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2014-05-28 11:58:46
psy OCD
OCD epidemiology, definitions, DDx, treatments
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  1. DDx (5)
    • 1. Anxiety disorders
    • obsessional symptoms are less than prominent than other anxiety symptoms
    • 2. Depression
    • obsessions can occur within depression, up to 50% with OCD experience depressive symptoms. If episode meets criteria, depression takes priority

    • 3.Schizophrenia
    • beliefs are delusional not obsessional (so not resisted, not reg as their own)
    • => secondary to part of depression or schiz, and remit when primary illness ie better

    • 4. Anakastic personality disorder
    • a lifelong personality of rigidity, often with v.high standards of orderliness, hygiene etc.. The pattern of obsessions and compulsions is absent unless OCD is superimposed.

    • 5. Organic causes
    • rarely e.g. Syndenham's chorea

    • 6. PTSD
    • can have recurrent memories or unbidden imagery and can have rituals to avoid triggering these. Careful histoy will reveal the initial trauma and the events, though distressing, are not seen as irrational. 
  2. Mx
    • 1. Education and self help 
    • as in anxiety
    • 2. CBT: exposure and response prevention
    • 3. SSRIs are affective, as is clomipramine (a TCA)
  3. Define Obsessions & themes
    • - recurrent unwanted intrusive thoughts, images or impulses that enter the patient's mind
    • - despite attempts to resist them
    • - thoughts are unpleasant but pt recognises them as both irrational and their own (unlike delusions or thought insertion)
    • - make pt feel acutely uncomfortable or anxious
    • (e.g feel responsible for the damage that their thought might do e.g a violent thought might harm so)
    • - themes: contamination, aggression, infectino, morality
  4. Define - Compulsion
    • - tension / discomfort if often 'undone' or neutralised by a compulsion
    • - repeated, stereotyped, and seemingly purposeful rituals that pt feels compelled to carry out
    • - despite irrational and may lack any obvious link to obsession
    • - common e.g cleaning, counting, checking and ordering objects
    • - can takes hours and severely affect quality of life
    • - resistance to both O & C may decrease or disappear in chronic case
  5. Epidemiology
    any year, OCD affects 1% if population, afflicting men and women equally
  6. what to ask
    • - how often these symptoms happen
    • - whether there is any pattern
    • - whether they arise from within the pt
    • - how long they can be resisted
    • - what pt does to relieve the distress
    • - consequences of thoughts/ acts
    • e.g. wasting time, low mood or difficulty in relationships
  7. ICD - 10
    A,B,C,D and 4 character codes
    A. Either obsessions or compulsions (or both) - present on most days for at least 2 weeks

    • B. Obsessions (O) (thoughts, ideas or images) and compulsions (C) (acts), all features must be present:
    • - acknowledged as originating in mind of pt,
    • and not imposed by outside persons or influences
    • - repetitive and unpleasant,
    • at least one O or C acknowledged as excessive or unreasonable
    • - tries to resist them
    • (but if very long-standing, resistance may be minimal). At least 1 O or C present, unsuccessfully resisted
    • - O thought or C act is not in itself pleasurable
    • (should be distinguished from the temporary relief of tension or anxiety)
    • C. O or C cause distress or interfere with the subject's social or individual functioning, usually by wasting time

    D. Most commonly used exclusion criteria: not due to other mental disorders, such as schizophrenia and related disorders (F2), or mood [affective] disorders (F3)

    • * 4 character codes
    • - Predominantly obsessional thoughts and ruminations
    • - Predominantly compulsive acts 
    • - Mixed obsessional thoughts and acts
    • - Other obsessive-compulsive disorders
    • - Obsessive-compulsive disorder, unspecified