-OCD- NOTES

Definition - Unwanted thoughts, impulses, or images that cause

anxiety.
No only worries about every life, personal attempts to ignore,
suppress, or neutralize. Usually from one's own mind. Neutralization -
central part, drives obsession, divided between psychosis and
neurosis.
Majority don't distinguish reality from internal thoughts of the mind.
I.e. delusions. Few know what the obsession comes from.
Common obsessions: contamination, fear of harming, doubting,
symmetry, somatic, sexual, hosting unacceptable urges, religious.
Pathological doubts - things related to somatic - i.e. body.
Useless to something thrown away
Sin - against neurology
Very wide range of obsessions.
Blurry line between psychosis and neurosis.
OCD - repetitive, specific function, prevent stress or bad things.
person does not have an observable symptom - i.e. counting,
praying, compensation. can be mental or physical.
Compulsions - checking, cleaning, repeat actions, ordering, mental
compulsions, collecting, touching, reassurance seeking, wanting
things evenly.
Reassurance, prominent in children, also adults e.g. contamination.
we must understand the function.
OCD is the 4th most common disorder, phobia, depression, alcohol
are top.
OCD - roughly as prevalent as diabetes
SOCIAL IMPACT - lowered self esteem, problems with relationships,
difficulty maintaining relationships, lowered standers for academic
achievement, lower career expectations - 13% of OCD have
attempted suicide. - ONLY B/C OF OCD ALONE.
OCD is among top 10 causes of years lived with a disability -
depressions is highest.
Many are in the psychological and psychiatric disorders seems to
differ by gender.
Boys - 13-15, girls develop 20-24
Treatment delayed, avg 17 years.
it is common, chronic, poorly understood and diagnosed patients try
to hide symptoms, thus not being diagnosed or treated failure to
screen for OCD. Difficulties in diagnosis
Healthcare barriers co morbidity
COMORBIDITY - rule rather than exception. co morbid condition
becomes more prevalent, although it is the minority.
YALE - brown OCD scale, Y-BOCS
Evaluation - time, interference with function, distress, resistance,
control.
Attempts to resist degree of control, probability they could resist. That
is the scale.
DIFFERENTIAL DIAGNOSIS! - Delusions, depressive nominations,
other anxiety disorders, OCD; the personality disorder, stereotypes,
impulse control disorders.
THERE IS MUCH CONFUSION - primary - recurrent, unwanted,
mental activity and recurrence, mal-adaptive behavior - only 2
symptoms, primarily very broad, obsessive thought.
OCPD is not like OCD
OCPD favors rules and regulations
STERIOTYPES - autistic, must look at functions with obsession
obsessive eating - does not meet criteria for OCD. not being done by
illicit _____, not for reassurance not to prevent obsess ional distress
COMPULSIONS -eating, drinking, gambling, - - for feeling goal, not
for keeping from bad.
fears are maintained through avoidance
AVOIDANCE - passive avoidance - staying away from specific
threads. i.e. touching something dirty,
ACTIVE AVOIDANCE- trying to was off whatever is on a hand
compulsions prevent habituation - e.g. cant get used to something.
failure to habituate prevents the realism thread appraisal valve. i.e
touching door knob can't correct the mistake. He cant get aids from a
door knob. - i.e. compulsions drive the obsessions
COGNITIVE FACTORS -
exaggerated sense of responsibility
importance of thoughts need to control thoughts, threat over-
estimation, intolerance of uncertainty, perfectionism, infallible, actually
horrible, can't deal with ambiguity.
OCD is a neuropsychiatric disorder.
deficits in behavioral inhibition
deficits in cognitive inhibition
-growing belief that OCD is in the front or stratus thermo frontal
cortex.
great degree of empirical support.

THOUGHT SUPRESSION leads to increased thought frequency -

OCD thinks about repressed thoughts more than frequently. normal
people can think about differences.

OCD-ers when they try not to think of something, they think about it
more.
TREATMENT - clomipramine is superior to placebo., selective SRIs
are superior to placebo.
eg fluvoxamine, sertaline, paroxetine. high doses of sri meds 20-
250mg of various SRIs
OCD does not have a large placebo response. medication is helpful,
but does not reduce significantly, still can apply for more medicine.
clamipromine may pack a better punch.
HEVAVIORAL TREATMENT -
If someone is afraid, gradual form of exposure. can't overcome
without confrontation. most prevent avoidant behaviors. however,
anxiety increases and forms habituation over correction ensures
coping with situations.
most practice at high levels - our correction. Must tolerate something
worse than natural situations.
Exposure and ritual precautions for ocd
exposure in real life - prolonged confrontation with anxiety invoking
stimuli. eg contact with contaminates.
IMAGINAL EXPOSURE - prolonged imagined exposure and
confrontation with feared disasters. e.g. becoming ill with the
contamination.
Ritual prevention - blocking of compulsions. e.g. leaving the bathroom
without washing hands.
THESE THINGS ARE TOLERABLE!
people will generally listen to suggestions which may help them.
more response to behavioral therapy, but not always. this is average.
if you allow leeway, abstinence is the optimal result.
experience things with the patient.
SRI medications work sometimes quickly, for people who have never
had treatment.
is OCD really caused by the brain?
educate the patient, develop hierarchy, some situations alone,
monitor rituals, objective view, e.g. spouse, friend, relative, family,
friend, boss, etc. much encouragement, discussion of risk. recognize
risk, the imminent risk.
SUMMARY -
OCD is common, chronic, and disabling. - Major threat to public
health.
OCD is biological, behavioral, and a cognitive disorder.
SRI medications can be effective/are effective.
CBT is effective and may be an optimal first line treatment - some
evidence of first line treatment, also where SRI fails.