OBSESSIVE-COMPULSIVE DISORDER

DR. T. K.

CELEBRITIES WITHOCD

TO KNOW WHAT IS OCD.HOW TO DIAGNOSE OCD

TO BE ABLE TO DEAL WITH PATIENT HAS OCD

CONTENT

• DEFINITION

• EPIDEMIOLOGY

• CLINICAL MANIFESTATIONS

• DSM 5

• DEFERENTIAL DIAGNOSIS

• MANAGEMENT

• SUMMARY & RECOMMENDATION

OBSESSIVE-COMPULSIVE DISORDER (OCD)

• CHARACTERIZED BY RECURRENT INTRUSIVE THOUGHTS,

IMAGES, OR URGES (OBSESSIONS) THAT TYPICALLY CAUSE

ANXIETY OR DISTRESS, AND BY REPETITIVE MENTAL OR

BEHAVIORAL ACTS (COMPULSIONS) THAT THE INDIVIDUAL

FEELS DRIVEN TO PERFORM, EITHER IN RESPONSE TO AN

OBSESSION OR ACCORDING TO RULES THAT HE OR SHE

BELIEVES MUST BE APPLIED RIGIDLY.

EPIDEMIOLOGY OF OCD

● THE 12-MONTH PREVALENCE (OCD) AMONG ADULTS

IN THE UNITED STATES 1.2 PERCENT & AN ESTIMATED

LIFETIME PREVALENCE OF 2.3 PERCENT.

• OCD TYPICALLY STARTS IN CHILDHOOD OR

ADOLESCENCE, PERSISTS THROUGHOUT A

PERSON’S LIFE, AND PRODUCES SUBSTANTIAL

IMPAIRMENT IN FUNCTIONING.

• FEMALE VS MALE

• COMORBIDITIES AT RATES HIGHER THAN IN THE GENERAL

POPULATION, INCLUDING MAJOR DEPRESSIVE DISORDER

AND OTHER ANXIETY DISORDERS.

• GENETIC AND ENVIRONMENTAL FACTORS CONTRIBUTE TO

THE ETIOLOGY OF OCD.

• CORTICO-STRIATO-THALAMO-CORTICAL (CSTC) CIRCUITS

IN THE PATHOPHYSIOLOGY OF THE DISORDER.

CLINICAL MANIFESTATIONS

• THE MAJORITY OF PATIENTS EXPERIENCED BOTH

OBSESSIONS AND COMPULSIONS, RATHER THAN ONE OR

THE OTHER.

OBSESSIONS

• 1. RECURRENT AND PERSISTENT THOUGHTS, URGES, OR

IMAGES THAT ARE EXPERIENCED, AT SOME TIME DURING

THE DISTURBANCE, AS INTRUSIVE AND UNWANTED, AND

THAT IN MOST INDIVIDUALS CAUSE MARKED ANXIETY OR

DISTRESS.

• 2. THE INDIVIDUAL ATTEMPTS TO IGNORE OR SUPPRESS

SUCH THOUGHTS, URGES, OR IMAGES, OR TO NEUTRALIZE

THEM WITH SOME OTHER THOUGHT OR ACTION (IE, BY

PERFORMING A COMPULSION).

COMMON OBSESSIONS IN OCDObsession % of Sample(N-200)

contamination 45

Pathological doubt 42

somatic 36

symmetry 31

aggressive 28

sexual 26

others 13

Multiple obsessions 60

COMPULSIONS

• 1. REPETITIVE BEHAVIORS (EG, HAND WASHING, ORDERING,

CHECKING) OR MENTAL ACTS (EG, PRAYING, COUNTING,

REPEATING WORDS SILENTLY) THAT THE INDIVIDUAL FEELS

DRIVEN TO PERFORM IN RESPONSE TO AN OBSESSION, OR

ACCORDING TO RULES THAT MUST BE APPLIED RIGIDLY.

• 2. THE BEHAVIORS OR MENTAL ACTS ARE AIMED AT

PREVENTING OR REDUCING ANXIETY OR DISTRESS OR

PREVENTING SOME DREADED EVENT OR SITUATION;

HOWEVER, THESE BEHAVIORS OR MENTAL ACTS EITHER ARE

NOT CONNECTED IN A REALISTIC WAY WITH WHAT THEY

ARE DESIGNED TO NEUTRALIZE OR PREVENT, OR ARE

CLEARLY EXCESSIVE.

COMMON COMPULSIONS IN OCD

Compulsion % of Sample (N = 200)

Checking 63

Washing and cleaning 50

Counting 36

Need to ask and confess 31

Symmetry and precision 28

Hoarding 18

Multiple compulsions 48

LINKING OBSESSIONS AND COMPULSIONS

DSM-5 DIAGNOSTIC CRITERIA

• A. PRESENCE OF OBSESSIONS, COMPULSIONS, OR BOTH.

• B. THE OBSESSIONS OR COMPULSIONS ARE TIME-

CONSUMING OR CAUSE CLINICALLY SIGNIFICANT DISTRESS

OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER

IMPORTANT AREAS OF FUNCTIONING.

