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OCD

OCD. Questions and answers. Sources are DSM-IV-TR, APA Practice Guideline, or Sadock and Sadock, 10 th edition unless otherwise indicated. As of 1Sep08. OCD. Q. DSM criteria?. OCD. A. Has either compulsions or obsessions

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OCD

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  1. OCD Questions and answers. Sources are DSM-IV-TR, APA Practice Guideline, or Sadock and Sadock, 10th edition unless otherwise indicated. As of 1Sep08

  2. OCD • Q. DSM criteria?

  3. OCD • A. Has either compulsions or obsessions • B. Person recognizes that the compulsions or obsessions are unreasonable or excessive (does not apply to children). • C. Compulsions or obsessions are distressing or disabling • D. Compulsions or obsessions are not within another disorder • E. Not direct effect of substance

  4. OCD – time requirements • Q. Minimum time of obsessions/compulsions to meet DSM-IV criteria?

  5. OCD - time • Ans. > 60 minutes unless very disabling and then can be shorter

  6. OCD • Q. What if the person doesn’t recognize that the obsessions or compulsions are excessive or unreasonable?

  7. OCD • Ans. add specifier, “With poor insight.”

  8. OCD - gender • Q. Gender prevalence?

  9. OCD - gender Ans. Boys more than girls, and equal in adults.

  10. OCD Prevalence • Q. What is prevalence in US?

  11. OCD - Prevalence Ans. Lifetime, 2.5% One year: 0.5%, i.e., 1/200 have the disorder in any given year.

  12. OCD - Onset • Q. What is usual age of onset?

  13. OCD - Onset Ans. Males: 6 – 15 years old Females: 20 -- 29.

  14. OCD – Familial Pattern • Q. What is familial pattern

  15. OCD – familial pattern Ans. Concordance rate: • Monozygotic [70%] > dizygotic twins [50%] • First degree relative higher (35%) than normal population.

  16. PANDAS • Q. Stands for?

  17. PANDAS Ans. Stands for: pediatric autoimmune neuroleptic disorder associated with streptococcal infections.

  18. Obsessions • Q. Most common obsession?

  19. Obsessions Ans. Most common is fear of contamination.

  20. Compulsions • Q. Most common compulsion?

  21. Compulsions Ans. Checking.

  22. Neuroanatomy • Q. Neuroanatomy of OCD?

  23. Neuroanatomy Ans. While far short of being diagnostic, there is a tendency for more gray matter and less white matter than normals

  24. Co-morbidity • Q. What psychiatric disorders, other than substance-related disorders, are most commonly associated with OCD?

  25. Co-morbidity Ans. • Most common is MDD, 2/3 (67%). • Social phobia: 25% • Tourette’s disorder: 5 - 7% • Tics: 20 - 30%

  26. OCD • Differential Diagnosis, list medical and psychiatric?

  27. OCD - differential Ans. • Medical: • Tourette’s disorder, • other tic disorder, • temporal lobe epilepsy • Psychiatric: • Schizophrenia, • Obsessive-compulsive personality disorder, • phobias, • depressive disorders

  28. Onset • Q. Average number of years between onset and treatment of OCD?

  29. OCD Ans. 17 years.

  30. Outline of OCD treatment • Q. What is basic treatment for OCD, speaking generally?

  31. Outline of treatment Ans. Basically: • SSRI/clomipramine and behavioral therapy

  32. FDA approved for OCD • Q. FDA has approved?

  33. FDA Ans. FDA has approved: • Clomipramine • Fluoxetine • Fluvoxamine • Paroxetine • Sertraline

  34. Dosing • Q. Typical doses of OCD with an SSRI?

  35. OCD Ans. Typically, dosing is higher than with MDD.

  36. OCD • Q. Onset of effectiveness in OCD when using an SSRI – when it is effective?

  37. OCD Ans. Should see improvement in 6 to 12 weeks.

  38. OCD • Q. If the SSRI is successful and then discontinued, what is likely to happen?

  39. OCD Ans. Symptoms will return in two months.

  40. Typical results • Q. Typical results with an SSRI?

  41. OCD Ans. About ½ have 1/3 improvement

  42. OCD augmentation • If partial response to an SSRI, what meds can you add that may make for further improvement?

  43. Augmentation Ans. • Atypical antipsychotic • Buspirone • Clomipramine • Clonazepam • Lithium • Venlafaxine • Valproate

  44. Treatment of PANDAS • Q. What is treatment?

  45. PANDAS • 1] plasmopheresis to clear antibodies • AND • 2] prophylactic antibiotics

  46. Behavioral therapy for OCD • Q. Behavioral therapies, three most common?

  47. Behavioral therapy Ans. Three most common: • 1. Exposure and response prevention • 2. Imaginal flooding • 3. Thought stopping

  48. Exposure and response prevention • Q. What is exposure and response prevention?

  49. OCD Ans. Exposure and response prevention consist of asking the pt to endure, in a graduated manner, the anxiety of a specific obsession the pt fears – and refrain from the associated compulsion.

  50. OCD • Q. What is imaginal flooding?

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