OCD

Question 1

List the obsessive-compulsive Related Disorders (5)

Answer 1

1. Obsessive-compulsive disorder
2. Body dysmorphic disorder
3. Hoarding Disorder
4. Trichotillomania
5. Excoriation Disorder

(there are also substance/medication-induced and those related to medical condition)

Question 2

Obsessive compulsive disorder: male/female

Answer 2

• M=F (males have earlier onset)

(Lifetime prevalence: 3%; 12-month prevalence US 1%; internationally 1-2%)

Question 3

Onset of obsessive-compulsive disorders

Answer 3

Late teens to early twenties

Question 4

Obsessive compulsive disorder course of disease

Answer 4

• 85% chronic
• 10% Progressive or deteriorating
• 2% episodic (periods of remission)

Question 5

Criteria for obsessive compulsive disorder (4)

Answer 5

1. Either obsessions or compulsions are both
2. They recognize that these are excessive or unreasonable (except in children)
3. Time-consuming (>1 hour/day)
4. Distress and impairment

Question 6

Define obsessions

Answer 6

• Recurrent and persistent thoughts, urges or images that are experienced - intrusive and inappropriate

(The person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action)

Question 7

Define compulsions

Answer 7

• Repetitive behaviors or mental actions patient feels driven to do in response to an obsession, or according to rules that must be applied rigidly

(trying to prevent or reduce anxiety or distress; Young children are not able to articulate the aims of these behaviors or mental acts)

Question 8

OCD specifiers (3): patient thinks that the OCD beliefs are ______

Answer 8

1. With good or fair insight: are definitely or probably not true
2. With poor insight: are probably true
3. With absent insight/delusional beliefs: absolutely are true

Question 9

OCD biological findings

Answer 9

• Dysfunction of the Corticostriatal circuit:
  
  • Orbitofrontal cortex
  • Caudate nuclei
  • Globus pallidus
• May occur in neurological disorders that involve the basal ganglia (Huntington’s disease)

Question 10

OCD: genetic risk factors:

1. First ° relative of adults with OCD
2. Concordance rate between Twins

Answer 10

1. 2X risk; If adult had childhood onset, risk 10X
2. 0.57 for monozygotic twins& 0.22 for dizygotic twins

(don’t memorize numbers, just know that genetics plays a role)

Question 11

OCD: pattern of anxiety (anxiety, cognitions and behaviors) (4)

Answer 11

1. Panic attacks: related to obsessive fears
2. Anticipatory anxiety: Triggers of O-C behavior
3. Typical cognitions: Obsessive fears of contamination, causing harm to others, not doing something “just right”
4. Typical behaviors: Washing/cleaning, checking, ordering, avoiding contaminants

Question 12

OCD treatment: first line and second line

Answer 12

• First line: SSRI, clomipramine, CBT, family therapy
• Second line: atypical antipsychotic augmentation

Question 13

Body dysmorphic disorder (BDD) is a preoccupation with a______.

Answer 13

• perceived flaw in physical appearance

(Repetitive behaviors or mental acts in response concerns → Significant distress/impairment)

Question 14

Body dysmorphic disorder specifiers they may have good/fair insight, poor insight or _______ (2)

Answer 14

• Muscle dysmorphia: think their muscles are too small
• Absent insight/delusional belief: completely convinced the dysmorphic beliefs are true

Question 15

Prevalence of OCD and subtypes (greatest to least):

Answer 15

1. Hoarding: 6%
2. OCD: 3% (1% in 1 yr period)
3. BDD: 3% of population
4. Trichotiloomania: 2%
5. Excoriation: 1.5%

(Excoriation & BDD ~ 70% female)

Question 16

Body dysmorphic disorder is most common with which features (3)

Answer 16

1. Skin
2. Hair
3. Nose

(Dermatology, cosmetic, orthodontia, and oral/maxillofaical surgery visits)

Question 17

Body dysmorphic disorder: course of disease (onset, acute v. chronic, remission)

Answer 17

1. Onset: adolescence - early adulthood
2. Chronic
3. Full remission rare

(Have genetic predisposition to obsessional thinking)

Question 18

BDD impairments

Answer 18

1. No work or school
2. Housebound
3. Psychiatrically hospitalized
4. Suicidal ideation & attempts

(Completed suicide 22-36x general population)

