Barangay Council for the Protection of Children (BCPC) Orientation.pptx
Ocd
1. Jen's mother called you in the
clinic telling you that her 18 years
old son is mentally ill.
she ask for your opinion regarding
his odd behavior and thoughts ,
she add that jens stop going to
school because of his illness.
3. Obsessive-Compulsive Disorder
Criteria:
• obsessive-compulsive disorder is described
as recurring obsessions or•Subjective (from inside)
compulsions
severe enough to be time consuming or It is
•Silly (pt. recog. That
untrue)
cause marked distress or significant
impairment •Unpleasant,
• An obsession is a recurrent and to resist
•Desire intrusive
thought, feeling, idea, or sensation
• A compulsion is a conscious, standardized,
recurring pattern of behavior, such as
counting, checking, or avoiding.
4. Some thing in the mind can be:
• Some thing in the mind which is
•Idea (thoughts)
repetitive & keeps coming, usu.
•Image (e.g. someone naked,
Unpleasant & distressing,Pt. try hard to
not halluc. )
resist them but theyImpulse (urge) to do some
• keeps coming.
thing.
5. EPIDEMIOLOGY
• The lifetime prevalence estimated at 2 to
3 %.
• 10 % of outpatients in psychiatric clinics.
• Among adults, men and women are
equally likely to be affected, but among
adolescents, boys are more commonly
affected than are girls.
• Age of onset : 2/3 below age of 25 yrs.
6. common co morbid psychiatric
diagnoses:
• major depressive disorder about 67 %,
• social phobia about 25 %,
• alcohol use disorders,
• specific phobia,
• panic disorder,
• eating disorders
9. Diagnostic Criteria for
Obsessive-Compulsive Disorder
A. Either obsessions or compulsions:
• Obsessions as defined by (1), (2), (3), and (4) :
1. recurrent and persistent thoughts, impulses, or images that are
experienced, at some time during the disturbance, as intrusive and
inappropriate and that cause marked anxiety or distress.
2. the thoughts, impulses, or images are not simply excessive worries
about real-life problems.
3. the person attempts to ignore or suppress such thoughts, impulses, or
images, or to neutralize them with some other thought or action.
4. the person recognizes that the obsessional thoughts, impulses, or
images are a product of his or her own mind (not imposed from without
as in thought insertion(.
• Compulsions as defined by (1) and (2( :
1. repetitive behaviors (eg, handwashing, ordering, checking) or mental
acts (eg, praying, counting, repeating words silently) that the person feels
driven to perform in response to an obsession, or according to rules that
must be applied rigidly.
2. the behaviors or mental acts are aimed at preventing or reducing
distress or preventing some dreaded event or situation; however, these
behaviors or mental acts either are not connected in a realistic way with
what they are designed to neutralize or prevent, or are clearly excessive.
10. • B. At some point during the course of the
disorder, the person has recognized that the
obsessions or compulsions are excessive or
unreasonable. Note: this does not apply to
children.
• C. The obsessions or compulsions cause
marked distress; are time-consuming (take
more than an hour a day); or significantly
interfere with the person's normal routine,
occupational (or academic) functioning, or
usual social activities or relationships.
11. • D. If another Axis I disorder is present, the content of
the obsessions or compulsions is not restricted to it
(eg, preoccupation with food in the presence of an
eating disorder; hair pulling in the presence of
trichotillomania; concern with appearance in the
presence of body dysmorphic disorder; preoccupation
with drugs in the presence of a substance use
disorder; preoccupation with having a serious illness in
the presence of hypochondriasis; preoccupation with
sexual urges or fantasies in the presence of a
paraphilia; or guilty ruminations in the presence of
major depressive disorder).
• E. The disturbance is not due to the direct effects of a
substance (eg, a drug of abuse, a medication) or a
general medical condition.
12. CLINICAL FEATURES
• many people manage to keep their
symptoms secret
• Patients with obsessive-compulsive
disorder often go to physicians other
than psychiatrists (e.g. pt. visit derma
clinic for complication of exx cleaning).
13. • Precipitance: about 50 to 70 percent of
patients occurs after a stressful event
( puperty, menstruation, marriage,
examination, death of close relative)
• Course: (episodic or chronic)
• Usu. Compulsions is 2ry to obsessions.
14. • The most common pattern is an
obsession of contamination, followed by
washing or accompanied by compulsive
avoidance of the presumably
contaminated object.
• The second most common pattern is an
obsession of doubt, followed by a
compulsion of checking.
15. • the third is intrusive obsessional
thoughts without a compulsion.
• The fourth is the need for symmetry or
precision, which can lead to a
compulsion of slowness.
16. Obsessions
(N = 200)
• Contamination 45%
• Pathological doubt 42%
• Need for symmetry 31%
• Aggressive 28%
• Sexual 26%
• Other 13%
• Multiple obsessions 60%
17. Compulsions
(N = 200)
• Checking 63%
• Washing 50%
• Counting 36%
• Need to ask or confess 31%
• Symmetry and precision 28%
• Hoarding 18%
• Multiple comparisons 48%
18. prognosis
• About 20 to 30 percent of patients have
significant improvement in their
symptoms,
• 40 to 50 percent have moderate
improvement,
• The remaining 20 to 40 percent of
patients either remain ill or have a
worsening of their symptoms.
