OCD

Question 1

Risk factors

Answer 1

Equal sex distribution
Mean onset - 20 but can occur at any age
Premorbid anxious/dependent on others/obsessional traits
-perfectionist
Often a triggering event

Question 2

Good and poor prognostic factors

Answer 2

Good prognosis

• good premorbid functioning with work and social life
• precipitating event
• episodic symptoms

Poor prognosis

• giving into compulsions
• long duration
• early onset
• comorbid mental illness (anxiety and depression often present)

Question 3

Obsessions
-presentation
Compulsions
-presentation
Diagnosis

Answer 3

Obsessions - distressing thoughts that cause anxiety

• know they are illogical
• feeling of impending doom
• results in rumination or compulsions

Compulsions - urges to peform safety behaviours

• temporary relief, resistance increases anxiety
• impact on social, ADLs

Common obsessions/compulsions

• hand washing, cleaning
• checking, counting, placing in order

Obessions, compulsions present on most days for 2wks

Question 4

Management

• mild
• moderate
• severe

Answer 4

Unlikely to resolve without treatment
Mild - low intensity CBT + Exposure Response Therapy (ERP)
Moderate/low intensity ineffective - SSRI/high intensity CBT + ERP
Severe - SSRI+CBT+ERP

SSRI effective - continue for 1 year to prevent relapse

• dose gradually increased over 2 months, often higher than depression dose
• if too low/stopped prematurely => relapse risk
• limit alcohol => worsens symptoms and stops SSRI functioning