ocd

what is the ICD-11 definition of OCD?

- recurrent obsessional thoughts or compulsive acts, often about ruminations

- on most days for at least 2 weeks

- associated with distress and interference with normal activity

what are ruminations?

unpleasant repetitive thoughts, out of character, such as being dirty or violent

what are ego-symptonic thoughts?

our thoughts of being kind, caring, helpful, supportive

what are ego-dystonic thoughts?

the thoughts we think we should not have as they do not fit with our self-image

what is the problem with ego-dystonic thoughts in OCD?

struggle to let go and move on from ego-dystonic thoughts - anxiety goes through the roof and they obsess over them

what is the function of the compulsive acts?

prevent some objectively unlikely event from happening - often involving harm to or caused by the patient

which part of the brain is responsible for the urges e.g. reminding you to lock your doors, brush your teeth etc?

caudate nucleus

where does the caudate nucleus send signals to?

cingulate gyrus - to keep the attention focus on it

what two other mental disorders are linked with OCD?

depression and tourettes

how is perfectionism associated with OCD?

can be intolerant of shortcomings in themselves and others - have high standards

what are perfectionists without OCD diagnosed as?

obsessional (anankastic) personality

what is the biological model of OCD?

- dysfunction in orbito-striatal area (caudate nucleus) and dorsolateral prefrontal cortex

- abnormalities in serotonergic (underactive) and glutamergic (overactive) neurotransmission

what is the cognitive behavioural model of OCD?

- most people have occasional intrusive thoughts, but dismiss them as meaningless and do not give them more thought

- however in OCD these develop into an obsession when they assume great significance to the individual causing greater anxiety

- anxiety motivates suppression of these thoughts, and ritual behaviours are developed to reduce anxiety further

what type of CBT is used for pts with OCD?

exposure and response prevention (ERP)

what is exposure and response prevention (ERP)?

expose the person to their intrusions and allow them to find their deepest fears underpinning their cognition

what pharmacological intervention can be used for OCD?

SSRI - sertraline

how can functional impairment in OCD be classified?

mild moderate or severe according to Y-BOCS scale

what is suggested in mild functional impairment OCD?

low-intensity exposure and response prevention (ERP) CBT

what is suggested for moderate functional impairment OCD?

ERP CBT OR an SSRI

which SSRI would be specifically for body dysmorphia?

fluoxetine

what should be given if an SSRI has no response or contraindicated?

clomipramine - non selective serotonin reuptake inhibitor (SRI)

what is the management for severe functional impairment?

refer to secondary care mental health team for assessment

what should be given whilst waiting for assessment?

SSRI and ERP CBT

what is different about SSRI treatment for OCD compared with depression?

- ocd requires a higher dose

- should continue it for at least 12 months to prevent relapse

- may take 12 weeks initially to see a response