Obsessive Compulsive Disorder OCD) Presentation

Presentation on OCD as per the DSM 5, its history, background, treatment and interventions

1. OBSESSIVE COMPULSIVE DISORDER (OCD) Ayesha azfar

2. This Photo by Unknown Author is licensed under CC BY-NC-SA outline

3. What is ocd? OCD is characterized by the presence of OBSESSIONS , COMPULSIONS or BOTH Obsessions : are unwanted and disturbing thoughts, images or impulses that suddenly pop into the mind and cause a great deal of anxiety or distress. Compulsions: are deliberate behaviors (e.g. washing, checking, ordering) or mental acts (e.g. praying, counting, repeating phrases) that are carried out to reduce the anxiety caused by the obsessions. (Anxietybc.com, 2015)

4. History

5. HISTORY

6. background

7. prevalence (Huffman and Dowdell, 2015)

8. Unpacking Ocd with Dr. kevin casey

9. Presenting problem Dr. Kevin Casey is a 42 year old medical doctor who has presented for treatment of OCD. He had been previously diagnosed with the disorder at the age of 12 and had been managing it (with ups and downs), until his recent marriage and starting a new job at Sacred Heart Hospital Eczematous eruptions related to excessive washing are also present Previous treatments that he has received for his condition are CT (Cognitive Therapy) and medication such as Zoloft

10. Case background Only child, who was first diagnosed at the age of 12 May have been triggered by parents insistence that he wash his hands thoroughly because of severe outbreak of influenza in schools During adolescence, developed “checking” behaviors such as turning on/off light switches, locks, faucets to make sure they were closed. Developed a routine of counting clothes 3 times each before putting them on Arranged and sorted school supplies in a very specific manner in each class Symptoms become more severe in times of stress or life changes Fared relatively well in medical school as he read his medical books and journals over and over again, and most tasks required repetition to perfect Once he entered his residency, the changing and fast paced nature of the job was too much and he had to drop out

11. Diagnostic assessment 300.3 (F42) Obsessive Compulsive Disorder, with good or fair insight 300.09 (F41.8) Other specified Anxiety Disorder, generalized anxiety not occurring more days than not V62.89 (Z60.0) Phase of Life Problem (American Psychiatric Association, 2013).

12. VIDEO

13. OBSESSIONS COMPULSIONS Contamination –Harm to self or others –Need for symmetry/order –Religious or moral concerns –Sexual or aggressive –Lucky or unlucky numbers Cleaning –Checking, counting, repeating –Ordering, straightening –Praying, confessing, reassurance seeking –Touching, tapping, or rubbing –Hoarding (Mayoclinic.org, 2016)

14. Compulsions are designed to neutralize an obsession Mayoclinic.org, 2016 )

15. SYMPTOMS Whenever Dr. Casey enters or exits a building, he must go in and out three times. When he makes an entrance in a building he needs to step in with his left foot first, and exhale simultaneously as his right foot plants. According to Dr. Casey, whenever he goes to the bathroom, the process involves going home and scrubbing down his home toilet with industrial strength cleaner for an hour. When he signs something, he must do it several times and utter his name as he signs it. Each day at work, he must touch every object (and person) in his first patient's room and say " Bink " repeatedly. Dr. Casey must put a new coaster on the top of a bottle after every time he takes a sip from it. He will turn lights on and off multiple times to make sure they have been turned off

16. DSM 5 Criteria (American Psychiatric Association, 2013).

17. Associated symptoms   (www.nami.org, 2015)

18. Differential diagnosis (American Psychiatric Association, 2013).

19. Differential diagnosis considered

20. OCD and anxiety seem to share a similarity between neural underpinnings and biomarkers and, environmental and situational factors. A variety of studies point to high comorbidity between the two disorders – people with one often have the other as well. Treatment strategies are quite similar as well ( Robinson, Smith and Segal, 2015). Rationale for rule out: Although client presents many of symptoms of GAD and clearly suffers from anxiety, much of his anxiety is related to stress when placed in new and changing circumstances. Past examples include transitioning from middle to high school, university etc.., starting a new job or entering a new relationship GAD (American Psychiatric Association, 2013).

21. Social anxiety disorder (social phobia) Social anxiety is the fear of social situations that involve interaction with other people. Social anxiety is the fear and anxiety of being negatively judged and evaluated by other people. Rationale for rule out: The main diagnostic criteria for this order is a fear or severe anxiousness of social situations. So far Dr. Casey has not displayed severe symptoms and neither does he actively seek to avoid all social situations. (American Psychiatric Association, 2013).

