OCD

Question 1

Define Obsessive Compulsive Disorder

Answer 1

A condition featuring recurrent obsession and/or compulsions, which may cause significant functional impairment/distress.

Question 2

Define obsession

Answer 2

• Unwanted, intrusive, recurrent thoughts, images or urges
• Usually causing marked anxiety or distress

Question 3

Define compulsions

Answer 3

• Repetitive behaviours or mental acts
  
  • Aimed at preventing/reducing anxiety or distress
• Recognised as being unnecessary, purposeless, excessive
• Feels driven to perform in response to an obsession

Question 4

Name two types of compulsions

Answer 4

• Overt: observable by others
  
  • ^eg. hand washing; checking; arranging; ordering
• Covert: unobservable mental acts
  
  • ^eg. counting; avoidance

Question 5

Outline the DSM-5 criteria for OCD

Answer 5

• Presence of obssessions, compulsions, or both
• Obsessions or compulsions, either:
  
  • Are time-consuming
  • Cause significant functional impairment/distress
• Not caused by substance abuse; medical condition; or alternative mental disorder

Question 6

Suggest two risk factors for OCD

Answer 6

• 1^o FHx
• Bimodal onset: age around 10yr and 21yr
  
  • Onset over 30yr is rare
• Child maltreatment; social isolation; bullying
• Pregnancy; postnatal period
  
  • Commonly worried about harming/neglecting baby

Question 7

Name two conditions associated with OCD

Answer 7

• Autistic Spectrum Disorders
• Gilles de la Tourette Syndrome

Question 8

Name three co-morbidities seen alongside OCD

Answer 8

• Depressive disorder (50-70%)
• Social phobia
• Specific phobia
• Eating disorders
• Schizophrenia

Question 9

Suggest a cause of late-onset OCD

Answer 9

Organic aetiology ^eg. stroke or SOL

Question 10

Outline the management of OCD

Answer 10

Stepped care: treatment (Step 3-5) by functional impairment

• Mild: Low intensity psychotherapy (self-help or group)
  
  • Exposure and response prevention (ERP); CBT
• Moderate: SSRI or moderate intensity ERP/CBT
  
  • Reassure craving and tolerance do not occur
  • Inform of delayed onset of effect up to 3/12
• Severe: SSRI (or clomipramine) and ERP/CBT

Social care considerations: involve family; carers; school; work

Question 11

What is Exposure and Response Prevention therapy?

Answer 11

A form of CBT used in the management of OCD:

• Exposes the patient to the distressing thoughts/images/urges
• Help them refrain from engaging their compulsions
• Reducing anxiety generated by their obsessions overtime

Question 12

When is clomipramine indicated for OCD?

Answer 12

2nd line treatment used for treatment-resistant OCD

Question 13

What can be used to assess the severity of OCD?

Answer 13

Yale-Brown Obsessive Compulsive Scale

Rates the severity of OCD symptoms