Obsessive Compulsive Disorder

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Obsessive Compulsive Disorder. Facts about Obsessive Compulsive Disorder Obsessive Compulsive Disorder is also known as OCD OCD is a medical disorder that causes problems in the information processing. OCD is classified by the DSM-IV as an anxiety disorder - PowerPoint PPT Presentation

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  • Obsessive CompulsiveDisorder

  • Facts about Obsessive Compulsive DisorderObsessive Compulsive Disorder is also known as OCDOCD is a medical disorder that causes problems in the information processing.OCD is classified by the DSM-IV as an anxiety disorderAffects over 3.3 Million Americans.

  • Obsession:Contamination of fears of germs or dirtCompulsion:Repeatedly washing

    Obsession: Needing to have things just soCompulsion: Hoarding or saving things

  • ObsessionsUnwanted thoughts, images, or impulses that occur over and overAre accompanied by uncomfortable feelings such as fear, doubt, or disgust.

  • CompulsionsRepetitive behaviorsIn response to the CompulsionsMost common is washing and checking things.

  • OCD is often confused with these other disorders:Major Depressive DisorderPanic DisorderSocial PhobiasADHD

  • OnsetCan occur any time from preschool age through adulthoodTypically by 40sEqually common in both male and female

  • Diagnosis Criteria according to DSM-IVCompulsion or Obsessions (Typically both are present)The Compulsion or Obsessions cause marked distressTypically no physical symptomsScales are available, but they take lots of timeGet a HistoryCommunication between patient and medical practitioner is key

  • Typical Course of OCDLong processOn average 3-4 doctors and over 9 years before receiving the correct diagnosis.Early diagnosis is important Medicine and Cognitive behavior therapy helps most individuals experience long term relief.

  • AssessmentVisits The Anxiety Disorder Interview Schedule-Revised (ADIS-R) The Yale-Brown Obsessive-Compulsive Symptom Checklist (Y-BOC) The Leyton Obessional Inventory (LoI) The State Trait Anxiety Inventory of Children (STAIC)

  • Cause of OCDNo concrete causesParents role and non-roleOrganic reasonsHead injuriesBrain ChemistryBasal GangliaEncephalitis

  • Differential Diagnosis

  • Depressive Disorder vs. OCDPreoccupation with depressive thoughtsI have no friendsRealistic vs. absurd

  • Generalized Anxiety Disorder vs. OCDExcessive worrying and thinkingAgain realistic vs. absurdPatient with OCD may have extremely intense/irrational thoughtsThe presence of compulsive rituals

  • Hypochondrias vs. OCDClosely relatedUnrealistic preoccupation of medical concernsPresence of checking rituals to decrease anxiety

  • Other illnesses and neurological disorders vs. OCDAnorexia and Dysmorphic disorderOccur in the context of another psychiatric disorderTourettes syndrome-increased rate of OCDTrichotillomaniaCompulsive behavior of pathological gamblers and substance abusers

  • Main Ideas of Differential DiagnosisThe presence of obsessive compulsive ritualsThe manner of the compulsive thoughtsFor example: unrealistic vs. realisticappropriate vs. inappropriate

  • TreatmentTwo typesA. PharmacotherapyB. Behavioral Therapy

  • Use of medications

    Controlling the symptoms of OCDLessening the intensity and frequency of the obsessions and compulsionsExamples of SSRIsProzacLuvoxPaxilZoloft

  • Medications Continued

    Improvement usually takes 3 weeksSymptoms are reduced but not eliminatedAnafranil 1st SRI usedSide effects: Sedation, blurry vision, weight gain, and sexual dysfunctionSide effects of SSRIsSide effects: Insomnia, motor restlessness, nausea, and diarrheaLong-Term treatment needed

  • Behavioral Therapy

    Exposure and Response PreventionNot able to eliminate their anxietyExtremely uncomfortable for OCD patient80-90% improvement Symptoms are reduced but not eliminatedFollow-up sessions needed for relapse prevention

  • Use of both therapies

    Severe case of OCDMild case of OCDUse of SSRIs and behavior therapy prove to have a 70% success rateTherapy determined by patientWillingness to take a medicationWillingness to work with a psychologist

  • Environmental Factors

    Positive and motivated patientFully trained therapist during behavior therapyOCD GroupsFamily provides encouragement and constant reassuranceShowing frustration with the patient may impact the compulsive behavior

  • New Research A new cognitive-behavioral therapyEmphasizes changing the OCD sufferers belief and thinking patterns

