OCD/PANDAS and PANS Flashcards
What is the main diagnostic criteria for obsessions?
▪️Recurrent and persistent thoughts/impulses/images
▪️Cause marked anxiety or distress
▪️Not simply excessive worries about real-life problems
▪️Attempts to suppress
▪️Recognises their a product of their own mind
What are the four components of the OCD cycle?
▪️Obsession
▪️Anxiety
▪️Compulsion
▪️Temporary relief
Gets stronger with time!
How common is OCD?
1-3%
What is the main demographic of OCD?
Two peaks:
▪️Childhood/adolescence - more males, symmetry and checking
▪️20-29 - more females, washing
What are the four main types of OCD?
▪️Contamination/washing (more common in older & religious groups
▪️Obsessions/checking
▪️Hoarding/saving
▪️Symmetry/order
What are the most common obsessional symptoms?
▪️Aggression
▪️Contamination
▪️Symmetry
▪️Somatic
What are the most common compulsive symptoms?
▪️Checking
▪️Cleaning
▪️Repeating
What psychiatric condition occurs lost commonly with OCD?
Depression (50-60%)
What evidence points towards a biological model of OCD?
▪️Familial prevalence
▪️Response to serotonergic drugs
▪️OCD symptoms in neurological conditions (e.g. Sydenham’s chorea)
▪️Acquired symptoms after BI
▪️Hyperactivity in front-subcortical circuits
▪️PANS/PANDAS
What has been found with twin studies of OCD?
▪️Highly genetic, particularly in children (45-65%)
▪️Unique environmental effects are equally important (e.g. trauma)
, ▪️Shared environmental effects are negligible
What targets for candidate genes have been proposed for the genetic basis of OCD?
▪️Serotonin
▪️Glutamate
▪️Dopamine
▪️GABA
▪️Neurodevelopmental factors (e.g. BDNF)
▪️Peptides (e.g. oxytocin
▪️SAPAP3
What environmental factors may contribute to the development of the OCD?
▪️Perinatal insults
▪️Childhood stressors
▪️Autoimmune factors (e.g. streptococcal infection)?
Do different subtypes of OCD have distinct neural correlates?
Yes!
Which brain regions have been implicated in OCD?
Frontostriarothalamic circuits implicated in cognitive and emotional processing
▪️VMPFC
▪️OFC
▪️Caudate nucleus
▪️Putamen/GP/thalamus
▪️Precentral gyrus
Can brain abnormalities seen in OCD be reversed with treatment?
Yes!
What do the NICE guidelines for treatment of OCD with mild functional impairment in children?
▪️Self help support
▪️Information for family
What do the NICE guidelines for treatment of OCD with moderate/severe functional impairment in children?
▪️CBT
▪️ERP
What can you consider for children with OCD if CBT and ERP have not been effective?
SSRIs (in combination!)
What techniques can be used in CBT for OCD?
▪️Functional analysis (formulation)
▪️Psychoeducation
▪️Goal setting
▪️Hierarchy of situations
▪️(Self) exposure and ritual prevention (ERP)
What rating scales can be used to assess OCD symptoms?
▪️Children’s Tale-Brown Obsessive Compulsive Scale (clinician administered)
▪️Obsessive Compulsive Inventory (self-administered)
What is the goal of ERP?
▪️To incrementally expose self to avoided and anxiety provoking situations
▪️Learn to sit with the distress/urge and delay/prevent the ritual or strategy normally used to neutralise anxiety
When would you consider medication for OCD?
▪️If psychological treatments haven’t worked
▪️If ERP not possible
▪️If comorbidities present
What medications can be used for OCD?
SSRIs
▪️Sertraline or fluvoxamine for children
▪️Citalopram for severe cases
What could be considered in cases of SSRI-refractory OCD?
Antipsychotic augmentation
(1/3 show meaningful response)