Ocd

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Ocd

  1. 1. O BSESSIVE C OMPULSIVE D ISORDER (OCD) Dr. Aftab Asif MRCPsych, London Associate Professor of Psychiatry, Fatima Jinnah Medical College / Sir Ganga Ram Hospital, Lahore
  2. 2. Obsessions <ul><li>Recurrent, Persistent ideas, thoughts, </li></ul><ul><li>images, or impulses that are ego </li></ul><ul><li>dystonic i.e., they are not as </li></ul><ul><li>voluntarily produced. Attempts are </li></ul><ul><li>made to ignore or suppress them. </li></ul>
  3. 3. Compulsions <ul><li>Repetitive & seemingly purposeful </li></ul><ul><li>behavior actions that are performed </li></ul><ul><li>according to certain rule or is a </li></ul><ul><li>stereotyped fashion </li></ul>
  4. 4. <ul><li>The obsessions or compulsions are a </li></ul><ul><li>significant source of distress to the </li></ul><ul><li>individual. </li></ul>
  5. 5. OCD Cycle <ul><li>OBSESSIONS </li></ul>COMPULSIONS BELIEF ANXIETY
  6. 6. Rate of Diagnosis of OCD Years 1970 1975 1980 1985 1990 OCD %
  7. 7. E PIDEMIOLOGY
  8. 8. <ul><li>General Population = 2-3% </li></ul><ul><li>= </li></ul><ul><li>Mean Age of Onset = 20 yrs. </li></ul><ul><li>Adolescent = Adults. </li></ul><ul><li>Unmarried, divorced / separate = 60-70% </li></ul>Life Time Prevalence 50-75% pt. with OCD
  9. 9. C LINICAL F EATURES
  10. 10. <ul><li>Contamination 45 % </li></ul><ul><li>Pathological doubt 42 % </li></ul><ul><li>Somatic 36 % </li></ul><ul><li>Aggressiveness 28 % </li></ul><ul><li>Sexual 26 % </li></ul>Obsessions Affective Disorder
  11. 11. <ul><li>Checking 63 % </li></ul><ul><li>Washing 50 % </li></ul><ul><li>Counting 36 % </li></ul><ul><li>Symmetry & precision 28 % </li></ul>Compulsions Affective Disorder
  12. 12. <ul><li>Impulsions </li></ul><ul><li>Meticulousness or perfectionism </li></ul><ul><li>Pathologic atonement </li></ul><ul><li>Repetitive displacement behavior </li></ul><ul><li>Stereotypic behavior </li></ul><ul><li>Self-injurious behavior </li></ul><ul><li>Pathologic overinvolvement </li></ul><ul><li>Pathologic persistence </li></ul><ul><li>Hoarding </li></ul><ul><li>Complex tics </li></ul><ul><li>Anxous ruminations & </li></ul><ul><li>excessive worries </li></ul><ul><li>Pathologic guilt </li></ul><ul><li>Degressive ruminations </li></ul><ul><li>Fantasies </li></ul><ul><li>Paranoid fears </li></ul><ul><li>Flashbacks </li></ul><ul><li>Pathologic attraction </li></ul><ul><li>Rigid thinking </li></ul><ul><li>Pathologic indecision </li></ul><ul><li>Realistic fears or concerns </li></ul><ul><li>  </li></ul>Differential Symptomatology Cognitive Differentiations Behavioral Differentiations
  13. 13. E TIOLOGY
  14. 14. Neurobiological Psychological Environmental Causes of OCD in short Neurobiological Psychological Environmental
  15. 15. Neurobiological factors <ul><li>Neurotransmitter Levels </li></ul><ul><li>Serotonin </li></ul>C S F 5HIAA Platelet 5HT “ ocd.jpg” “ normal.jpg”
  16. 16. B . Brain Imaging Studies <ul><li>CT / MRI : Decrease size of caudate nuclei </li></ul><ul><li>PET: Increased activity in frontal lobe & basal </li></ul><ul><li>ganglia </li></ul>
  17. 17. C. Genetics <ul><li>35% in first degree relation. </li></ul>
  18. 18. Psychological factors <ul><li>Cognitive appraisal of intrusive thoughts. </li></ul><ul><li>Overestimation of danger. </li></ul><ul><li>Inflated personal responsibility. </li></ul><ul><li>Thought-action fusion. </li></ul><ul><li>Thought-suppression. </li></ul><ul><li>Cognitive deficits in selective attention.  </li></ul><ul><li>Deficits in inhibiting irrelevant stimulI (particularly internal ones such as intrusive thoughts). </li></ul>
  19. 19. Environmental factors <ul><li>Early childhood conflicts: </li></ul><ul><li>This is an early theory that suggests conflicts or problems during childhood are the roots of OCD. </li></ul><ul><li>This is specifically looking at either permissive or mainly unengaged parenting techniques. </li></ul>
  20. 20. <ul><li>Major life transitions such as moving schools have been reported to contribute to triggering OCD symptoms. </li></ul><ul><li>Stressful events, just as a traumatic event of losing a loved one, can trigger OCD. </li></ul>Major life transitions / Stressful events
  21. 21. Differential Diagnosis <ul><li>Tourette's disorder (TD) </li></ul><ul><li>Motor or vocal tics disorder </li></ul><ul><li>90% of TD OCD </li></ul><ul><li>5-7 % OCD TD </li></ul>
  22. 22. Cont…. <ul><li>Schizophrenia </li></ul><ul><li>Major Depression </li></ul><ul><li>Personality Disorder </li></ul><ul><li>Phobias </li></ul><ul><li>Dysmorphic Disorder </li></ul>
  23. 23. Other Illnesses Close to OCD <ul><li>Obsessive compulsive personality disorder </li></ul><ul><li>Generalized Anxiety disorder </li></ul><ul><li>Anorexia Nervosa </li></ul><ul><li>Hypochondriasis </li></ul><ul><li>Pathologic skinpicking </li></ul><ul><li>Trichotillomania </li></ul>
  24. 24. T REATMENT
  25. 25. Pharmacotherapy <ul><li>TCA/Clomipramine </li></ul><ul><li>SSRI </li></ul><ul><li>Adjunctive medications </li></ul><ul><li>Sertraline </li></ul><ul><li>Citalopram </li></ul><ul><li>Fluoxetine etc. </li></ul>
  26. 26. Psychotherapy
  27. 27. <ul><li>Thought stopping </li></ul><ul><li>Response prevention </li></ul><ul><li>Exposure etc. </li></ul><ul><li>Most effective for OCD. </li></ul>Supportive therapy is always helpful Cognitive Behavioral Therapy
  28. 28. Neurosurgery <ul><li>For chronic, uncontrollable,deteriorate </li></ul><ul><li>patient only. </li></ul><ul><li>Anterior cingulotomy </li></ul><ul><li>Limbic leucotomy </li></ul><ul><li>Anterior capsulotomy </li></ul><ul><li>Subcaudate tractotomy </li></ul><ul><li>Not used in Pakistan </li></ul>
  29. 29. THANK YOU

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