Obsessive Compulsive Spectrum Disorders

8/17/2019 Obsessive Compulsive Spectrum Disorders

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Obsessive CompulsiveSpectrum Disorders

PRESENTER: DR. CAROLINE DIASCHAIRPERSON: DR. KRISHNA!RTH"


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Co#cept o$ spectrum

• To i#dic%te &u%lit%tive disti#ctio# %risi#'$rom % &u%#tit%tive co#ti#uum• To ide#ti$( % 'roup o$ disorders))*u%lit%tivel( disti#ct i# %ppe%r%#cebut believed to be rel%ted $romp%t+o'e#etic poi#t o$ vie,• Di-ere#t me%#i#' ro%d %re%s o$ps(c+i%tric p+e#ome#% rel%ti#' to %si#'le me#t%l disorder


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Co#cept o$ spectrum

•Not co#ti#uum•%#i$est%tio#s v%r( ,idel( i# t(pe %#dseverit(

•All /i#ds o$ combi#%tio#s %re possible

• T+ese combi#%tio#s s(#dromes


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OC spectrum disorders

model o$ medic%l cl%ssi0c%tio# ,+erev%rious ps(c+i%tric1 #eurolo'ic%l %#d2ormedic%l co#ditio#s %re described %s e3isti#'o# % spectrum o$ co#ditio#s rel%ted to

obsessive4compulsive disorder 5OCD6

T+e model su''ests t+%t m%#( co#ditio#soverl%p ,it+ OCD i# s(mptom%tic pro0le1demo'r%p+ics1 $%mil( +istor(1 #eurobiolo'(1comorbidit(1 cli#ic%l course %#d respo#se tov%rious p+%rm%cot+er%pies


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OCD

•DD•H(poc+o#dri%sis•A#ore3i% #ervos%

Preoccupation with body

Motor disorders

• Tics• Tourette7s disorder•S(de#+%m7s c+ore%•PANDAS

Impulse control

disorder Tric+otillom%#i%P%t+olo'ic%l '%mbli#'Compulsive se3u%ldisorderKleptom%#i%


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OTOR DISORDERS

• Tourette7s disorder

•

S(de#+%m7s c+ore%• Tics

•PANDAS


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IP!LSE CONTROL DISORDERS• Tric+otillom%#i%

• Kleptom%#i%

•

P%t+olo'ic%l '%mbli#'• P(rom%#i%

• I#termitte#t e3plosive disorder

•

Compulsive se3u%l disorder• Compulsive bu(i#'

• S/i# pic/i#' 5derm%tillom%#i%6

• N%il biti#' 5o#(c+op+%'i%6


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PREOCC!PATION 8ITH OD"•od( d(smorp+ic disorder

•H(poc+o#dri%sis

•

A#ore3i% #ervos%•ulimi% #ervos%


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Co#troversi%l

•Autism•Subst%#ce use disorder

•Sel$ i#9urious be+%vior

•

Deperso#%li%tio#•OCPD


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COORIDIT"

•P%tie#ts ,it+ OCSD +%ve +i'+ r%te o$comorbidit( o$ OCD

• Tourette s(#drome 4 ;?=•P%t+olo'ic%l '%mblers 4 @. timesrel%tive ris/

•DD 4 >


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%mil( +istor(

•Amo#' 0rst de'ree rel%tives o$ OCD 4+i'+ prev%le#ce o$ DD1+(poc+o#dri%sis

•

Rel%tives o$ OCD pts. +%ve +i'+erprev%le#ce o$ tic disorder

•Rel%tive o$ tic disorder p%tie#ts +%vei#cre%sed r%te o$ OCD

•Rel%tives o$ e%ti#' disorder p%tie#ts+%ve +i'+er prev%le#ce o$ OCD

•OCD is more prev%le#t i# rel%tives o$

%utism


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A#im%l studies

•Ho3b 'e#e mut%tio#s i# mice•E3cessive 'roomi#'