22. OCPD Often confused with OCD. OCPD is a personality disorder and organization techniques and repetitive behaviors are used as a means to achieve perfection, not to alleviate anxiety. People with OCPD want to have control over themselves and everything that surrounds them. Rationale for rule out: OCPD OCD Ego Syntonic Absence of true obsessions and compulsions Rigid standards, morals and ethics Expect everyone to have the same standards as well Ego Dystonic Behaviors develop as a way to alleviate anxiety An awareness of   the maladaptiveness of the compulsions Dr. Casey is very aware of his compulsions and how they are a deterrent to his everyday life (Thomsen et al., 2013)

23. Treatment & Interventions The two main treatment strategies include  PHARMACOTHERAPY  and  PSYCHOTHERAPY   Depending on the severity of symptoms, clinicians will suggest therapy or a combination of both therapy and pharmaceutical intervention. ( Weidle et al., 2014) A lot of times, the  treatment does not result in an overall cure of the disorder , however, it does relieve the intensity and severity of the symptoms. The goal is for the individual to learn how to be able to return to  their daily life  and not let the obsessions and compulsions disrupt their daily functioning. (Robinson, Smith and Segal, 2015)

24. Medical Treatments Clinical trials have shown that drugs that impact on serotonin can significantly decrease OCD symptoms. (Garcia et al., 2010) Examples of these SRIs include the following; clomipramine ( Anafranil ) flouxetine (Prozac), fluvoxamine (Luvox), Paroxetine (Paxil) sertraline (Zoloft). • Studies have shown that more than 3/4 of patients are helped by these medications to some degree. • In more than ½ , medications relieve symptoms by diminishing the frequency and intensity of the obsessions and compulsions. • Side effects can be an issue (Weight gain, dry mouth, nausea, diarrhea) (Helpguide.org, 2015)

25. interventions

26. Recommended treatment for Dr. casey

27. ERP (exposure response prevention) ERP is now usually administered as part of a broader program of CBT specifically designed for OCD. Treatment proceeds on a step-by-step basis, with the therapy being guided by the client’s ability to tolerate the anxiety and control compulsive acts ( Foa , 2010). The client will rank orders OCD situations he perceives as threatening (contamination, symmetry stc ) The client is then systematically exposed to symptom triggers, of gradually increasing intensity, while the individual is to suppress his or her usual ritualized response (washing hands, turning lights on/off). When a patient does not respond in the face of a potent trigger, extinction of the response can take place.

28. Treatment goals and objectives To promote the unlearning of the strong link that has existed between having an urge and giving into the urge. The client’s wife should be involved when possible, and they may have to be willing to change their responses to the patient ( eg , not provide requested reassurance to irrational doubts). To be useful in working on a client’s resistance to accepting recommended treatments  Helping the client to appreciate the interpersonal effects that his OCD symptoms are having on others.  

29. Thankyou!!! Thoughts Comments Questions

30. references American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association. Anxietybc.com. (2015). What Is Obsessive-Compulsive Disorder? | Anxiety BC. [online] Available at: http://www.anxietybc.com/resources/ocd.php Foa , E.B., (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialougues Clinical Neuroscience, 12, 199-207 Garcia AM Sapyta JJ Moore PS Freeman JB et al (2010). Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). Journal of the American Academy of Child and Adolescent Psychiatry 49, 1024–1033. https://doi.org/10.1016/j.jaac.2010.06.013 Helpguide.org. (2015). Obsessive-Compulsive Disorder (OCD): Symptoms, Behavior, and Treatment. [online] Available at: http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm Huffman, K. and Dowdell, K. (2015). Psychology In Action. 11th ed. Hoboken, NJ: Wiley Custom Learning Solutions, pp.462, 481-484.

31. references Mayoclinic.org. (2016). Obsessive-compulsive disorder (OCD) Tests and diagnosis - Mayo Clinic. [online] Available at: http://www.mayoclinic.org/diseases-conditions/ocd/basics/tests-diagnosis/con-20027827 Nichols, H. (2014). What is obsessive-compulsive disorder (OCD)? What causes obsessive-compulsive behavior?. [online] Medical News Today. Available at: http://www.medicalnewstoday.com/articles/178508.php Robinson, L., Smith, M. and Segal, J. (2015). Obsessive-Compulsive Disorder (OCD): Symptoms, Behavior, and Treatment. [online] Helpguide.org. Available at: http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder- ocd.htm Thomsen, P., Torp, N., Dahl, K., Christensen, K., Englyst , I., Melin , K., Nissen , J., Hybel , K., Valderhaug , R., Weidle , B., Skarphedinsson , G., Bahr, P. and Ivarsson, T. (2013). The Nordic long-term OCD treatment study ( NordLOTS ): rationale, design, and methods. Child and Adolescent Psychiatry and Mental Health, [online] 7(1), p.41. Available at: http://dx.doi.org/10.1186/1753-2000-7-41 Weidle , B., Ivarsson, T., Thomsen, P., Lydersen , S. and Jozefiak , T. (2014). Quality of life in children with OCD before and after treatment. European Child & Adolescent Psychiatry, [online] 24(9), pp.1061-1074. Available at: http://dx.doi.org/10.1007/s00787-014-0659-z www.nami.org. (2015). The Invisible Disease: An OCD Account. [online] Available at: http://www.nami.org/Personal- Stories/The-Invisible-Disease-An-OCD-