OCD - Mental health Exam 2

pt has unwanted aversive cognitive experiences connected with feelings of dread, loathing, or sense of something’s wrong. They are aware that their concern are inappropriate and try to ignore or suppress them. this is called

Obsessions

overt behaviors or covert mental acts performed to reduce intensity of adverse obsessions. occur as behaviors governed by rigid but irrelevant internal specifications. this is called

compulsions

what pop is most affected by OCD

young adults

how do genetics play a role in OCD

occurs in greater freq in family members of OCD pts vs general pop. childhood OCD is a higher family hx. linked to TOurette syndrome gene

pt has aversive experiences of dread and uncertainty, or sense something is wrong. obsessive thoughts are certain ideas associated with obsessive experiences. form of aversive mental images, dread and disgust, feelings that something bad will happen or that something has to be completed. obsessions can be present without compulsions. this is

OCD

This OCD sx takes form of willed responses directed at reducing aversive circumstances associated with obsessive thoughts. carried out in concordance with ideation. overt or silent mental acts like checking, praying, counting. repetitive or steoeotyped fashion 

compulsions

are pts with OCD aware that they have unrealistic or excessive fears and behaviors.

yes. some pts lose insight during exacerbations of illness.

how is avoidance a sx of ocd

secondary sx. avoids circumstances that trigger aversive obsessions or lead to compulsions.

how are associated experiences triggered to OCd

pts thoughts and concerns diverge from awareness of reality. most OCD pts recognize its absurd, aware of demeaning perceptions others have of them. they have a strong fear they’ll be considered crazy so they hide their sx or socially isolate. they feel like they’re losing control of their actions.

what are the two pathologic forms of OCD

facilitation and antagonistic-defensive dyad. facilitation is when a pt ensures that their family member doesn’t interfere with their fears thru pleading and demanding. antagonistic defensive dyad is when the partner acts in a demeaning way and doesn’t understand the pt has an illness, making dz worse.

how to dx OCD with yale brown obsessive compulsive scale (YBOCS)

max score is 40, >31 is extreme, 24-31 severe, 16-23 moderate, <16 mild to subclinical (usually no tx). untreated pts are usually at 23-25.

pt has persistent intrusive concerns about adverse circumstances in future. Differ from obsessions bc they’re realistic in nature, even tho they’re excessive. obsessions are immediate, aversive sensory experiences with dreadful mental images and unrealistic fears. This isn’t OCD it’s..

anxious ruminations

pt has heightened experience of responsibility for misfortune or harm. Responsibility is usually excessive for circumstance and is delusional in nature. different from obsessions in where individuals believe they're responsible for a bad circumstance and have excessive remorse. This isn’t OCD it’s..

pathologic guilt

pt has persistent cognitive reprocessing of past memories and experiences associated with sadness, loss, and regret. This isn’t OCD it’s..

depressive ruminations

pt has anger related mental processes involving past or future ego injuries that lead to the thought that they will be offended in some way by someone. usually in pts with personality d/o and in ppl with passive aggressive personalities. different than aggressive obsession bc they’re ego driven. This isn’t OCD it’s..

aggressive ruminations

mental stories that individual entertains extending for a time. attractive component even tho pt knows they aren’t likely to be real. This isn’t OCD it’s..

fantasies

pt has a concern that someone else harbors malevolent intent toward affected individual. associated with anger, leading to violent preemptive measures to protect themselves. OCD pts have fears of being harmed like with poison but the fear is that they’re a random victim, not a target. This isn’t OCD it’s..

paranoid fears

pt has intense intrusive experiences associated with memories of past trauma events. different than obsessions bc they come from past memories, NOT horrible images unrelated to previous experience. This isn’t OCD it’s..

flashback

cognitive and visceral experience draw a individual toward maladaptive behavior. feelings of desire, longing, or need for release of tension and the urge to satisfy that desire. Not an obsession bc in ocd obsessions are an aversive experience and triggers behavior based on escape not gratification. pts don’t like their obsessions. This isn’t OCD it’s..

pathologic attractions

unable to adopt a new perspective. ego syntonic and may be delusional in nature. argumentative, repetitive, and returns to same point over and over. can’t adopt the perspective of another individual. This isn’t OCD it’s..

rigid thinking

individual can’t make choices with potential outcomes. individuals become paralyzed bc they can’t make any decision. Dread in OCD pts motivates decisions. This isn’t OCD it’s..

pathologic indecision

pts with realistic fears or concerns that can be confused for OCD. pts with a hx of violence or pathologic absent-mindedness have concerns that problems will recur. This isn’t OCD it’s..

realistic fear/concern

maladaptive behaviors that an individual is attracted to or feels the need to perform. they need gratification, satisfaction, or release of tension. can be violent or destructive. compulsions on the other hand are drawn to act and derives inherent pleasure from completion. Not harmful. This isn’t OCD it’s..

