obsessive-compulsive and related disorders

pathophysiology of OCD

cortico-striato-thalamo-cortical loop

cycle of obsession, anxiety, compulsion, reinforcement, obsession, etc

syndeham’s chorea

rapid, uncoordinated jerking movements primarily in face, hands, and feet after infection with group-A strep

pediatric autoimmune neuropsychiatric disorders (PANDAS)

OCD symptoms appear after strep infection

obsessive-compulsive disorder key diagnostic criteria

obsessions, compulsions, or both that are time consuming or cause significant distress

obsessions

intrusive and persistent thoughts, urges, or images that cause anxiety or distress

attempted to ignore, suppress, or neutralize with other thought or action

compulsions

repetitive behaviors or mental acts driven to perform in response to obsession

aimed at reducing anxiety but are not realistic

OCD ego relation

ego-dystonic (not pleasurable)

female development of OCD

19.5 years

male development of OCD

10 years

obsessive-compulsive disorder treatment

1st - exposure response therapy, maybe CBT, medications

first line medications for OCD

fluoxetine

fluvoxamine

paroxetine

sertraline

second line medications for OCD

clomipramine

venlafaxine

medication dose for OCD

often maxed out

body dysmorphic disorder key diagnostic criteria

preoccupation with perceived defects or flaws in physical appearance only that are slight or not observable to others

performed repetitive behaviors or mental acts in response to concerns

body dysmorphic disorder treatment

SSRI (or clomipramine as 2nd line) and CBT tailored to BDD

exposure response prevention therapy

hoarding disorder key diagnostic criteria

persistent difficulty discarding possessions regardless of actual value

accumulation of possessions that congest living areas and compromise their use

trichotillomania key diagnostic criteria

recurrent pulling out of one’s hair resulting in hair loss

repeated attempts to stop hair pulling

excoriation disorder key diagnostic criteria

recurrent skin picking resulting in lesions

repeated attempts to stop skin picking

trichotillomania and excoriation treatment

1st - SSRI or clomipramine at high doses

augment with n-acetylcysteine in adults