Transcript Obsessive Complusive Disorder

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
Affects over 3.3 Million Americans.
Obsession:
Contamination of fears of germs or dirt
Compulsion:
Repeatedly washing
Obsession:
Needing to have things “just so”
Compulsion:
Hoarding or saving things
Obsessions
Unwanted thoughts, images, or impulses that
occur over and over
Are accompanied by uncomfortable feelings
such as fear, doubt, or disgust.
Compulsions
Repetitive behaviors
In response to the Compulsions
Most common is washing and checking
things.
OCD is often confused with these other disorders:
Major Depressive Disorder
Panic Disorder
Social Phobias
ADHD
Onset
Can occur any time from preschool age
through adulthood
Typically by 40’s
Equally common in both male and female
Diagnosis Criteria according to DSM-IV
Compulsion or Obsessions (Typically both are
present)
The Compulsion or Obsessions cause marked distress
Typically no physical symptoms
Scales are available, but they take lots of time
Get a History
Communication between patient and medical
practitioner is key
Typical Course of OCD
 Long process
 On 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.
Assessment
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Visits
The Anxiety Disorder Interview ScheduleRevised (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 OCD
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No concrete causes
Parents role and non-role
Organic reasons
Head injuries
 Brain Chemistry
 Basal Ganglia
 Encephalitis
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Differential Diagnosis
Depressive Disorder vs. OCD
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Preoccupation with depressive thoughts
“I have no friends”
Realistic vs. absurd
Generalized Anxiety Disorder vs. OCD
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Excessive worrying and thinking
Again realistic vs. absurd
Patient with OCD may have extremely
intense/irrational thoughts
The presence of compulsive rituals
Hypochondrias vs. OCD
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Closely related
Unrealistic preoccupation of medical concerns
Presence of “checking rituals” to decrease
anxiety
Other illnesses and neurological
disorders vs. OCD
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Anorexia and Dysmorphic disorder
Occur in the context of another psychiatric
disorder
Tourette’s syndrome-increased rate of OCD
Trichotillomania
Compulsive behavior of pathological gamblers
and substance abusers
Main Ideas of Differential Diagnosis
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The presence of obsessive compulsive rituals
The manner of the compulsive thoughts
For example: unrealistic vs. realistic
appropriate vs. inappropriate
Treatment
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Two types
A. Pharmacotherapy
 B. Behavioral Therapy
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Use of medications
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Controlling the symptoms of OCD
Lessening the intensity and frequency of the
obsessions and compulsions
Examples of SSRI’s
Prozac
 Luvox
 Paxil
 Zoloft
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Medications Continued
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Improvement usually takes 3 weeks
Symptoms are reduced but not eliminated
Anafranil– 1st SRI used
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Side effects of SSRI’s
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Side effects: Sedation, blurry vision, weight gain,
and sexual dysfunction
Side effects: Insomnia, motor restlessness, nausea,
and diarrhea
Long-Term treatment needed
Behavioral Therapy
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“Exposure” and “Response Prevention”
Not able to eliminate their anxiety
Extremely uncomfortable for OCD patient
80-90% improvement
Symptoms are reduced but not eliminated
Follow-up sessions needed for relapse
prevention
Use of both therapies
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Severe case of OCD
Mild case of OCD
Use of SSRI’s and behavior therapy prove to
have a 70% success rate
Therapy determined by patient
Willingness to take a medication
 Willingness to work with a psychologist
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Environmental Factors
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Positive and motivated patient
Fully trained therapist during behavior therapy
OCD Groups
Family provides encouragement and constant
reassurance
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Showing frustration with the patient may impact the
compulsive behavior
New Research
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A new cognitive-behavioral therapy
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Emphasizes changing the OCD sufferer’s 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 Process
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Subjects 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 OCD
Of the 7 subjects, 5 respondents through
advertisement, 2 were referred
Initial Screening
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Psychiatric evaluation
Yale-Brown Obsessive Compulsive Scale (YBOCS)
Data on Demographic and Clinical features
Family History of any psychiatric disorder in
first-degree relatives
Obsessions in 7 Women with
Postpartum-Onset OCD
Symptom
Obsessions
Aggressive
Contamination
Religious
Pathological doubt
Sexual
Symmetry
Other
Number
7
5
3
2
1
1
1
%
100
71
43
29
14
14
14
Compulsions in 7 Women with
Postpartum-Onset OCD
Symptom
Compulsions
Checking
Cleaning
Ordering
Counting
Superstitious behaviors
Number
4
1
1
1
1
%
57
14
14
14
14
Psychiatric Disorders in First Degree Relatives of 7 subjects.
