Obsessions create 2: ANXIETY → builds up until 3: compulsion carried out → 4: RELIEF
DDx OCD
- Obsessions + compulsions: Eating disorders, anankastic personality disorder, body dysmorphic disorder
- Primarily obsessions: anxiety disorders (phobic…), depressive disorder, Hypochondriacal disorder, schizophrenia
- Primarily compulsions: tourette’s, kleptomania
- Organic: dementia, epilepsy, head injury
Rx OCD
- Psychological
a. CBT (including ERP: exposure and response prevention)
b. Behavioural therapy
c. Psychotherapy
2. Pharmacological
a. 1st line: SSRIs (sertraline, citalopram, fluoxetine)
b. 2nd line: Clomipramine (combined w/ citalopram in more severe cases
c. Adjuncts: anti-psychotic (haloperidol)
Also:
• Physical: ECT (if suicidal)
• Identity suicide risk
• Rx co-morbid depression
Define somatoform disorder
- Group of disorders whose Sx’s suggest or take the form of a physical disorder but in the absence of a physiological illness, leading to the presumption they are caused by psychological factors
- Sufferers repeatedly seek medical attention
RFs somatoform disorder
Risk factors CRAMPS
- Childhood abuse
- Reinforcement of illness behaviours
- Anxiety disorders
- Mood disorders
- Personality disorders
- Social stressors
Pathophysiology and aetiology somatoform disorder
Biological
• Neuroendocrine genes (genetics)
Psychological
• A high proportion of those w/ PTSD have somatoform disorder
• Association between somatization + physical or sexual abuse
Social
• Adopting of ‘sick role’ to gain relief from stress
o Pt’s adopt a sick role which provides relief from stressful or unachievable interpersonal expectations (primary gain). This offers attention, care from others and, in some societies, financial gain (secondary gain)
CFs somatoform disorder
ICD-10 Classifications:
PUSHy SOMATOFORM (pt’s push for Ix’s to be performed)
- Persistent somatoform pain disorder**
- Undifferentiated somatoform disorder
- Somatization disorder**
- Hypochondriacal disorder (including body dysmorphic disorder)**
- SOMATOFORM autonomic dysfunction
What is somatization disorder
- Briquet’s syndrome
- Multiple, recurrent and frequently changing physical Sx’s not explained by a physical illness
- W>M (10:1)
- Long Hx of contact w/ medical services
Common symptoms somatization disorder
o GI → Abdo pain, N+V, bloating, regurgitation, loose bowel motions, swallowing difficulty
o CV → Chest pain, SOB at rest, palpitations
o CU → Dysuria, frequency, incontinence, vaginal discharge, menstrual problems
o Others → discoloration or itching of skin, arthralgia, paraesthesia in limbs, headaches, visual disturbance
ICD 10 somatization disorder diagnosis
• ICD10 (requires all 4):
- 2+ years of physical Sx’s unexplained by detectable physical disorder
- preoccupation w/ Sx’s causes physical distress which leads to repeatedly seeking medical consultations + requesting Ix’s
- continuous refusal by pt’s to accept reassurance from Dr’s that there is no physical cause to their sx’s
- 6+ symptoms
Hypochondriacal disorder
- Pt misinterprets normal bodily sensations, which leads them to the non-delusional preoccupation that they have a serious physical disease
- Refuse to accept reassurance from Dr’s
Persistent somatoform pain disorder
- Persistent (6+ mths) and severe pain that can’t be explained by a physical disorder
- Pain occurs usually as result of psychosocial stressor + emotional difficulties
- Difference w/ somatization disorder → Pain = primary feature (no or small number of other Sx’s)
Ix Somatoform disorders
• Thorough physical exam
• Blood tests: FBC (anaemia, infection), U+Es (electrolyte disturbance), LFTs (liver or biliary pathology), CRP (infection, inflammation), TFTs (thyroid dysfunction)
• Further Ix’s:
o GI Sx’s: AXR, Stool culture, OGD, colonoscopy, diagnostic laparoscopy
o CV Sx’s: ECG, 24hr tape, ECHO, angiogram
o GU: urine dipstick, MSU, cystoscopy
Rx Somatoform disorders
Biological
- Antidepressants (SSRIs) for underlying mood disorder
- Physical exercise (enhances self-esteem + can esp. help body dysmorphia)
Psychological
- CBT = MAINSTAY
Social
- Stress relieving activities (meditation + long walks + exercise)
- Interview/involve family members who serve to reinforce sick role
Think somatoform disorder if…
Think somatoform disorder if: multiple Sx’s from dif systems, vague Sx’s, chronic course, presence of a mental health disorder, Hx of extensive diagnostic testing, rejection of previous clinicians
Dissociative (conversion) disorder define
- Persistent or recurrent episodes of distressing feeling of unreality or detachment
- Either to outside world (derealisation) or to the person’s own body, thoughts, feelings or behaviour (depersonalisation)
Aetiology dissociative (conversion) disorder
- Dissociation → ‘separating off’ certain memories from normal consciousness (psychological defence mechanism – used to cope w/ emotional conflict that is so distressing for the pt that it is prevented from entering the conscious mind)
- Conversion → distressing events are transformed into physical Sx’s (like somatoform disorders can lead to primary/secondary gain)
CFs dissociative (conversion) disorder
- Pt may report they are a ‘passive observer’ of what is going on around them or of their own actions
- Emotional numbness (inability to experience feelings)
- Dream/trance-like state
- Alterations in perception
- Insight preserved (unlike passivity phenomena) – pt recognises the experience as abnormal
IMPORTANT → painful/stressful thoughts are subconsciously converted into more bearable physical Sx’s by the pt
Categories of dissociative disorder (ICD-10 Subclassifications)
- Dissociative amnesia: loss of memory (amnesia) usually centred on traumatic events (+ usually partial and selective)
- Dissociative fugue: all features of dissociative amnesia + purposeful travel beyond everyday range (amnesia for this travel)
- Dissociative stupor: absence of voluntary movement + normal responsiveness to external stimuli
- Trance and possession disorders: temp. loss of the sense of personal identity + full awareness of the surroundings
- Dissociative motor disorders: loss of ability to move the whole or a part of a limb(s)
- Dissociative convulsions: convulsions (mimic epileptic seizures) → tongue biting, incontinence to urine = rare → consciousness maintained (or replaced by stupor/trance)
- Dissociative anaesthesia + sensory loss: numbness, tingling (paraesthesia)
Ix dissociative disorder
• Use rating scale: CAMBRIDGE DEPERSONALIZATION SCALE
• Exclude organic causes (hyperventilation, hypoglycaemia, migraine, epilepsy…): CT/MRI, EEG…
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