DSM-5 DIAGNOSTIC CRITERIA

• C. THE OBSESSIVE-COMPULSIVE SYMPTOMS ARE NOT

ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A

SUBSTANCE (EG, A DRUG OF ABUSE, A MEDICATION) OR

ANOTHER MEDICAL CONDITION.

• D. THE DISTURBANCE IS NOT BETTER EXPLAINED BY THE

SYMPTOMS OF ANOTHER MENTAL DISORDER.

• SPECIFIERS FOR OCD IN DSM-5 — SPECIFIERS FOR THE

DISORDER INCLUDE ASSESSMENTS OF THE PATIENT’S

INSIGHT AND PRESENCE/HISTORY OF A TIC DISORDER.

DIFFERENTIAL DIAGNOSIS

• ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION

• SUBSTANCE INDUCED ANXIETY DISORDER

• BODY DYSMORPHICDISORDER

• SPECIFIC OR SOCIAL PHOBIAS (TRICHOTILLOMANIA)

• MAJOR DEPRESSIVE

EPISODE

• GENERALIZED ANXIETY

DISORDER

• HYPOCHONDRIASIS

• SPECIFIC PHOBIA

• DELUSIONAL DISORDER

• PSYCHOTIC DISORDER

NOT OTHERWISE

SPECIFIED

TREATMENT

• PHARMACOTHERAPY

• COGNITIVE-BEHAVIORAL THERAPY

• PSYCHOSURGERY

• DEEP BRAIN STIMULATION

PHARMACOTHERAPY

• SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)

ANTIDEPRESSANTS: FLUOXETINE, FLUVOXAMINE, SERTRALI

NE, PAROXETINE

• CLOMIPRAMINE: A TRICYCLIC ANTIDEPRESSANT THAT

INHIBITS THE REUPTAKE OF SEROTONIN AND

NOREPINEPHRINE.

• VENLAFAXINE: A SEROTONIN NOREPINEPHRINE REUPTAKE

INHIBITOR (SNRI) ANTIDEPRESSANT

SUMMARY AND RECOMMENDATIONS

• WE RECOMMEND THAT PATIENTS WITH (OCD) BE TREATED

WITH (CBT), (SSRI) MEDICATION, OR BOTH (GRADE 1A).

• FOR MOST PATIENTS WITH OCD, WE SUGGEST FIRST-LINE

TREATMENT WITH EXPOSURE AND RESPONSE PREVENTION

(A TYPE OF CBT) RATHER THAN TREATMENT WITH AN SSRI

MEDICATION (GRADE 2B).

• FOR PATIENTS WITH OCD AND A SEVERE, CO-OCCURRING

DISORDER THAT IS TYPICALLY RESPONSIVE TO SSRI

TREATMENT, WE SUGGEST INITIAL TREATMENT OF BOTH

DISORDERS WITH AN SSRI (GRADE 2C).

• DOSES OF CITALOPRAM ABOVE 40 MG/DAY ARE NO

LONGER RECOMMENDED BY THE FDA DUE TO THE RISK OF

QTC INTERVAL PROLONGATION.

• IF AN ADEQUATE TRIAL OF THE SSRI RESULTS IN NO

RESPONSE, WE SUGGEST TREATMENT WITH A DIFFERENT

SSRI, CLOMIPRAMINE, OR VENLAFAXINE (GRADE 2C).

• IF A TRIAL OF AN SSRI OR SNRI RESULTS IN A PARTIAL

RESPONSE, BUT THE PATIENT CONTINUES TO EXPERIENCE

CLINICALLY SIGNIFICANT SYMPTOMS, WE SUGGEST

AUGMENTING THE ANTIDEPRESSANT WITH CBT BEFORE

TRYING AN ANTIPSYCHOTIC MEDICATION

(EG, RISPERIDONE 0.5 TO 3 MG/DAY) (GRADE 2B).

• SSRIS AND CLOMIPRAMINE GENERALLY LEAD TO

IMPROVEMENT IN 40 TO 60 PERCENT OF PEOPLE WITH

OCD. WHEN PATIENTS HAVE AN ADEQUATE RESPONSE,

PRACTICE GUIDELINES RECOMMEND THAT THEY BE

MAINTAINED ON THE MEDICATION FOR AT LEAST ONE TO

TWO YEARS

OCD EXPERIENCES

OCD Not OCDA man who washes his hands 100

times a day until they are red and

raw

A woman who unfailingly

washer her hands before every

meal

A women who locks and relocks her

door before going to work every day

– for half an hour

A woman who double-checks

that her apartment door and

windows are locked each night

before she goes to bed.

A college student who must tap on

the door frame of every classroom 14

times before entering

A musician who practices a

difficult passage over and over

again until its perfect

A man who stores 19 years of

newspapers “just in case” – with no

system for filling or retrieving

A woman who dedicates all her

spare time and money to

building her record collection

REFERENCE