Relatives Affected (N = 18) Total of 60
N
Disorder
Mood disorders
Bipolar disorder
Major depression
Psychotic disorders
Psychoactive substance use disorders
Alcohol
Other
Anxiety disorders
%
4
9
0
22
50
0
5
2
0
28
11
0
Subject 1 Current/Past DSM IV
Diagnosis
Age 28
Current Diagnoses:
Bipolar disorder I
Panic disorder
OCD
GAD
Age
12
13
19
13
Past Diagnoses:
PTSD
Anorexia nervosa
Age
26
14
Subject 2 Current/Past DSM IV
Diagnosis
Age 31
Current Diagnoses:
Recurrent MDD
OCD
GAD
Age
17
29
10
Past Diagnoses:
Alcohol abuse
Social Phobia
Age
28
10
Subject 3 Current/Past DSM IV
Diagnosis
Age 41
Current Diagnoses:
Recurrent MDD
OCD
Age
39
41
Past Diagnoses:
Binge eating disorder
Age
?
Subject 4 Current/Past DSM IV
Diagnosis
Age 42
Current Diagnoses:
Recurrent MDD
partial remission
OCD
Binge eating disorder
Age
39
31
17
Past Diagnoses:
Age
Cannabis dependence 19
Subject 5 Current/Past DSM IV
Diagnosis
Age 26
Current Diagnoses:
Recurrent MDD
OCD
PTSD
Age
15
26
15
Past Diagnoses:
Alcohol abuse
Age
23
Subject 6 Current/Past DSM IV
Diagnosis
Age 28
Current Diagnoses:
Panic Disorder
OCD
Age
25
25
Past Diagnoses:
MDD
Age
25
Subject 7 Current/Past DSM IV
Diagnosis
Age 26
Current Diagnoses:
Bipolar disorder II
depressed
OCD
Age
26
26
Past Diagnoses:
None
Age
Of the 7 subjects 4 did not enter the
fluvoxamine trial.
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3 were excluded because they wish to continue
breast feeding
1 was excluded because of the diagnosis of
bipolar I
The Test
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Subjects received fluvoxamine 50 mg/day
The dose was increased on a flexible schedule as
tolerated with a maximum dose of 300 mg/day
Subjects 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 Success
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Primary successful outcome measure was the YBOCS was defined as greater than or equal 30%
decrease its total score
Corresponding with clinical improvement in
symptoms
Secondary outcome measures were changes in
the Hamilton Rating Scale for Depression
(HAM-D) and anxiety (HAM-A)
Subject 2
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Completed 12 weeks
Final dose was 300 mg/day
Side effects headache,
heartburn, dry mouth and
insomnia
Had a past history of no
response to 3 trials of
serotonin reuptake inhibitors
No improvement with
fluvoxmine
YBCOS
total
30
25
YBOCS
obsessio
n
YBOCS
compulsi
on
HAM-D
20
15
10
5
HAM-A
0
Base
Final
Subject 4
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Completed 12 weeks
Final dose was 200
mg/day
Reported side effects:
headache, dry mouth,
heart palpitations and
anorgasmia
Positive response to drug
YBCOS
total
20
18
16
YBOCS
obsessio
n
YBOCS
compulsi
on
HAM-D
14
12
10
8
6
4
2
HAM-A
0
Base
Final
Subject 5
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Completed 3 weeks due
to car accident
(unrelated)
Final dose was 150
mg/day
Reported side effects:
anorgasmia
Positive response to drug
25
YBCOS
total
20
YBOCS
obsessio
n
YBOCS
compulsi
on
HAM-D
15
10
5
HAM-A
0
Base
Final
Case Study Conclusion
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2 of the 3 subjects improved with treatment
This subject that did not improve had a history
of poor response to multiple treatment
This trial was limited by its uncontrolled nature
and the small number of subjects
Larger controlled study is needed responsiveness
of postpartum-onset OCD to serotonin
reuptake inhibitors
Obsessive
Compulsive
Disorder