DSM-5 diagnostic criteria for obsessive-compulsive disorder
- Characterized by obsessions, compulsions or both
- The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupations, or other important areas of functioning
- The obsessive-compulsive sx are not attributable to the physiological effects of a substance, another medical condition, or another psychiatric diagnosis
Define obsessions
- Recurrent and persistent thoughts, urges, or images that are experienced, at some point during the disturbance, as intrusive and unwanted, and that causes marked anxiety or distress in most individuals
- Individual attempts to ignore or suppress such thoughts, urges, or images or to “neutralize” them with some other thought or action (e.g by performing a compulsion)
Define compulsions
Competitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
what are compulsions aimed at?
Aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
onset of OCD
- Mean age of onset: 19.5 yrs
- Onset after 35 is unusual but does occur
- Onset is usually gradual and not abrupt
course of OCD
- Course is chronic with waxing and waning symptoms
- Remission is low without treatment
- Prevalence in US: 1.2%
- Women > men; but males more commonly effected in childhood
List the medications usually used in the management of obsessive-compulsive disorder
- SSRIs, MAOIs, TCAs
* Adjunct: anxiolytics, atypical antipsychotics
Identify the best treatment regimen for a patient with obsessive-compulsive disorder
Combined pharmacotherapy and cognitive behavioral therapy