Question 19

Body dysmorphic disorder treatments (3)

Answer 19

1. CBT: correcting cognitive distortions
2. SSRIs
3. Don’t refer to a plastic surgeon

(Be empathy, instill hope, educate about the condition, focus on suffering and impact on life)

Question 20

Criteria for hoarding disorder

Answer 20

1. Difficulty discarding possessions, regardless actual value→congest and clutter active living areas

(significant impairment, not caused by other disorder)

Question 21

Hoarding disorder: course of disease

Answer 21

1. Symptoms may begin 11-15 yo
2. Severity increases w/ each decade of life
3. Chronic course
4. Twin studies: approximately 50% variablility genetic

Question 22

Hoarding disorder treatment focuses on:

Answer 22

1. Excessive acquisition
2. Difficulty discarding or letting go of possessions
3. Disorganization and clutter

Question 23

CBT for Hoarding disorder focuses on

Answer 23

1. Thoughts and feelings about not acquiring things/getting rid of them
2. Avoidance of anxiety due to lack of object/being less than perfectly prepared
3. Test what will happen if does not acquire/how it will feel to not be perfectly prepared

Question 24

Criteria for trichotillomania

Answer 24

• Recurrent pulling out of one’s hair → noticeable hair loss

(Attempts to stop pulling hair, causes distress/impairment)

Question 25

Course of disease: trichotillomania

Answer 25

1. Childhood onset 2. Chronic course 3. 70-90% are female (Can affect any area where hair grows)

Question 26

Trichotillomania patients may swallow the hair, which can lead to

Answer 26

trichobezoar (hair ball)

Question 27

Treatment for trichotillomania

Answer 27

1. Behavioral therapy 2. Cognitive therapy 3. Medication 4. Hypnosis

Question 28

Behavioral therapy for trichotillomania

Answer 28

1. Self-monitoring (habit record) 2. Habit reversal (apply barriers to hairpulling – gloves, hat; perform physically incompatible action – knitting, clenching a ball) (self-monitoring will cut down on behavior by 1/3; works on all behaviors that a patient wants to stop)

Question 29

Medications for trichotillomania (2)

Answer 29

1. Clomipramine 2. N-acetylcysteine (glutamate modulator) (possibly Olazapine; one study)

Question 30

Cognitive therapy for trichotillomania consists of correcting \_\_\_\_\_\_.

Answer 30

faulty beliefs about self and to improve self-esteem

Question 31

Diagnostic criteria for excoriation disorder (skin-picking)

Answer 31

* Recurrent skin picking→skin lesions (tries to stop, distress/impairment, not explained by other conditions or drugs)

Question 32

Excoriation disorder: course of disease (onset, trigger, course)

Answer 32

1. Onset: adolescence, (usually w/onset of puberty) 2. Begins with dermatological condition (e.g. acne) 3. Course: chronic (Average 2.8 hrs/day picking or resisting)

Question 33

Excoriation disorder: treatment

Answer 33

Same as trichotillomania (Cognitive or behavioral therapy, meds, hypnosis)

Question 34

Medication for excoriation disorder (3)

Answer 34

1. SSRI 2. Doxepin 3. N-acetylcystein (Lithium, gabapentin, olanzapine all have positive data)

Question 35

Substance / medication - induced obsessive-compulsive and related disorder criteria

Answer 35

* OCD symptoms cuased by substance/medication * Symptoms develop during or soon after substance intoxication or withdrawal or after exposure to a medication

Question 36

Obsessive-compulsive and Related Disorders due to another medical condition

Answer 36

* OCD symptoms caused by medical condition * Evidence from H&P or labs that the symptoms are the consequence of another medical condition * Does not occur exclusively during delirium

Question 37

PANDAS (acronym)

Answer 37

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (not in DSM 5)

Question 38

PANDAS

Answer 38

1. Follows Strep infection 2. Positive anti-streptococcal AB titer 3. Rapid onset of OCD symptoms and/or tics after infection (Etiology: unknown; possibly antibodies interfere with basal ganglia function)

Question 39

PANDAS treatment (2)

Answer 39

1. SSRI 2. CBT