Chp 4: OCD Diagnosis

What distinguishes Obsessive-Compulsive and Related Disorders from anxiety disorders in DSM-5?

They are characterized by repetitive thoughts and/or behaviors that cause distress and functional impairment.

What are the DSM-5-TR diagnostic criteria for obsessions in OCD?

Recurrent, persistent thoughts/urges/images that are intrusive, unwanted, and cause marked anxiety or distress.

What are compulsions in the context of OCD?

Repetitive behaviors or mental acts performed in response to obsessions, aimed at preventing anxiety or preventing a dreaded event.

What is the time criterion for diagnosing OCD?

More than 1 hour per day or significant distress/impairment.

What are the insight specifiers in OCD?

Good/fair insight, poor insight, and absent insight/delusional.

What is the most common subtype of OCD?

Contamination/Cleaning, affecting approximately 45% of individuals with OCD.

What behaviors are associated with the Doubt/Checking subtype of OCD?

Repeatedly checking locks, appliances, and body parts due to fear of harm.

What characterizes Body Dysmorphic Disorder (BDD) according to DSM-5-TR?

Preoccupation with perceived defects/flaws in appearance, leading to repetitive behaviors like mirror checking and excessive grooming.

What is a significant risk factor associated with Body Dysmorphic Disorder?

80% of individuals with BDD have suicidal ideation, the highest of any disorder.

What defines Hoarding Disorder in DSM-5-TR?

Persistent difficulty discarding possessions regardless of value, leading to significant distress and impairment.

What is Trichotillomania?

A disorder characterized by recurrent pulling of one's hair, leading to hair loss.

What is Excoriation (Skin-Picking) Disorder?

A disorder involving recurrent skin picking that leads to skin lesions and significant distress or impairment.

What are common triggers for skin picking in Excoriation Disorder?

Irregularities, stress, and boredom.

What differentiates OCD from Generalized Anxiety Disorder (GAD)?

OCD obsessions go beyond real-life worries, while GAD focuses on real-life concerns.

What is the lifetime prevalence of OCD worldwide?

2-3%.

What is the typical age of onset for OCD?

Bimodal, with peaks in childhood (10-12 years) and early adulthood (19-21 years).

What is the prevalence of Body Dysmorphic Disorder in the general population?

1.7-2.4%.

What is the prevalence of Hoarding Disorder?

2-6%, which is higher than OCD.

What is the gender pattern observed in Trichotillomania and Excoriation Disorder?

More prevalent in females, with a ratio of 4:1.

What cultural variations exist in OCD content?

Religious obsessions in religious cultures and specific cultural syndromes like Taijin kyofusho in Japan.

What is the course of OCD without treatment?

Chronic waxing and waning, with 85% experiencing symptoms without treatment.

What is the specifier for muscle dysmorphia in Body Dysmorphic Disorder?

Preoccupation with being too small or insufficiently muscular.

What is the typical age of onset for Body Dysmorphic Disorder?

12-13 years.

What is the significance of insight in differential diagnosis of OCD?

Insight level is crucial in distinguishing OCD from psychotic disorders.

What are the key components of the OCD circuit in neuroanatomy?

Orbitofrontal cortex (hyperactive signal), Anterior cingulate cortex (error detection), Caudate nucleus (fails to suppress signals), Thalamus (relays/amplifies signals).

What neurotransmitter dysfunction is primarily associated with OCD?

Serotonin dysfunction is the primary system, with SSRIs being effective.

What is the heritability percentage range for OCD based on twin studies?

45-65% heritability.

What is PANDAS in relation to OCD?

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus; controversial sudden onset of OCD after strep infection.

What cognitive model belief leads to compulsive checking in OCD?

Inflated Responsibility: the belief that one is responsible for preventing harm.

What is the Negative Reinforcement Cycle in OCD?

Obsession leads to anxiety, compulsion provides temporary relief, reinforcing the compulsion.

How does childhood trauma relate to OCD onset?

30-50% of individuals with OCD report childhood abuse or neglect.

What are the components of the Cognitive-Behavioral Model for OCD?

Obsessional beliefs include inflated responsibility, overimportance of thoughts, need to control thoughts, overestimation of threat, intolerance of uncertainty, and perfectionism.

What is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)?

The gold standard structured assessment for OCD.

What role does the Caudate nucleus play in the OCD circuit?

It fails to suppress signals from the orbitofrontal cortex.

What is the significance of the Thalamus in the OCD circuit?

It relays and amplifies signals related to obsessions and compulsions.

What psychological factor involves the belief that thinking about harm makes it more likely to occur?

Thought-Action Fusion (Likelihood TAF).

What is the impact of family accommodation on OCD treatment?

90% of families accommodate OCD rituals, which reduces motivation for treatment.

What is the purpose of the Obsessive Beliefs Questionnaire (OBQ)?

To assess obsessional beliefs related to OCD.

What is the role of neuroinflammation in OCD?

Microglial activation and elevated cytokines have been observed in some OCD patients.

What is the relationship between OCD and tic disorders?

Dopamine is involved especially in tic-related OCD.

What is the Behavioral Avoidance Test?

A direct observation method assessing avoidance of feared stimuli.

What is the significance of the neuroplasticity model in understanding OCD?

Repetitive behaviors strengthen neural circuits, explaining why symptoms become automatic.

What are common environmental factors that may trigger OCD?

