Obsessive Compulsive Disorders

Question 1

What are obsessions?

Answer 1

• 1) Unwelcome, persistent, recurrent, intrusive thoughts distressing to the invididual,
• 2) not excess worries about real life problems
• 3) ind attempts to suppress or neutralise them and
• 4) recognises them as absurd (egodystonic) and product of own mind (i.e. not thought insertion)

Question 2

What are compulsions

Answer 2

• Repetitive, purposeful, physical or mental behaviours performed with reluctance in response to an obsession.
• Carried out according to certain rules in a stereotyped fashion,
• designed to neutralise or prevent discomfort or a dreaded event.
• excessive and not connected to obsession
• individual realises behaviour is unreasonable

Question 3

What are examples of compulsions?

Answer 3

• hand washing, cleaning
• counting, checking
• touching and rearrangement of objects to achieve symmetry
• mental compulsions
• hoarding
• arithmomania
• onomatomania
• folie du pourquoi
• excessive tidiness

Question 4

What is arithmomania

Answer 4

Compulsive counting

Question 5

What is onomatomania?

Answer 5

Compulsion to utter forbidden word

Question 6

what is folie du pourquoi?

Answer 6

Compulsion to seek explanations for commonplace facts by asking endless questions

Question 7

What happens if compulsions are resisted?

Answer 7

Anxiety builds until compulsion completed

Question 8

What characterises OCD?

Answer 8

A. Obsession +/- compulsions
B. Recognised as unreaosnable
C. Cause marked distress and are time consuming / interfere significantly with routine
D. Other Axis I excluded
E. Exclusion of GMC

• Time consuming (>1h/d) obsessions / compulsions
• Present most days for at least two weeks
• Distressing and interfere with activities
• avoidance of triggers

Question 9

Onset of OCD?

Answer 9

Adolescence

Question 10

OCD subtypes?

Answer 10

• 1. O&Cs: concerned with contamination (most common)
• 2. Checking compulsions in response to obsessional thoughts about potential harm (e.g. leaving gas on)
• 3. Obsessions without overt compulsive acts
• 4. Hoarding

Question 11

Complications of OCD?

Answer 11

-Depression
-Anxiolytic abuse
-EtOH abuse
Distress and functional impairment similar to psychotic d/os

Question 12

OCD prevalence?

Answer 12

2-3%

Question 13

Medical illness a/w OCD?

Answer 13

Streptococcal infection (PANDAS subtype)

Question 14

Aetiology OCD?

Answer 14

• FHx: 50% of OCD, tics, Tourette’s
• Parental overprotection
• Biochem: 5HT esp
• Cortico-striatal-thalamic circuit (mediates social behaviour)

Question 15

Psychoanalytic theory of OCD?

Answer 15

Defences against cruel and aggressive fantasies (filling the mind with obsessional thoughts prevents undesirable ideas entering consciousness) and defensive regression to anal stage of development

Question 16

Behavioural theory of OCD?

Answer 16

-Compulsive behaviour is learned and maintained by OPERANT conditioning: anxiety reduction following compulsive behaviour strengthens/increases need to perform compulsion following obsession.

Question 17

What is PANDAS?

Answer 17

Paediatric autoimmune neuropsychiatric disorders associated with streptococci

Question 18

What is BDD?

Answer 18

• Preoccupation with imagined defect in appearance or markedly excessive concern with a slight physical anomaly
• Time consuming behaviours: mirror gazing, comparing features, excessive camouflaging, skin picking

Question 19

Management OC disorders (OCD, BDD)?

Answer 19

• CBT (psychoeducation; graded exposure therapy; relaxation)
• Drug: SSRIs or clomipramine
• Regular review of mental state and risk
• Exclude medical causes
• Liase with work / study

Question 20

Response to drugs and CBT?

Answer 20

~75%

placebo 5%

Question 21

What is anakanistic personality disorder?

Answer 21

(aka OCD personality d/o)
Characteristics:
-rigid thinking
-perfectionism interfering with task completion
-Moralistic rule preoccupation
-excessive cleanliness
-high standards seldom achieved
-tendency to hoard
-emotional coldness

Question 22

Medication used in OCD?

Answer 22

-SSRI e.g.
==>fluoxetine 20-80mg/d
==>sertraline 50 - 200mg
==> fluvoxamine 25mg nocte