•E3cessive +%ir remov%l

•

Simil%r to tric+otillom%#i%•I$ tre%ted ,it+ SSRI t+ere is #o 'roomi#'


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A#im%l studies

•comp%#io# %#d domestic %#im%lsdemo#str%te repetitive #o#$u#ctio#%lmotoric be+%viors

•%cr%l lic/ derm%titis 5p%, lic/i#'6

•R%poport %#d colle%'ues demo#str%ted

t+%t %cr%l lic/ derm%titis1 li/e OCD1 respo#dsmore

robustl( to clomipr%mi#e t+%# todesipr%mi#e

•p+%rm%cot+er%peutic respo#se o$ t+isco#ditio# seems to mimic t+%t o$ OCD


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Is it possible t+%t t+e OC spectrum o$disorders c%# be de0#ed %lo#' #euro)

evolutio#%r( co#sider%tio#s

•Horses) stereot(pies i# locomotio#

•

Co,s %#d pi's ) c+e,i#' stereot(pies•Prim%tes ) 'roomi#' %b#orm%lities

•some p%tie#ts ,it+ OCD1 bod(d(smorp+ic disorder1 tric+otillom%#i%1%#d #%il biti#' c%# be co#ceptu%lied %ssu-eri#' $rom %b#orm%l 'roomi#'


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NE!ROCIRC!ITR"

DISR!PTION O CONTROL ECHANISS:•Cortico)stri%t%l #eurocircuitr( : medi%tet+e co#trol o$ procedur%l str%te'ies

•D(s$u#ctio# i# t+e co#trol o$ procedur%lstr%te'ies ,it+ i#%ppropri%te rele%se o$s(mptoms r%#'i#' $rom simple motoric

stereot(pies to more comple3 be+%vior%lpro'r%ms


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•#eurolo'ic disorders c+%r%cteried b(stri%t%l lesio#s m%( be %ccomp%#ied b(

obsessive)compulsive s(mptoms•$u#ctio#%l im%'i#' studies demo#str%tet+%t duri#' implicit le%r#i#' t+ere isstri%t%l %ctiv%tio# i# +e%lt+( co#trols but

%b#orm%l e3tr%)stri%t%l %ctivit( i# OCD•success$ul tre%tme#t1 ,+et+er usi#'medic%tio#1 co'#itive)be+%vior%lt+er%p(1 or #eurosur'er(1 results i#decre%sed s(mptoms %#d %ltered %ctivit(i# cortico)stri%t%l circuitr(


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DISR!PTION O RE8ARD ECHANISS

•Cortico)stri%t%l circuitr( : medi%te re,%rdprocesses ) t+e ve#tr%l stri%tum

•OCD : %bse#ce o$ % $eeli#' o$ 'o%l completio#%$ter %# %ctio# is per$ormed: people co#ti#ue,it+ t+eir compulsio#s repetitivel( u#til t+ere is

0#%ll( t+e se#se t+%t t+i#'s %re #o, FF9ustri'+t.77

Alt+ou'+ OCD %#d dru' %ddictio# +%ve

si'#i0c%#t p+e#ome#olo'ic %#d ps(c+obiolo'icdi-ere#ces1 bot+ co#ditio#s m%( bec+%r%cteried b( disruptio# o$ re,%rd processes%#d co#se&ue#t compulsive be+%vior


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NE!ROCHEISTR"

T+e Seroto#i# H(pot+esis:OCD

•Hi'+er levels o$ HIAA

•

Reductio# i# ; HIAA %$ter tre%tme#t ,it+clomipr%mi#e

•et% 4 c+loro p+e#(l piper%i#e 5mCPP6%dmi#ist%tio# 4 seroto#i# %'o#ist 4

,orse#i#' o$ OCD•SSRI %re e-ective i# tre%tme#t


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R%poport %#d colle%'ues : clomipr%mi#e