  • Case Study of Obsessive Compulsive Disorder Women with

    Postpartum-Onset OCD Lesley M. Arnold, M.D.Presented by Lawrence Pierce

  • Several lines of evidence suggest that postpartum women are at increased risk for the development or worsening of obsessive-compulsive disorder

  • Recruiting ProcessSubjects were recruited from outpatient practice at the University of Cincinnati Medical Center and advertising for a study for postpartum women.Nine potential subjects were identified.Two were excluded because they did not meet the DSM-IV criteria for OCDOf the 7 subjects, 5 respondents through advertisement, 2 were referred

  • Initial ScreeningPsychiatric evaluationYale-Brown Obsessive Compulsive Scale (Y-BOCS)Data on Demographic and Clinical featuresFamily History of any psychiatric disorder in first-degree relatives

  • Obsessions in 7 Women with Postpartum-Onset OCDSymptomObsessions AggressiveContaminationReligiousPathological doubtSexualSymmetryOther

    Number % 7100 5 71 3 43 2 29 1 14 1 14 1 14

  • Compulsions in 7 Women with Postpartum-Onset OCDSymptomCompulsions CheckingCleaningOrderingCountingSuperstitious behaviors

    Number % 457 1 14 1 14 1 14 1 14

  • Psychiatric Disorders in First Degree Relatives of 7 subjects.

    Relatives Affected (N = 18) Total of 60Disorder N %Mood disordersBipolar disorder 4 22Major depression 9 50Psychotic disorders 0 0Psychoactive substance use disorders Alcohol 5 28Other 2 11Anxiety disorders 0 0

  • Subject 1 Current/Past DSM IV DiagnosisAge 28Current Diagnoses: AgeBipolar disorder I 12Panic disorder 13OCD 19GAD 13

    Past Diagnoses: AgePTSD 26Anorexia nervosa 14

  • Subject 2 Current/Past DSM IV DiagnosisAge 31Current Diagnoses: AgeRecurrent MDD 17OCD 29GAD 10

    Past Diagnoses: AgeAlcohol abuse 28Social Phobia 10

  • Subject 3 Current/Past DSM IV DiagnosisAge 41Current Diagnoses: AgeRecurrent MDD 39OCD 41

    Past Diagnoses: AgeBinge eating disorder ?

  • Subject 4 Current/Past DSM IV DiagnosisAge 42Current Diagnoses: AgeRecurrent MDDpartial remission 39OCD 31Binge eating disorder 17

    Past Diagnoses: AgeCannabis dependence 19

  • Subject 5 Current/Past DSM IV DiagnosisAge 26Current Diagnoses: AgeRecurrent MDD 15OCD 26PTSD 15

    Past Diagnoses: AgeAlcohol abuse 23

  • Subject 6 Current/Past DSM IV DiagnosisAge 28Current Diagnoses: AgePanic Disorder 25OCD 25

    Past Diagnoses: AgeMDD 25

  • Subject 7 Current/Past DSM IV DiagnosisAge 26Current Diagnoses: AgeBipolar disorder II depressed 26OCD 26

    Past Diagnoses: AgeNone

  • Of the 7 subjects 4 did not enter the fluvoxamine trial. 3 were excluded because they wish to continue breast feeding1 was excluded because of the diagnosis of bipolar I

  • The TestSubjects received fluvoxamine 50 mg/dayThe dose was increased on a flexible schedule as tolerated with a maximum dose of 300 mg/daySubjects received no psychotropic medication except zolpidem tartrate 5 to 10 mg at bedtime as needed to help with insomnia Subjects evaluated weeks 1,2,3,4,6,8 and 12 and reported any treatment-related illness then

  • Measure of SuccessPrimary successful outcome measure was the Y-BOCS was defined as greater than or equal 30% decrease its total scoreCorresponding with clinical improvement in symptomsSecondary outcome measures were changes in the Hamilton Rating Scale for Depression (HAM-D) and anxiety (HAM-A)

  • Subject 2Completed 12 weeksFinal dose was 300 mg/daySide effects headache, heartburn, dry mouth and insomnia Had a past history of no response to 3 trials of serotonin reuptake inhibitorsNo improvement with fluvoxmine

  • Subject 4Completed 12 weeksFinal dose was 200 mg/dayReported side effects: headache, dry mouth, heart palpitations and anorgasmiaPositive response to drug

  • Subject 5Completed 3 weeks due to car accident (unrelated)Final dose was 150 mg/dayReported side effects: anorgasmiaPositive response to drug

  • Case Study Conclusion2 of the 3 subjects improved with treatmentThis subject t