OCD

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

OCD

• Q. DSM criteria?

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

OCD – time requirements

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

OCD - time

• Ans. > 60 minutes unless very disabling and then can be shorter

OCD

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

OCD

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

OCD - gender

• Q. Gender prevalence?

OCD - gender

Ans. Boys more than girls, and equal in adults.

OCD Prevalence

• Q. What is prevalence in US?

OCD - Prevalence

Ans.

Lifetime, 2.5%

One year: 0.5%, i.e., 1/200 have the disorder in any given year.

OCD - Onset

• Q. What is usual age of onset?

OCD - Onset

Ans.

Males: 6 – 15 years old

Females: 20 -- 29.

OCD – Familial Pattern

• Q. What is familial pattern

OCD – familial pattern

Ans. Concordance rate:

• Monozygotic [70%] > dizygotic twins [50%]

• First degree relative higher (35%) than normal population.

PANDAS

• Q. Stands for?

PANDAS

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

Obsessions

• Q. Most common obsession?

Obsessions

Ans. Most common is fear of contamination.

Compulsions

• Q. Most common compulsion?

Compulsions

Ans. Checking.

Neuroanatomy

• Q. Neuroanatomy of OCD?

Neuroanatomy

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

Co-morbidity

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

Co-morbidity

Ans.

• Most common is MDD, 2/3 (67%).

• Social phobia: 25%

• Tourette’s disorder: 5 - 7%

• Tics: 20 - 30%

OCD

• Differential Diagnosis, list medical and psychiatric?

OCD - differential

Ans. • Medical:

– Tourette’s disorder,– other tic disorder, – temporal lobe epilepsy

• Psychiatric: – Schizophrenia, – Obsessive-compulsive personality disorder, – phobias, – depressive disorders

Onset

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

OCD

Ans. 17 years.

Outline of OCD treatment

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

Outline of treatment

Ans. Basically:

• SSRI/clomipramine and behavioral therapy

FDA approved for OCD

• Q. FDA has approved?

FDA

Ans. FDA has approved:

• Clomipramine

• Fluoxetine

• Fluvoxamine

• Paroxetine

• Sertraline

Dosing

• Q. Typical doses of OCD with an SSRI?

OCD

Ans. Typically, dosing is higher than with MDD.

OCD

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

OCD

Ans. Should see improvement in 6 to 12 weeks.

OCD

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

OCD

Ans. Symptoms will return in two months.

Typical results

• Q. Typical results with an SSRI?

OCD

Ans. About ½ have 1/3 improvement

OCD augmentation

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

Augmentation

Ans.

• Atypical antipsychotic

• Buspirone

• Clomipramine

• Clonazepam

• Lithium

• Venlafaxine

• Valproate

Treatment of PANDAS

• Q. What is treatment?

PANDAS

• 1] plasmopheresis to clear antibodies

• AND

• 2] prophylactic antibiotics

Behavioral therapy for OCD

• Q. Behavioral therapies, three most common?

Behavioral therapy

Ans. Three most common:

• 1. Exposure and response prevention

• 2. Imaginal flooding

• 3. Thought stopping

Exposure and response prevention

• Q. What is exposure and response prevention?

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.

OCD

• Q. What is imaginal flooding?

OCD

Ans. Imaginal flooding consists of having the pt provoked by the obsessions by continually repeating the thought to where the thought no longer provokes fearfulness.

OCD

Q. What is thought stopping?

OCD

Ans. Thought stopping consists of having a technique to stop the pt compulsive thought, e.g., the pt keeps needing to repeat a short prayer and one has the pt shout when that happens, or make a loud noise or snapping a rubber band on the wrist to where it stings.

OCD

• Q. Behavioral therapy helps what % of OCD pts?

OCD

Ans. 3/5

OCD

• Q. Usefulness of relaxation techniques in OCD?

OCD

Ans. Relaxation techniques have not been shown to be helpful

OCD

• Q. Pt only has obsessions, not compulsions. In addition to techniques already mentioned, what psychotherapy technique might be tried?

OCD

Ans. The pt can try not resisting, “just let them pass through.” Also can audio tape and the pt can listen to the tape until no loner upsetting.

OCD

• Q. Typical length of time of behavioral therapy sessions?

OCD

• 90 minutes – and homework

OCD

• Q. Typically, how many sessions?

OCD

• 13 to 20 sessions

Families

• Q. What should you tell families of OCD pts as to how they should relate to the pt?

OCD

Ans.

• Avoid condemnation

• And

• Avoid reassurance