,%s superior to desipr%mi#e i# % r%#'eo$ repetitive s(mptoms ot+er t+%# OCD

E': +%ir pulli#' 1 #%il biti#' 1 stereot(picbe+%viors 1 obsessive4 compulsive

s(mptoms i# %utistic disorder 1s(mptoms o$ bod( d(smorp+ic disorder 1sel$)i#9urious be+%vior i# me#t%lret%rd%tio#


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Autism :decre%sed c%p%cit( to s(#t+esieseroto#i# duri#' developme#t

E%ti#' disorder: 4 lo,er ; HT 4 moder%tedieti#' c%uses +(perse#sitivit( o$ ;HTc

4 e3%cerb%tio# o$ e%ti#' disorder


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•de #ovo productio# or e3%cerb%tio# o$ tics,it+ dop%mi#e %'o#ists1 %#d dop%mi#ebloc/ers +%ve lo#' bee# /#o,# to be e-ective

i# TD

•i#cre%sed stri%t%l dop%mi#e upt%/e sites i# TD

•u#ctio#%l im%'i#' studies +%ve co#0rmed're%ter t+%# #orm%l stri%t%l dop%mi#etr%#sporter de#sities

•o#o('otic t,i#s ,it+ TD)) i#cre%sedc%ud%te D receptor bi#di#' ,%s %ssoci%ted,it+ i#cre%sed tic severit(


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NE!ROANATOIC:

S"DENHA7S CHOREA

Alter%tio#s to b%s%l '%#'li%

Si'#%l +(per i#te#sit( i# c%ud%te #ucleus

PANDAS

E#l%r'ed b%s%l '%#'li%

TO!RETTE S"NDROE

olume o$ c%ud%te #ucleus ,%s decre%sed


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A!TIS

E#l%r'eme#t o$ c%ud%te

DDC%ud%te #ucle%r %s(mmetr(I#cre%sed ,+ite m%tter volume

TRICHOTILLOANIA

Decre%sed le$t put%me# %#d le#ticul%r#ucleus


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%s%l %#'li% H(pot+esis:

•b%sed o# d%t% t+%t OCD is medi%ted b(t+e stri%tum %#d le%ds to % co#cept o$ OCspectrum disorders comprisi#' t+ose

co#ditio#s i# ,+ic+ ps(c+op%t+olo'( o$t+e stri%tum le%ds to u#,%#ted repetitivebe+%vior

•Developmental basal ganglia syndrome(DBGS) - d(s$u#ctio#%l b%s%l '%#'li%developme#t ,+o prese#t ,it+ tics1 OCD1%#d ot+er s(mptoms


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I!NE ECHANISS:

•p%tie#ts m%( develop OC s(mptoms i# t+e

%$term%t+ o$ streptococc%l i#$ectio# ))%#ti#ucle%r %#tibodies

•A#ti b%s%l '%#'li% %#tibodies $ou#d i# OCD

•A#tiput%me# %#tibodies i# %#ore3i%

#ervos%•D2B@ e3pressio# %ppe%rs i#cre%sed i#c+ild+ood)o#set OCD %#d TD %#d i# %utism

•CS t(pe B c(to/i#es1 co#siste#t ,it+ %cell)medi%ted immu#e process4prepo#der%#ce i# OCD


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PS"CHOD"NAIC ACTORS:

•reud : obsessive)compulsive #eurosis1

%#d obsessive)compulsive ps(c+osis l%(o# % spectrum %#d ,ere %ll c+%r%cteriedb( speci0c u#co#scious mec+%#isms 5e'1+ei'+te#ed %#%l

drive6

•I$ de$e#ses %'%i#st u#co#scious

mec+%#isms %re pe#etr%ted1 % #eurosisor eve# % ps(c+osis m%( emer'e


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COP!LSIIT" vs IP!LSIIT"

•OCD spectrum : dime#sio# o$compulsivit( %#d impulsivit(

•compulsivit( m%( reJect +%rm %void%#ce1,+ere%s impulsivit( reJects ris/ see/i#'

