Obsessive Compulsive Disorder and Post Traumatic Stress Disorder

Neuropsychiatric disorder characterized by obsessions and/or compulsions that are distressing to the patient, time consuming, or significantly impairing

obsessive compulsive disorder

• recurrent and persistent thoughts, impulses, or images that are intrusive or unwanted

• patient tries to ignore/suppress thoughts

• patient understands thoughts are product of their mind

obsessions

• repetitive behavior or mental acts that person feels driven to perform in response to an obsession

• behaviors or mental act meant to prevent or reduce distress/dreaded event that are not connected

compulsion

given the following obsession, what is the compulsion:

fear of contamination

washing, cleaning

given the following obsession, what is the compulsion:

fear of contamination

washing or cleaning

given the following obsession, what is the compulsion:

unwanted sexual or aggressive thoughts or images

checking on things

praying

doing and undoing things

asking for reassurance

given the following obsession, what is the compulsion:

doubts: door unlocked

repeated checking behaviors

given the following obsession, what is the compulsion:

concerns about throwing away something valuable

hoarding

given the following obsession, what is the compulsion:

need for symmetry

ordering, arranging, balancing, straightening things until they are “just right”

which criteria is used to diagnose patients with OCD

yale brown obsessive compulsive scale (Y-BOCS)

Interpret Y-BOCS score for OCD

extremely severe

32-40

Interpret Y-BOCS score for OCD

severe

24-31

Interpret Y-BOCS score for OCD

moderate

16-23

Interpret Y-BOCS score for OCD

mild

8-15

Interpret Y-BOCS score for OCD

subclinical

0-7

using Y-BOCS criteria- what is definition of a response

>25% reduction in score

using Y-BOCS criteria- what is definition of a remission

Score less than 8

OCD: trichotillomania

compulsive hair pulling

OCD: Excoriation Disorder

skin picking (causes skin lesion)

OCD: Body Dysmorphic Disorder

body image disoreder

OCD: Hoarding Disorder

persistent difficulty parting with possessions regardless of their value

what treatment must all patients with OCD get

psychotherapy: CBT + ERP Therapy

what does CBT + ERP Therapy have a stronger effect on

compulsions

what are pharmacologic agents recommended for treatment of OCD

SSRIs

Clomipramine (TCA)

Augment agents for treatment resistance

When should clomipramine be used over SSRI for OCD

after failing 2 SSRIs

options for OCD treatment resistance

add psychotherapy

increase SSRI dose

alternative SSRI

switch to clomipramine

switch to venlafaxine (less preferred than clomipramine)

augment with antipsychotic

augment with clomipramine

Mental disorder that can develop after exposure to actual or threatened death, serious injury, or sexual violence

PTSD

True or False: an act must be committed to an individual in order for them to develop PTSD

false- they could develop PTSD by learning indirectly that it happened to close relative or friend

is this considered a normal stress response or PTSD:
trauma creates stress reaction (fight or flight)

normal stress response

is this considered a normal stress response or PTSD:
people often feel relief after stressful event

normal stress response

is this considered a normal stress response or PTSD:
relief after stressful event followed by fear, anger, and anxiety

normal stress response

is this considered a normal stress response or PTSD:
symptoms gradually diminish

normal stress response

is this considered a normal stress response or PTSD:
increased severity of symptoms

PTSD

is this considered a normal stress response or PTSD:
high impairment in social, occupational, and physical functioning

PTSD

is this considered a normal stress response or PTSD:
long duration of symptoms

PTSD

4 core symptoms of PTSD

1. Re-experience or Intrusion

2. Avoidance and Numbing

3. Negative Alterations in Cognition and Mood

4. Hyperarousal (hypervigilance)

PTSD: Re-experience/Intrusion

reexperiencing trauma

nightmares/flashbacks

PTSD: avoidance and numbing

feeling numb towards the situation

avoiding situations/pictures that remind them of the event

PTSD: negative alterations in cognition and mood

persistent depression/anxiety

unable to remember full detail of events

PTSD: hyperarousal (hypervigilance)

small things set patient off

on edge/irritable

What is the gold standard for assessment of PTSD

CAPS-5

First line therapy for patients with PTSD

Trauma Focused Therapy

• Cognitive processing therapy

• Eye movement desensitization and reprocessing

• Prolonged exposure

Second line therapy for PTSD

Pharmacotherapy

SSRIs (paroxetine or sertraline)

SNRIs (venlafaxine)

Prazosin (only for nightmares)

Which condition has specific recommendations for SSRIs to use

PTSD

Which SSRIs are recommended for the treatment of PTSD

Paroxetine

Sertraline

What agent should be used for patients with PTSD and have nightmares

Prazosin

Prazosin MOA

alpha-1 antagonist

what agents should never be used in patients with PTSD

benzodiazepines

cannabis