impulsions

motivated by pos sense of accomplishment in completing activities in a proper manner. believes others should behave in a similar manner regardless of if their behavior is just. NOt the same as obsessions bc it is reinforced with positive consequences. OCD pts know their behavior is crazy. This isn’t OCD it’s..

perfectionism

motivated by guilt or fear of punishment, regret past actions and seek to reduce discomfort by performing penitent behaviors like religious rituals, or self mutilation. not the same as compulsions bc it isn’t motivated by doubt or incompletion but rather willfully carried out to dec feelings of guilt. This isn’t OCD it’s..

pathological atonement

performed to escape or nub aversive experiences associated with an affective stagelike depression/anxiety. mimic OCD where they engage in repetitive cleaning or straightening to reduce stress. function of behavior is to numb the psychic distress assoc w the primary condition. This isn’t OCD it’s..

repetitive replacement behavior

repetition of thoughts, speech, or brief behaviors. can be carried out w/o conscious thought bc it dec awareness of anxiety or other aversive experiences. occurs in response to urge without any component. carries out without purpose in mind. This isn’t OCD it’s..

pervasive behavior

form of perseveration that is rhythmic in nature. simpler than pervasive behavior, associated with reward or reduced awareness of anxiety. occurs in normal children, also those with organic illnesses. This isn’t OCD it’s..

stereotypic behavior

an escape behavior to reduce intensity of aversive affective experience. occurs as pathologic manipulative process or as self punitive process. release of tension associated with visualizing self injury. OCD doesn’t involve self harm. This isn’t OCD it’s..

self injurious behavior

individual is busy with a single process or set of processes to the exclusion of the other. individual carries out the process with a lot of focus. experiences gratification from the process as its occurring or upon completion. is pathologic when individual neglects or cant attend to other more important tasks. This isn’t OCD it’s..

pathologic overinvolvement

pt contributes to pursue an endeavor or interaction despite repeated failure or rebuff. pt has rigidity of thought or doesn’t want to accept unwanted circumstances. This isn’t OCD it’s..

pathologic persistence

pt has unreasonable urge to collect items without a reason or thinking they need it in the future. can occur in secrecy. This isn’t OCD it’s..

hoarding

unwanted urges without rational motivation. localized muscle groups. obsessions associated with tics, that if they don’t do the tic something bad will happen. This isn’t OCD it’s..

complex tics

pt has meticulousness, persistence, rigidity, personal isolation. ego syntonic = ideas are acceptable to the person’s values and ways of thinking. no sense of dread like pts with OCD. they just have a desire for others to conform to their standards.

OCPD

excessive fears of certain situations. involves fear of situations that others might experience as mildly aversive or anxiety provoking (contact with snakes or spiders). avoidance is prominent and effective in preventing anxiety. this isn’t OCD this is

specific phobias

unreasonable persistent concerns that something is wrong with them, leading to repetitive request for medical care. concerns are only about their body. this isn’t OCD this dz is

hypochondriasis

pt has unreasonable sense that something is malformed, inadequate, or offensive to others. spends too much time looking at or seeking medical or surgical tx. they believe that they are truly abnormal. this isn’t OCD this is

body dysmorphic d/o

pt has urges to pull hair from body. associated with pleasure or release of tension. OCD has similar compulsion, not doing it for pleasure release. this dz isn’t OCD it’s

Trichotillomania

excesisve concern with body image with refusal to eat. delusional perception they’re overweight when they’rre severely underweight. no insight regarding concern. this dz isn’t OCD it’s

anorexia nervosa. OCD would be i dont wanna eat bc of a fear, anorexia is a body image issue

how to tx OCD w therapy

mild = stress reduction, psychiatrist. Psychotherapy (exposure & response prevention), experience averse condition without performing compulsion. is effective for 70%.

how to tx OCD with meds

preferential serotonergic reuptake inhibitors (PSRIs): most effective. some SSRIs (fluox, sertraline, paroxetine) and TCA like clomipramine (more effective). doesn’t get rid of the syndrome but dec the sx

if a pt doesn’t respond to a PSRI in 8-12 wks what do you do. then if they don’t respond again what do you do. then if all else fails what do you finally do.

first switch the PSRI, then choose a 3rd option PSRI. then after the PSRIs don’t work tx w clomipramine a TCA

what is the most effective pharmacologic tx for OCD

PSRIs

what is adjunct therapy for a pt who also has anxiety or seizures and OCD

clonazepam

if all else fails what do you give pt for OCD, esp if pt has panic or phobic sx

MAOI. Clonazepam, carbamazepine.

if pt didn’t respond to PSRI and adjunct tx and they have OCD and seizure hx what do you give them

clonazepam

last resort therapy for OCD

neurosurgery. B/L cingulotomy, limbic leukotomy, anterior capsulotomy.

pt has severe OCD that was treated with 3 full trials of PSRIs and one trial of clomipramine and trials of neuroleptics and clonazepam. what are they indicated for next?

neurosurgery. exhausted all options

recurrent episodic post infectious OCD in kids has been tx with what experimental tx

immunosuppressive measures like steroids, plasmapheresis, and IG tx