Trauma, stressful life events, and learning experiences such as modeling and direct conditioning.

What is the role of cytokines in OCD?

Elevated cytokines have been found in some OCD patients, suggesting a link to immune/inflammatory factors.

What is the Dimensional Obsessive-Compulsive Scale (DOCS)?

A self-report measure assessing the dimensions of obsessive-compulsive symptoms.

What is the impact of perfectionism on OCD symptoms?

Perfectionism leads to 'not just right' experiences and can result in symmetry and ordering compulsions.

What is the gold standard treatment for OCD?

Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP)

What is the efficacy rate of CBT with ERP for OCD?

60-85% response rate

What are the key components of CBT with ERP?

Psychoeducation, exposure, response prevention, cognitive restructuring, and relapse prevention

What principle explains the decrease in anxiety with prolonged exposure?

Habituation

What is the purpose of response prevention in ERP?

To block compulsions following exposure to feared stimuli

What is the focus of Inference-Based Cognitive Behavioral Therapy (I-CBT)?

Reasoning processes that create obsessional doubts

What is Acceptance and Commitment Therapy (ACT) designed to help with?

Accepting obsessions without engaging in compulsions

What is a treatment adaptation for Body Dysmorphic Disorder?

Mirror retraining and challenging appearance assumptions

What is the main focus of treatment for Hoarding Disorder?

Cognitive restructuring and skills training for organizing

What is Habit Reversal Training (HRT) used for?

Treating hair-pulling and skin-picking disorders

What was the first effective medication for OCD discovered in the 1960s?

Clomipramine (Anafranil)

What are the first-line medications for OCD in the second generation?

SSRIs, which are safer and better tolerated than clomipramine

What is the typical dosing range for Fluoxetine in treating OCD?

40-80mg

What is the expected response rate for SSRIs in OCD treatment?

40-60% achieve more than 35% symptom reduction

What should be done if a patient shows partial response to SSRIs?

Augment with an antipsychotic

What is the role of Transcranial Magnetic Stimulation (TMS) in OCD treatment?

FDA approved for OCD, targeting the supplementary motor area or OFC

What are the unique challenges faced by adolescents with OCD?

Peer relationships, identity formation, and academic pressure

What is the impact of PANDAS/PANS on OCD presentation?

Sudden onset following strep infection with dramatic symptoms

What is the primary concern with geriatric patients suffering from Hoarding Disorder?

Safety risks and cognitive decline complicating treatment

What is the treatment approach for severe treatment-resistant OCD?

Deep Brain Stimulation (DBS)

What is the expected response rate for patients undergoing DBS for OCD?

60-70% in severe cases

What are the common side effects of Clomipramine?

Anticholinergic effects, cardiac issues, and seizure risk

What is the significance of the term 'Maybe' thinking in I-CBT?

It transforms possibility into probability, fueling obsessional doubts

What is the main goal of motivational interviewing in treating Hoarding Disorder?

Address ambivalence and encourage change

What is the focus of the Comprehensive Behavioral Model (ComB)?

Understanding and addressing the behaviors associated with hair-pulling and skin-picking

What are the emerging treatments for OCD mentioned in the research section?

Ketamine, psychedelics like psilocybin, and anti-inflammatory approaches

What are connectivity studies in neuroimaging related to OCD?

They examine alterations in the default mode network.

How can brain scans be used in OCD treatment?

They can predict treatment response.

What is real-time fMRI used for in OCD treatment?

It is used for neurofeedback treatment.

What do GWAS studies aim to identify in OCD research?

They identify risk variants associated with OCD.

What are polygenic risk scores used for in OCD?

They predict the onset of OCD.

What is the significance of gene-environment interactions in OCD?

They highlight the role of epigenetics in OCD.

What novel treatment shows rapid improvement for OCD?

Ketamine.

How is psilocybin being researched in relation to OCD?

It is being studied as a treatment for OCD.

What is a debated topic regarding PANDAS/PANS?

The existence of an autoimmune mechanism.

What is a major controversy in OCD treatment regarding antibiotics?

Whether to use antibiotics versus standard care.

What diagnostic issue involves the spectrum concept in OCD?

The OCD spectrum is expanding.

What is the difference between dimensional and categorical approaches in OCD severity?

Dimensional considers a severity continuum, while categorical classifies into distinct categories.

What is a significant concern regarding OCD's functional impact on employment?

40% of individuals with severe OCD are unemployed.

What is the economic burden of OCD in the US?

The annual cost is $10.6 billion.

What percentage of individuals with OCD experience significant improvement with treatment?

60-85% show significant improvement.

What factors predict a good outcome for OCD treatment?

Shorter duration before treatment, good insight, compliance with ERP, lower severity, and no comorbidity.

What comorbidity is most common with OCD?

Depression, with a lifetime comorbidity of 60-70%.

What cultural consideration affects OCD content in religious cultures?

Scrupulosity obsessions are prevalent.

What is a common misdiagnosis for perinatal OCD?

It can be confused with psychosis.

What is the prevalence of OCD in perinatal populations?

2-3% during pregnancy and postpartum.

What is a unique feature of OCD in LGBTQ+ populations?

Doubts about sexual orientation.

What is 'cybochondria' in relation to OCD?

Health-related searching behaviors online.

What emerging concept in OCD treatment challenges traditional exposure methods?

The inference-based approach.