OCD(obsessive compulsive disorders .pptx

Lecturer

1. Obsessive compulsive disorder

2. Introduction OCD is characterized by a group of symptoms which are characterized by: Intrusive thoughts, Rituals, Preoccupations and Compulsions. Obsessions :- mental events characterized by intrusive and unwanted repetitive thoughts, urges, impulses or images - often cause marked anxiety and distress Compulsions :- repeated behaviors or mental acts which are done in response to obsessions.

3. Epidemiology It is one of the low represented psychiatric disorders because patients tend to be to embarrassed to seek health care. Life time prevalence in the general population is 2-3% but subclinical cases are more prevalent. The M:F ratio is equal in adults; but more common in boys in the adolescent age group.

4. Etiology Biological Factors Neurotransmitters Hypothesis that there is dysregulation of serotonin which is evidenced by many drug trials. 2. Brain imaging findings Altered function in the neurocircuit between orbitofrontal cortex, striatum and cingulate.

5. Cont. 3. Genetics Has significant genetic component and higher role in childhood-onset OCD. Significantly higher concordance rate for monozygotic twins than Dizygotic.

6. Cont. II. Behavioral Factors Learning theory suggests that obsessions are conditioned stimuli. previously neutral objects and thoughts become conditioned stimuli capable of provoking anxiety.

7. Cont. Compulsion develops when a person discovers that a certain action reduces anxiety attached to an obsessional thought. The individual develops active avoidance strategies in the form of compulsions or ritualistic behavior to control the anxiety.

8. Cont. III. Psychosocial Factors 1. Personality factors OCD VS OCPD. OCPD associated with obsessive concern for details, perfectionism. Only 15- 35% of patients with OCD have had premorbid obsessional traits.

9. Clinical Features Some patients may have only obsessions or compulsions but most patients have both. The patients understand the irrationality of their symptoms. Patients are often embarrassed by or ashamed of their symptoms so careful screening is necessary. The compulsion might be carried out in order to decrease the anxiety associated with the obsession but not always successful and it might even worsen the anxiety. Their anxiety also worsens when they resist the compulsion.

10. Cont . Common obsessions include: Contamination Pathological doubt Somatic Need for symmetry Aggressive Sexual

11. Cont. Common compulsions include: Checking Washing Counting Need to ask or confess Symmetry and precision Hoarding Multiple comparisons

12. 1. Contamination/Cleansing The most common pattern. It is an obsession of contamination followed by washing or accompanied by compulsive avoidance of the presumably contaminated object. The feared object is usually hard to avoid e.g. feces, urine, dust or germs. Patients may rub off their skin by washing excessively or may not leave their homes because of the fear of germs.

13. 2. Pathological Doubt/Checking The second most common presentation. Obsession of doubt followed by compulsion of checking. The obsession often implies some danger of violence(forgetting to turn off a stove, to lock a door). The checking may involve multiple trips. Their emotional response involves feeling guilty about having forgetting or committing something.

14. 3. Intrusive or Forbidden Thoughts The third most common type. Intrusive thoughts without a compulsion. This can be thoughts of sexual or aggressive acts that is reprehensible to the patient or can be suicidal ideation. They may report themselves to the police or confess to a priest.

15. 4. Symmetry/Ordering The fourth common pattern. Have the need for symmetry and precision. It can lead to a compulsion of slowness and it can take them hours to complete a task, e.g. eating a meal, shaving.

16. Diagnosis

17. Comorbidities MDD- 67% OCRDs Social anxiety disorder- 25% Substance use disorder GAD, Specific phobias, Panic disorder Personality disorders( schizotypal and OCPD). Tourette’s disorder- 5-7% Tics- 20-30% of patients

18. Approach to the patient Take a detailed history. Age of onset. The type and severity of symptoms. Precipitating factors. Try to understand the cycle of obsession and compulsion. Assess the negative impact of the OCD symptoms and the avoidance of triggers. The extent of insight. The presence of comorbid conditions. Try to assess the patients explanatory model of OCD.

19. Management Pharmacotherapy First line are antidepressants: start with SSRIs or Clomipramine. Psychotherapy (Cognitive behavioral therapy) Exposure response prevention Other Therapies Surgery Deep brain stimulation ECT

20. References Kaplan and Sadock’s comprehensive textbook of psychiatry, 10 th edition. Kaplan and Sadock’s Synopsis of Psychiartry 11 th and 12 th edition.

21. Thank you.