19. DIFFERENTIAL DIAGNOSIS
• Nl. Preoccupation : e.g. one preoccupied
about exams.
• Depression
• SCZ (e.g.: delusion, well be accepted by the
pt. with out resistence).
• Tic Dx. : (involuntary movement )here there is
no resistance to it,
• Obsessional personality: here the one is not
distressed by his acts & will not try to resist
them.
20. Treatment
• Psychotherapy :
– Supportive : let the pt. talk about his problem, reassure,
explain & advice .
– CBT
– Behavioral therapy: exposure & response prevention.
• Pharmacotherapy:
– Minor tranquilizer (anxioletics)
– Antidepressants :
• TCA ( clomepramine)
• SSRI ( paroxetin)
• ECT ( for depression )
• Psychosurgery: cingulotomy ( disconnect fronto-
thalamic connection to decrease distress & anxiety
with obsessions )
23. Case:
• Jens is German and 18 years old. He
stopped going to high school because of
his illness.
24. Problem
• When he was almost 15 years old, Jen's
parents noticed that after his newspaper
and magazine delivery rounds, Jens
would wash his hands more and more
often and for a longer and longer time.
Eventually he ended up spending more
than an hour under the shower. When
asked about it, Jens told his parents that
he felt as if he were being contaminated
by a popular women's magazine.
25. • He also feared that through contact with
boys from less academic schools, he
might become like them—"common,
slimy, impulsive, aggressive, and
stupid." Because he was afraid that he
might be touched by such schoolboys in
the bus, he insisted that his mother take
him to school every day by car.
26. • Jens soon came to regard the walls,
furniture, and other objects in his
parents' home as contaminated by their
less educated visitors. Only his own
room, where no one else was allowed,
seemed uninfected. He soon came to
regard entire streets, buildings, shops,
and playgrounds as contaminated, and
he often went out of his way to avoid
passing these places.
27. • He gave up his beloved tennis and also
stopped playing on the football team. He
spent almost all of his spare time in his room
with the blinds down, sitting for hours in his
chair doing nothing. He even refused to put
on his washed and ironed clothing unless his
mother had washed and ironed it under his
supervision. In the end he could no longer
read newspapers and magazines and could
no longer touch his school books. He soon
became a complete failure at school because
he could no longer follow the lessons and no
longer did any school work.
28. • Worst of all were his evening rituals in
the shower, where he spent hours using
several bottles of shower gel. He would
clean his fingernails until they bled, and
his skin became chapped and sore.
When his parents tried to prevent him
from showering excessively, he became
aggressive.
29. • To their desperate attempts to make him
realize that his fear of contamination and
his endless washing were devoid of any
realistic foundation, he constantly
responded, "I know it's nonsense, but I
just have to do it; I can't help it." He was
often quite desperate and unhappy
about his situation and kept crying about
it.
30. History.
• Jens grew up as the second of four children. The
father was an architect, and the mother worked as a
librarian. His birth and childhood were quite normal.
From infancy Jens was always very well behaved,
orderly, and helpful. At school he was ambitious, and
his grades were above average. He always kept his
room clean and tidy and did not want playmates to
come and make it untidy. At about the age of 13 he
grew a lot in height, and at the age of 14 he was
already more than 1.8 m tall, with the physical
appearance of a young man. Before his illness he was
very keen on sports, especially tennis, football, and
cycling.
31. • His 49-year-old father came from a family of
professional soldiers, with a very strict and
efficiency-oriented upbringing, and his 50-
year-old mother came from a similar family
and had always made very high demands on
herself. A cousin of the father was reported to
suffer from a severe compulsion neurosis, but
otherwise there was no information about
psychiatric disorders in the family.
32. Findings
• On referral Jens appeared shy and
reticent, with apparent difficulties in
talking about himself and particularly
about his emotions. He was aware that
his obsessions and compulsions were
his own ideas or impulses and that they
were nonsensical. Initially he had tried to
resist them, but eventually he realized
that he simply could not do it.
33. • In the beginning giving in to the impulses
relieved his tensions, but later on it
became a torture. There was no
evidence of hallucinatory experiences or
delusional ideas. His speech was
normal, and no catatonic features were
observed. Throughout the interview he
appeared mildly depressed. No cognitive
deficiencies were detected, and he was
fully oriented in all respects.
34. DISCUSSION
• Jens meets the criteria for an obsessive-compulsive
disorder with mixed obsessional thoughts and acts.
For several years he experienced obsessions of
contamination and compulsions of washing that were
repetitive and unpleasant, causing severe distress and
interference with social and individual functioning. He
acknowledged that the obsessions and compulsions
originated from his own mind and that they were
unreasonable. He had initially tried to resist his
compulsions, but eventually he had to give in to them.
There is no evidence of primary schizophrenic or
affective disorders.
35. • A few depressive symptoms are
mentioned, but not enough to meet the
criteria of a depressive episode, and
such symptoms obviously appear
secondary to his obsessive-compulsive
disorder. Exaggerated personality traits
of an anancastic nature are described,
but they are not sufficient to meet the
criteria for a personality disorder, which
his young age will also hardly allow.