•OCD $%lls o# t+e compulsive e#d o$ %#OCD spectrum1 ,+ere%s impulsivedisorders $%ll o# t+e impulsive e#d

•

disorders suc+ %s TD1 tric+otillom%#i%1%#d obsessive4 compulsive perso#%lit(disorder demo#str%te bot+ compulsive%#d impulsive c+%r%cteristics


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IP!LSE CONTROL DISORDER

•I#%bilit( to resist %ctio#s t+%t +%ve#e'%tive co#se&ue#ces

•Impulses i#cre%se te#sio# %#d provideple%sure1 'r%ti0c%tio# %#d rele%se duri#'%ct

•Also possess % compulsive compo#e#t i#t+%t be+%viors become drive# %s

i#dividu%l e3perie#ces 'uilt %#d dis'ust%#d t+e 'o%l o$ t+e be+%vior is to reducet+e %#3iet(


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TRICHOTILLOANIA

EpidemiologyPrev%le#ce


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TRICHOTILLOANIA

•

Repetitive +%ir pulli#' t+%t results i# si'#i0c%#t+%ir loss

• T+ere is %# i#cre%si#' level o$ te#sio#immedi%tel( be$ore +%ir pulli#' or duri#'

%ttempts to %void pulli#'• T+ere is % se#s%tio# o$ relie$1 ple%sure or'r%ti0c%tio# duri#' +%ir pulli#'

• T+e pulli#' is #ot e3pl%i#ed b( 'e#er%l medic%l

co#ditio#2ot+er me#t%l disorder•Si'#i0c%#t distress or imp%irme#t i#occup%tio#%l1 soci%l or ot+er %re%s o$$u#ctio#i#' is e3perie#ced %s % result o$ pulli#'


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TRICHOTILLOANIA

E#viro#me#t%l $%ctors) %cts %s tri''eri#'eve#ts

•P+(sic%l $e%tures o$ +%ir)color2s+%pe2te3ture

•Ne'%tive co'#itio#) %bout %ppe%r%#ce1$e%r o$ bei#' #e'%tivel( ev%lu%ted1s+%me rel%ted co'#itio#s

•

Ne'%tive %-ective st%tes)%#3iet(1$rustr%tio#1 lo#eli#ess1 $%ti'ue

•Speci0c setti#'s) stud(i#'1 ,%tc+i#' T1drivi#'1 t%l/i#' over p+o#e


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TRICHOTILLOANIA

Possible subt(pes

•ocused +%ir pulli#'

•

No# $ocused +%ir pulli#'


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TRICHOTILLOANIA

Treatment• T+ere is #eit+er % u#ivers%l #or %complete respo#se to %#( tre%tme#ts $or

TT

•o#ot+er%p( ,it+ CT orp+%rm%cot+er%p( is li/el( to produceo#l( p%rti%l s(mptom reductio# i# t+e

lo#' ru#•i'+t (ield superior improveme#t ,+e#combi#ed) but #o evide#ce support


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TRICHOTILLOANIA

P+%rm%cot+er%p(SSRI

Clomipr%mi#e

Ps(c+ot+er%p(

CT2T) H%bit revers%l1 %,%re#esstr%i#i#'1 stimulus co#trol


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PATHOLOICAL ALIN

•Public +e%lt+ issue

•B


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PATHOLOICAL ALIN

•Recurre#t '%mbli#' t+ou'+ts %#d

be+%viors

•Loss o$ co#trol over '%mbli#'be+%vior

•

!#%ble to resist t+e impulse to'%mble

•E3+ibit +i'+er level o$ obsessio#%lit(

•Obsessive t+ou'+ts %bout '%mbli#'%#d compulsive be+%vior


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PATHOLOICAL ALIN

Tre%me#t:

Ps(c+ot+er%peutic %ppro%c+es:

