Obsessive compulsive disorder: Causes, Pathophysiology, Clinical Manifestations, DSM-5 criteria, History, Examination, Rating Scales, Differential Diagnoses, Treatment

1. OBSESSIVE -
COMPULSIVE
DISORDER
BY ANNAM ZAHID

2. WHAT IS OCD?
● Anxiety disorder
● Obsession: thoughts which are repetitive,
intrusive and senseless
● Compulsion: act which controls the
thought, time consuming

3. EPIDEMIOLOGY
● 9-11 years for boys
● 11-13 years for girls

4. ● The lifetime prevalence of OCD is
significantly higher in familial cases
● The glutamate transporter SLCA1 on
chromosome 9 is implicated as a gene
for pediatric OCD
Etiology: Biological
Genetics

5. Etiology: Biological
Possible autoimmune subtype
● Infections with group A beta-hemolytic
streptococcus (GABHS) is believed to result in
basal ganglia inflammation
● Immune-related dysregulation

6. Etiology: Biological
Serotonin Hypothesis
● Several studies have shown that clomipramine and
several other selective serotonin reuptake inhibitors
(SSRIs) are effective antiobsessional agents
● Basal hyperactivity of the 5-HT neurotransmission system

7. Etiology: Biological
The Dopamine Hypothesis
● Gilles De La Tourette Syndrome (GTS)
associated OCD
● Well-documented clinical response to
haloperidol and other dopamine antagonists

8. Etiology: Biological
Neuroimaging
StructuralFUNCTIONAL

9. Etiology: Environmental
● Psychological stress
● Reinforcement
● Perinatal events

11. Clinical Manifestations
Obsessions
- Contamination
- Pathological
doubt
- Sexual or violent
intrusive
thoughts
- Fear of causing
harm
- Symmetry
Compulsions
- Checking
- Washing
- Counting
- Hoarding
- Arranging
things

13. Management: History taking
DSM-5 Criteria
Intrusive thoughts cause
marked anxiety or distress
Neutralization of obsessions
attempted
Time
consuming

14. Management: History taking
Review of Systems Mood disorders
Substance abuse
Psychosis
Any major
illness

15. Management: History taking
Past Psychiatric History
- Similar/Dissimilar episode
- Acute/Chronic
- Persistently chronic/Remitting and relapsing
- Medications

16. Management: History taking
● Past Medical History
- Streptococcal
infections
- Rheumatic fever
- Sydenham’s
chorea
● Family History
- OCD
- Tourette disorder
- Tics
- ADHD

17. Management: Examination
● General Physical Examination
● Neurological Examination
- Assess for injuries in brain regions implicated in
OCD

18. Management: Rating scales
● CY-BOCS
● OCD Subscales of the child behaviour
checklist

19. Management: Differential Diagnosis
CHILDREN ADULTS
- NORMAL
DEVELOPMENT
- EARLY ONSET
PSYCHOSIS
- AUTISM
SPECTRUM
DISORDERS
- TIC DISORDER
- OTHERS
- ANXIETY
DISORDERS
- HOARDING
DISORDERS
- MAJOR
DEPRESSIVE
DISORDER
- TIC
DISORDERS
- PSYCHOTIC
DISORDERS

20. Treatment
COGNITIVE
BEHAVIORAL
THERAPY
CONSIDERATIONS:
- Cognition
- Insight
- OCD Subtypes
- Comorbidity
- Patient Preference
- Availability
Mechanisms of CBT
- Correct
dysfunctional beliefs
- Avoid Ritualistic
Behaviours
- Exposure to feared
stimuli

21. Treatment
COGNITIVE
BEHAVIORAL
THERAPY
PSYCHO
EDUCAT
ION
COGNITIVE
TRAINING
MAPPING OCD
ERP
RELAPSE
PREVENTION
TRAINING

22. Treatment
PHARMACOTHERAPY SSRI’S
● Fluoxetine
● Fluvoxamine
● Sertraline
● Paroxetine (adolescents)

23. Treatment
PHARMACOTHERAPY
Clomipramine

24. PHARMACOTHERAPY
ATYPICAL
ANTIPSYCHOTICS
RISPERIDONE
LITHIUM
BUSPIRONE

25. THANKYOU!