OCD - obsessive compulsive disorder

What is the term used to describe a mental disorder where a person has certain thoughts repeatedly or feels the need to perform certain routines repeatedly?

OCD

What is the term used to describe unwanted thoughts that cause anxiety and interfere with life and can include forbidden thoughts e.g., pedophile?

Obsessions

What is the term used to describe continuous activities the person feels they must do to prevent obsessional thoughts?

Compulsion

How many steps are there in OCD?

6

What is step 1 of OCD management?

Awareness and recognition

What is step 2 of OCD management?

Recognition and awareness

What is steps 3-5 of OCD management?

Treatment options for adults with OCD

What is step 6 of OCD?

Intensive and inpatient treatment

What teams should be involved diagnosing in step 1 of OCD?

Specialist teams help with training and support

What questions may be asked in step 2 of OCD management?

Ask direct questions e.g., do you have any thoughts that may disturb you that you want to get rid of but you can‘t

What issues may patients present with when being diagnosed with OCD due to compulsions?

Dermatological conditions e.g., from repeated handwashing or patients may come in for repeat screening of the same disease

What are some potential differentials for OCD?

Somatic symptom disorders, delusional disorder, Autism, substance induced OCD

What questionnaires can be used in OCD?

ICD-10 or DSM-5 criteria

What does the ICD-10 questionnaire for OCD involve?

Discusses reoccurring presence of reoccurring obsessional thoughts e.g., ideas/images that are distressing to the patent, compulsive actions e.g., rituals repeated many times to prevent an unlikely event and if resisted, worsens anxiety

What does DSM-5 involve for OCD?

Looks at obsessions, compulsions or both - causes marked distress, time-consuming and affects the patients daily routine and social life, not attributable to other disorders/physiological symptoms of other disorders

What is mild first line treatment of OCD?

Low intensity psychological treatment e.g., group CBT, individual self help

What is mild 2nd line CBT that is unable to engage with low intensity psychological treatment or for moderate OCD?

SSRI or more intensive CBT

What is the treatment for severe OCD?

Combined treatment of SSRI and CBT

What SSRIs are usually used in OCD?

Paroxetine, fluoxetine, sertraline, citalopram

What patients have an increased risk of suicidal thoughts/self harm?

under 30s treated with SSRIs

What side effects may mean an SSRI has to be swapped to another in the same class?

Akathisia, restlessness or agitation

How long should an effective antidepressant be used for at least in bipolar?

12 months to prevent relapse

What drug therapy is NOT routinely used in OCD?

TCAs aside from clomipramine, SNRIs e.g., venlafaxine, MAOIs, anxiolytics

When should clomipramine or an alternative SSRI be offered?

No adequate response for treatment of SSRI + CBT or no response to SSRI alone and not engaged with CBT

When should patients be referred to an MDT for specific assessment and further treatment planning e.g., for treatment with additional CBT, adding an antipsychotic or combining clomipramine and citalopram?

No response to trial of 1 SSRI alone, SSRI + CBT and full trial of clomipramine

What antipsychotic can be used in OCD?

Risperidone

What monitoring should be done for clomipramine?

BP and ECG before treatment

What patients is clomipramine cautioned in?

Those at risk of suicide as toxic in overdose so prescribe in small quantities

What act may need to be used if patients are resistant for treatment of OCD?

Mental Health Act for sectioning

When is inpatient treatment considered for OCD?

• Risk to life

• Severe self-neglect

• Extreme distress or functional impairment

• No response to pharmacotherapy or psychological treatment

• Person has additional diagnoses e.g., severe depression, anorexia or schizophrenia

• Person has reversal of normal night/day patterns so makes daytime therapy impossible

• Compulsions and avoidance so severe they cannot undergo normal activities

When can benzodiazepines be used in OCD?

Short periods to counter early SSRI activation