Obsessive-Compulsive Disorder Assessment, Diagnosis, and Case Studies

Flashcards covering Y-BOCS, MOCI, OCD definitions and diagnostics from ICD-11, compulsion/obsession classifications, and the detailed case study of Charles.

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

The Y-BOCS is a semi-structured interview used to assess the severity of OCD symptoms.

How is the Y-BOCS structured, scored, and administered?

It contains $10$ items ($5$ about obsessions and $5$ about compulsions), each rated from $0\text{--}4$ based on symptoms experienced during the previous week. It can take around $30$ minutes, and interviewers can also use a checklist containing $50+$ types of obsessions and compulsions organized into $15$ categories.

What are the total score severity ranges for the Y-BOCS?

The total score ranges from $0\text{--}40$: $8\text{--}15$ indicates Mild, $16\text{--}23$ indicates Moderate, $24\text{--}31$ indicates Severe, and $32\text{--}40$ indicates Extreme.

How did Goodman et al. Clasa) demonstrate the inter-rater reliability of the Y-BOCS?

Goodman et al. Clasa) tested $40$ people with OCD who were assessed by four different interviewers, finding excellent agreement between the interviewers and showing it is a reliable measure of OCD symptom severity.

What are the limitations and weaknesses of the Y-BOCS assessment?

It rates symptoms based on the previous week only, missing day-to-day variations (e.g., symptoms worsening when not working). Additionally, without qualitative data to explain scores, clinicians may not fully understand overall functioning.

What was the primary aim of Hodgson and Rachman (1977) in creating the Maudsley Obsessive-Compulsive Inventory (MOCI)?

They aimed to create a classification system for different types of OCD to help researchers study the causes and treatment of OCD.

How was the MOCI developed and tested?

Hodgson and Rachman interviewed $30$ people with OCD, created $65$ True/False statements, reduced it to the $30$ most useful items distinguishing OCD from anxiety, and tested it on patients at Maudsley hospital in London.

Which major and minor types of OCD were identified by the MOCI?

The two major types identified were Cleaning and Checking, and the two minor types identified were Slowness and Doubting.

What evidence supports the test-retest reliability of the MOCI?

Hodgson and Rachman tested $50$ students twice with a $1$ month gap, and $89BA$ of the $1500$ pairs of scores were the same, demonstrating high consistency over time.

Why can the forced True/False format of the MOCI reduce validity?

It creates problems if a statement is only sometimes true or if a person lacks a baseline understanding (such as a person with OCD not knowing what an average amount of soap is), potentially leading to misdiagnosis.

How does the transcript define obsessions versus compulsions?

Obsessions are repetitive, persistent, unwanted, and intrusive thoughts and images. Compulsions are repetitive acts or behaviors (physical such as tapping/touching or mental such as counting) carried out in response to neutralise negative thoughts.

What is thought-event fusion according to the ICD-11 framework?

Thought-event fusion is the belief that one's thoughts can directly cause something to happen, leading the person to feel compelled to perform a compulsion to neutralise the thought.

How are levels of insight classified when receiving an OCD diagnosis?

Poor or absent insight means the person strongly believes obsessive thoughts are true and compulsions prevent bad things. Fair or good insight means the person usually recognizes obsessive thoughts are not true or realistic, though high anxiety can make this harder to recognize.

What diagnostic requirements regarding time and life impact exist for OCD?

Obsessions and compulsions must be time-consuming (more than $1$ hour a day) and symptoms must cause distress or have a negative impact on personal, social, school, or work life.

What four types of obsessions are detailed in the notes?

Contamination (terror of passing germs/illness), Harm Safety (obsessive thoughts about accidents/fires), Symmetry/order (discomfort unless items are aligned/in order), and Forbidden thoughts/taboos (such as sexual thoughts).

What four types of compulsions are detailed in the notes?

Cleaning (forced cleaning until hands are sore), Checking (checking doors/windows/appliances multiple times), Counting, ordering and arranging of possessions (spending hours organizing desk items), and Ritualistic physical and/or mental acts (saying prayers repeatedly or ritualistic washing).

What were the early symptoms and onset details of Charles's OCD case history?

Charles developed OCD at age $12$, believing something was sticky on his skin (calling honey the worst thing). He showered for up to $3$ hours at a time, passed soap hand-to-hand after set times, and took $2$ hours for daily dressing routines due to general slowness.

How did Charles react when Rapport/Rapoport explained the EEG procedure?

When told an EEG involved putting sticky paste on his scalp, Charles became very distressed because he was upset people like his sisters would call him crazy, and he stayed up all night washing the following day.

What medical treatment was prescribed to Charles and what was the long-term outcome?

Charles was given clominpramine, a tricyclic anti-depressant. It helped short-term, but he developed tolerance requiring larger doses and relapsed within a year; his symptoms returned but were more manageable than before.

How did Charles's condition affect his schooling and his parents' coping mechanisms?

Charles's symptoms worsened until he was unable to attend school. His mother constantly cleaned the house, asked visitors to wash hands, and eventually stopped inviting people over; his father coped by working longer hours.

What were the primary qualitative strength and methodological weakness of the case study on Charles?

The strength was that Rapport collected rich qualitative data in Charles's own words, increasing validity. The weakness was that it involved only one participant over $2$ years of adolescence, making findings ungeneralisable to older or younger individuals.