Ps(c+o%#%l(sis

CT

P+%rm%cot+er%p(:•SSRI7s

•ood St%biliers: c%rb%m%epi#e1 lit+ium

•Opioid %#t%'o#ists) #%ltre3o#e

%mblers %#o#(mous


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INTERITTENT EPLOSIE DISORDER:• Periodic episodes o$ %''ressio# t+%t

resulted i# serious %tt%c/s o# people orpropert(• T+e de'ree o$ %''ressio# is 'rossl( out o$

proportio# to t+e precipit%ti#' stressor

Tre%tme#tPs(c+osoci%l:I#dividu%l ps(c+ot+er%piesroup ps(c+ot+er%pies

edsood st%bilierset% bloc/ersSSRIs


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KLEPTOANIA

Recurre#t1 impulsive p%t+olo'ic%lste%li#'

Resist%#ce to ste%li#' is met ,it+

%#3iet( %#d te#sio#

COP!LSIE !"IN

!#co#troll%ble bu(i#' ,+ic+ is m%r/edl(distressi#'1 time co#sumi#' %#dresulti#' i# socio occup%tio#%ld(s$u#ctio#


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NONPARAPHILIC SE!AL COP!LSIONS:

•Cultur%ll( %ccept%ble

•I#cre%se i# $re&ue#c( %#d i#te#sit( ,+ic+

i#ter$ere ,it+ se3u%l i#tim%c(•!su%ll( %cted out 5to di-ere#ti%te $rom se3u%lobsessio#s6

P"ROANIA• Recurre#t purposeless ot+er t+%# te#sio#

relie$Q 0re setti#'• Te#sio# or %-ective %rous%l be$ore setti#'

t+e 0re• Attr%ctio# to t+e 0re %#d its situ%tio#%l

co#te3t• Ple%sure ,it+ setti#' t+e 0re or its %$term%t+


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H"POCHONDRIASIS

•Disorder c+%r b( t+e $e%r or belie$ t+%to#e +%s % severe ill#ess b%sed o# si'#sor s(mptoms

• T(pic%ll(1 t+ese pts. E3perie#ce %reductio# i# %#3iet( %$ter t+e p+(sici%#visit1 but t+is reductio# l%sts o#l( +oursor d%(s

•

8+e# %#ot+er s(mptom retur#s t+e%#3iet( resur$%ces %#d t+e c(cle o$+(poc+o#dri%c%l ,orr( resumes


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H"POCHONDRIASIS

P+e#ome#olo'(:•R%smusse# %#d Eise#: pts. 8it+ OCD ,+o+%ve som%tic or ill#ess obsessio#s %revirtu%ll( i#disti#'uis+%ble $rom pts. 8it+

+(poc+o#dri%sis•Obsessio#s: i#trusive1 distressi#' %#d o#l(tempor%ril( respo#sive to re%ssu%r%#ce

•Compulsio#s: repetitive %#d per$ormed toreduce distress1 m%#i$esti#' prim%ril( i#t+e $orm o$ c+ec/i#' o#es bod( or c+ec/i#',it+ ot+ers


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H"POCHONDRIASIS

•%rs/( : c%# be disti#'uis+ed b%sed o#t+e prese#ce o$ som%tic se#s%tio#s %#do# t+e de'ree o$ i#si'+t

•OCD: $e%rs %re u#re%listic %#d tr( toresist t+em

•H(poc+o#dri%sis: +i'+ de'ree o$co#victio#

•%llo# : $e%r o$ +%vi#' %# ill#ess vs $e%ro$ 'etti#' %# ill#ess


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H"POCHONDRIASIS

Tre%tme#t:•P+%rm%coter%p( : SSRI7s 4Juo3eti#e1clomipr%mi#e1 Juvo3%mi#e

•

CT


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OD" D"SORPHIC DISORDER

•B@: reco'#ied %s % disti#ct disorderi# DS IIIR

•Preoccup%tio# ,it+ im%'i#ed J%, i#%ppe%r%#ce or e3cessive distress %boutsli'+t imper$ectio#


