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OBSESSIVE-COMPULSIVE
DISORDER
DR. T. K.
CELEBRITIES WITH
OCD
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 OCD
Obsession % 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 DYSMORPHIC
DISORDER
• 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 OCD
A 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
Ocd pathophysiology & updated treatment

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Ocd pathophysiology & updated treatment

  • 3. TO KNOW WHAT IS OCD. HOW TO DIAGNOSE OCD TO BE ABLE TO DEAL WITH PATIENT HAS OCD
  • 4. CONTENT • DEFINITION • EPIDEMIOLOGY • CLINICAL MANIFESTATIONS • DSM 5 • DEFERENTIAL DIAGNOSIS • MANAGEMENT • SUMMARY & RECOMMENDATION
  • 5. 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.
  • 6. 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
  • 7. • 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.
  • 8. CLINICAL MANIFESTATIONS • THE MAJORITY OF PATIENTS EXPERIENCED BOTH OBSESSIONS AND COMPULSIONS, RATHER THAN ONE OR THE OTHER.
  • 9. 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).
  • 10. COMMON OBSESSIONS IN OCD Obsession % of Sample(N-200) contamination 45 Pathological doubt 42 somatic 36 symmetry 31 aggressive 28 sexual 26 others 13 Multiple obsessions 60
  • 11. 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.
  • 12. 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
  • 14. 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.
  • 15. 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.
  • 16. • SPECIFIERS FOR OCD IN DSM-5 — SPECIFIERS FOR THE DISORDER INCLUDE ASSESSMENTS OF THE PATIENT’S INSIGHT AND PRESENCE/HISTORY OF A TIC DISORDER.
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  • 19. DIFFERENTIAL DIAGNOSIS • ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION • SUBSTANCE INDUCED ANXIETY DISORDER • BODY DYSMORPHIC DISORDER • SPECIFIC OR SOCIAL PHOBIAS (TRICHOTILLOMANIA) • MAJOR DEPRESSIVE EPISODE • GENERALIZED ANXIETY DISORDER • HYPOCHONDRIASIS • SPECIFIC PHOBIA • DELUSIONAL DISORDER • PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED
  • 20. TREATMENT • PHARMACOTHERAPY • COGNITIVE-BEHAVIORAL THERAPY • PSYCHOSURGERY • DEEP BRAIN STIMULATION
  • 21. 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
  • 22. 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).
  • 23. • 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.
  • 24. • 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).
  • 25. • 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
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  • 27. OCD EXPERIENCES OCD Not OCD A 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