Lecture 53: OCD

Question 1

What do obsessions lead to?

Answer 1

Obsession = anxiety

Question 2

What are obsessions?

Answer 2

1. Unwanted thoughts, images or impulses that cause ANXIETY/distress
2. Attempts to ignore, suppress or neurtralize but cant do so effectively
3. Not simply excessive worries about real-life problems
4. Recognized as the product of one’s mind

Question 3

What are compulsions?

Answer 3

Repetitive behaviors used to ease discomfort

Cardinal feature: neutralization of obsessive discomfort

Question 4

What are types of compulsions?

Answer 4

1. Mental compulsions
   -special words, images, numbers recreated mentally to neutralize anxiety
   -special prayers repeated in a set manner
   -mental counting
   -mental list making
   -mental reviewing
   Girl thinking about princess waving her hand to subjects in a very slow and patterned manner
2. Checking Compulsions
   -double checking shit that is true (like are you sure, are you sure?)

Question 5

What is the clinical course?

Answer 5

1. unremitting and chronic
2. Phasic with periods of complete remission
3. Episodic

Question 6

What are the comorbidities of OCD?

Answer 6

1. Mood disorders
2. Other anxiety disorders
3. Tic disorders
4. Eating disorders
5. Psychotics disorders
6. Personality disorders

Question 7

What are the genetics of OCD?

Answer 7

53-87% for monozygotic twins
It is not destiny, however
-increased risk for first-degree relatives

Question 8

What do PET studies demonstrate?

Answer 8

1. Abnormally high activity in orbital cortex and in head of caudate nucleus

Question 9

What is the spectrum of OCD?

Answer 9

Trichotillomania (compulsion to pull out hair)
Pathologic gambling
Body dysmorphic disorder
Hypochonriasis
Binge eating disorder
Autistic disorders

Question 10

What is the OCD cycle?

Answer 10

Obssession  distress  compulsion  relief

Question 11

What is the point of behavioral therapy?

Answer 11

Treatment tries to break connection between distress and compulsion
Have the anxious thoughts but DON’T try to do anything about it…deal with it

Question 12

What is CBT for OCD?

Answer 12

1. Exposure in vivo
2. Imaginal exposure
3. Ritual prevention
4. Cognitive interventions

Question 13

What are exposures in vivo?

Answer 13

A type of CBT treatment for OCD

Prolonged confrontation with anxiety-evoking stimuli (e.g. contact with contamination)

Question 14

Imaginal exposure?

Answer 14

A type of CBT treatment for OCD

Prolonged imaginal confrontation with feared disasters (eg hitting pedestrian while driving)

Question 15

Ritual prevention?

Answer 15

Blocking of compulsions (eg leaving the kitchen w/o checking the stove)

Question 16

What is Cognitive Interventions?

Answer 16

Correcting erroneous cognitions (eg anxiety wont decrease w/o ritualizing)

Question 17

What is a simplified theoretical approach of OCD?

Answer 17

Do the thing you’re afraid of

The more you do it, the easier it gets

Question 18

What is the primary measure of OCD symptom severity?

Answer 18

Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
0-40
16+ = OCD
Typical college student = 4-5…finals = 7

Question 19

What are the pharamaco therapy strategies?

Answer 19

SSRI

Question 20

What are characteristics of SSRIs for OCD treatment?

Answer 20

A. Consistently superior to placebo in dozens of RCTs
B. typical reduction of 6-10 points of Y-BOCS
C. maintenance of gains with continued treatment
D. relapse upon SSRI discontinuation
E. Side effects include suicidal ideation

Question 21

What are characteristics of CBT for OCD treatment?

Answer 21

A. typical reduction of 10-15 points on Y-BOCS
B. Maintenance of gains following discontinuation
Not a lot of experts out there

Question 22

Is there any difference in efficacy between CBT + drugs and CBT?

Answer 22

Mixed findings for superiority of combination of medication + behavior
-combined treatment does NOT impede monotherapies

Question 23

What is COMB?

Answer 23

Combined of medication and behavior