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•

Compulsive mirror c+ec/i#'•Less i#si'+t t+%# OCD p%tie#ts

•C+ro#ic course %#d simil%r %'e %t o#set

•

Hi'+ co morbidit( ,it+ soci%l p+obi%1depressio# %#d tric+otillom%#i%

•Pts ,it+ DD co#ceptu%lied %s v%r(i#'bet,ee# % co#ti#uum o$ i#si'+t or

u#cert%i#t())) t,o v%ri%#ts o$ t+e s%medisorder


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Tre%tme#t:•SSRI7s: eve# ,+e# DD co#cer#s re%c+delusio#%l proportio#s

•

Re$r%ctor( c%ses5 delusio#%lcompo#e#t 6:

Au'me#t%tio# ,it+ lo, doses o$ %t(pic%l%#ti #euroleptics suc+ %s risperido#e

•CT


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ANOREIA NEROSA•Obsessive $e%rs %bout bei#' $%t

•Compulsive %ttempts to reduce ,ei'+t

!LIIA NEROSA•Preoccupied ,it+ bod( im%'e

•Le%ds to compulsive vomiti#' %#dimpulsive l%3%tive %buse

•i#'e e%ti#'

•Compulsive e%ti#' ,it+out e-orts todecre%se ,ei'+t


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TO!RETTE7S S"NDROE

•#eurolo'ic%l co#ditio# c+%r%cteried b(motor %#d voc%l tics

•Repetitive moveme#ts or utter%#ces

•odil( se#s%tio#1 me#t%l ur'es %#dte#sio#

• Tics %re believed to result $rom

d(s$u#ctio# i# cortic%l %#d subcortic%lre'io#s1 t+e t+%l%mus 1 b%s%l '%#'li%%#d $ro#t%l corte3

• Neuro%#%tomic models $%ilures i#


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• Neuro%#%tomic models) $%ilures i#circuits co##ecti#' t+e br%i#s corte3 %#dsubcorte31 %#d im%'i#'

tec+#i&ues implic%te t+e b%s%l '%#'li%%#d $ro#t%l corte3

•

Some $orms o$ OCD m%( be 'e#etic%ll(li#/ed to Tourettes

•A subset o$ OCD is t+ou'+t to

be etiolo'ic%ll( rel%ted to Tourettes %#dm%( be % di-ere#t e3pressio# o$ t+e s%me$%ctors t+%t %re import%#t $or t+ee3pressio# o$ tics

S"DENHA7S CHOREA:


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S"DENHA S CHOREA:

•#eurolo'ic%l disorder o$ c+ild+ood resulti#'

$rom i#$ectio# vi% roup A bet%)+emol(ticstreptococcus

•r%pid1 irre'ul%r1 %#d %imless i#volu#t%r(moveme#ts o$ t+e %rms %#d le's1 tru#/1 %#d

$%ci%l muscles•'irls more o$te# t+%# bo(s 5; %#d B; (e%rs 6

•u#coordi#%ted moveme#ts1 muscul%r,e%/#ess1 stumbli#' %#d $%lli#'1 slurred

speec+1 dicult( co#ce#tr%ti#' %#d ,riti#'1%#d emotio#%l i#st%bilit(

•@;= +%ve %''ressive1 co#t%mi#%tio#obsessio#s

PANDAS : P%edi%tric Autoimmu#e


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PANDAS : P%edi%tric Autoimmu#eNeurops(c+i%tric Disorders Associ%ted,it+ Streptococcus

• Prese#ce o$ OCD2tic disorder

• Pedi%tric o#set

• Acute o#set %#d dr%m%tic s(mptome3%cerb%tio#

• C+orei$orm moveme#ts or motor+(per%ctivit(

• Tempor%l %ssoci%tio# ,it+ et%+emol(tic streptococci


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CRITICISS

•

Repetitive#ess is #ot t+e sole criteri% $orobsessio# %#d compulsio#s

•Co'#itive medi%tio# is di-ere#t %crosst+e disorders

• Tre%tme#t respo#se is #ot t+e criteri% 4e3: %spiri# is use$ul i# IHD1 %rt+ritis %#d$ever. Di-ere#ces i# ps(c+ot+er%peutic

pri#ciples•Hi'+ de'ree o$ comorbidit( ,it+%-ective disorders


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DS

•

0ve dime#sio#s o$ OCD s(mptoms5S(mmetr(1 Ho%rdi#'18%s+i#'2co#t%mi#%tio#1 8orries %boutH%rm2C+ec/i#'2Doubt1 T%boo t+ou'+ts 5Se3

%#d viole#ce6•stro#' evide#ce $rom %t le%st t+ree out o$t+e 0ve dom%i#s 5i.e.1 p+e#ome#olo'(1comorbidit(1 $%mil( +istor(1 $ro#to)stri%t%l

br%i# circuitr( e.'.1 c%ud%te +(per%ctivit(Q1or tre%tme#t respo#se61 ,it+ eit+er $%mil(+istor( or $ro#to)stri%t%l br%i# circuitr(re&uired


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DS

•

%sed o# t+is criterio#1 stro#'estevide#ce $or % rel%tio#s+ip ,it+ OCD ,%s$or Tourettes1 bod( d(smorp+ic disorder1%#d +(poc+o#dri%sis . %lso support $or

OCPD1 +o%rdi#'1 S(de#+%ms2PANDAS1tric+otillom%#i%1 %#d e%ti#' disorders1%#d t+e le%st support $or s/i#)pic/i#'%#d #%il)biti#'


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DS

•

DSM-IV impulse co#trol disorders %#d t+eICDs)NOS 5i#cludi#' impulsive)compulsivebu(i#'1 se31 %#d i#ter#et use6 be 'roupedto'et+er i#to % #e, c%te'or( c%lled

e+%vior%l %#d Subst%#ce Addictio#s1 or%lter#%tivel( Impulsive)CompulsiveDisorders

•Possible subt(pes o$ OCD to be co#sidered

i#clude: tic)rel%ted1 c+ild+ood)o#set1s(mmetr( t(pe1 +o%rdi#' t(pe1 post)p%rtum1 poor i#si'+t1 impulsive t(pe1i#%tte#tive t(pe %#d PANDAS


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DS

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Re'%rdi#' subt(pes $or OCD1 stro#'estevide#ce ,%s $or %# e%rl()o#set t(pe1 $or,+ic+ PANDAS could be listed %s % speci0er5si#ce %ll PANDAS c%ses %re e%rl()o#set but

#ot %ll e%rl()o#set c%ses %re PANDAS6•DD1 +(poc+o#dri%sis1 %#d tic disorders))i#clusio# i#to %# OC spectrum 'roupi#'

•%lso proposed t+%t t+e re,%rd2impulse

co#trol rel%ted disorders 5e.'.1 p%t+olo'ic%l'%mbli#'1 tric+otillom%#i%6 #ot be i#cludedi# t+e OCD spectrum


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de0#itio# o$ obsessio# be revisitedsi#ce #ot ever(o#e ,it+ OCDe3perie#ces t+em %s i#trusive %s is#o, re&uired i# DSM-IV

•%'reei#' o# t+e import%#ce o$i#cre%si#' %,%re#ess o$ t+e comorbidit(bet,ee# sc+iop+re#i% %#d obsessive

compulsive disorder1 t+e 'roup ,%sdivided o# ,+et+er % speci0er $or sc+io)obsessive t(pe s+ould be %dded tosc+iop+re#i%


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S!AR"

OCD %#d OCSD•Simil%rities i# p+e#ome#olo'(

•%mil( members o$ OCD +%ve +i'+er r%te o$OCSD %#d vise vers%

•Si'#i0c%#t comorbidit( bet,ee# t+edisorders

•Simil%r tre%tme#t respo#se

•

Simil%rities i# #eurobiolo'(


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THANK "O!

Obsessive Compulsive Spectrum Disorders

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