The document provides an overview of obsessive-compulsive disorder (OCD), including its definitions, epidemiology, comorbidity, etiology, diagnosis, and treatment options. It discusses key characteristics such as obsessions and compulsions, as well as statistical data on prevalence and associated disorders. Treatment options include pharmacotherapy, such as SSRIs and clomipramine, and behavioral therapies like exposure and response prevention, with an emphasis on the need for individualized approaches.

1. Obsessive-Compulsive Disorder
(OCD)
by-Gulilat Sisay
moderator : Dr. Solomon Dabi

2. Outlines
• Definitions
• Epidimiology
• Comorbidity
• Etiology
• Diagnosis
• Clinical features
• Differential diagnosis
• Course and prognosis
• Treatment

3. Definition
An obsession
• is a recurrent and intrusive thought, feeling, idea, or
sensation.
• In contrast to an obsession, which is a mental event,
a compulsion is a behavior.
A compulsion
• is a conscious, standardized, recurrent behavior,
such as counting, checking, or avoiding.

4. OCD cont…
• OCD is one of the more disabling and potentially
chronic anxiety disorders.
• A patient with OCD may have an obsession, a
compulsion, or both
• A patient with OCD realizes the irrationality of the
obsession and experiences both the obsession and
the compulsion as ego-dystonic (i.e., unwanted
behaviour

5. Epidemiology
• lifetime prevalence in the general population estimated
at 2 to 3 %.
• Among adults, men and women are equally likely to be
affected.
• Among adolescents, boys are more commonly affected
than girls
• The mean age of onset is about 20 years
• Single persons are more frequently affected with OCD
than are married persons
• OCD occurs less often among blacks than among whites

6. Comorbidity
• The lifetime prevalence for
major depressive disorder-- 67%
social phobia -- 25 %.
• Other common comorbid include alcohol use
disorders, GAD, specific phobia, panic disorder,
eating disorders, and personality disorders.
• Tourette's disorder in 5 to 7%
• 20 to 30% of patients with OCD have a history of tics.

7. Etiology
Biological Factors
Neurotransmitters
• Serotonergic System-Data show that
serotonergic drugs are more effective than
drugs that affect other neurotransmitter
systems, but whether serotonin is involved in
the cause of OCD is not clear
• Noradrenergic System-Currently, less evidence
exists for dysfunction in the noradrenergic
system in OCD

8. Cont....
• Neuroimmunology
• Some interest exists in a positive link between
streptococcal infection and OCD.
• GABHS infection can cause rheumatic fever,
and approximately 10 to 30 percent of the
patients develop Sydenham's chorea and
show obsessive-compulsive symptoms.

9. Cont....
Brain-Imaging Studies
•Neuroimaging in patients with OCD has
produced converging data implicating altered
function in the neurocircuitry between
orbitofrontal cortex, caudate, and thalamus
Genetics- OCD has a significant genetic
component

10. • Behavioral Factors-According to learning
theorists, obsessions are conditioned stimuli
• Psychosocial Factors
 Personality Factors-Only about 15 to 35 percent
of patients with OCD have had premorbid
obsessional traits.
Psychodynamic Factors- may be of great help in
understanding problems with treatment
compliance, interpersonal difficulties, and
personality problems accompanying the Axis I
disorder

11. DSM-IV-TR Diagnostic Criteria for Obsessive-
Compulsive Disorder

13. Major Symptom Patterns
• OCD has four major symptom patterns
• Contamination Washing
• Pathological doubt checking
• Intrusive thoughts
• Symmetry Slowness
• Other symptoms religious obsessions and
compulsive hoarding pattern

14. Differential Diagnosis
Medical Conditions
OCD-like disorders that are associated
with basal ganglia diseases, such as
Sydenham's chorea and Huntington's disease.
 Tourette's Disorder -Tourette's syndrome is
associated with a pattern of recurrent vocal
and motor tics that bears only a slight
resemblance to OCD

15. Other Psychiatric Conditions
obsessive-compulsive personality disorder
Psychosis-can be differentiated from OCD by
(1) patients with OCD can almost always
acknowledge the unreasonable nature of their
symptoms, and
(2) psychotic illnesses are typically
associated with a host of other features that are
not characteristic of OCD
Depression-best distinguished by their courses

16. Course and Prognosis
• More than half of patients have a sudden onset of
symptoms.
• The onset of symptoms for about 50 to 70% of
patients occurs after a stressful events.
• Some experience a fluctuating course, and others
experience a constant one.
• 20-30% will have significant improvement.
• 40 to 50% have moderate improvement.
• 20 to 40 % of patients either remain ill or their
symptoms worsen.

17. Poor prognostic indicators
• yielding to (rather than resisting) compulsions,
• childhood onset,
• bizarre compulsions,
• the need for hospitalization,
• a coexisting major depressive disorder,
• delusional beliefs,
• the presence of overvalued ideas (i.e., some
acceptance of obsessions and compulsions),
• the presence of a personality disorder (especially
schizotypal personality disorder).

18. A good prognosis is indicated by
•good social and occupational adjustment,
• the presence of a precipitating event, and
•an episodic nature of the symptoms

19. Treatment
• pharmacotherapy, behavior therapy, or a
combination of both is effective in significantly
reducing the symptoms of patients with OCD.
• The decision about which therapy to use is based on
the clinician's judgment and experience and the
patient's acceptance of the various modalities.

20. Pharmacotherapy
SSRIs
• first-line treatment
• Higher dose is used usually
• lead to improvement in 40 to 60 %
Clomipramine(TCAs)
• has been the first-line therapy for many years.
• associated with frequent anticholinergic side effects,
postural hypotension, somnolence, and weight gain.

21. • If treatment with clomipramine or an SSRI is
unsuccessful, many therapists augment the
first drug by the addition of valproate , lithium
, or carbamazepine
• venlafaxine, pindolol , and the monoamine
oxidase inhibitors (MAOIs), especially
phenelzine can also be tried

22. Behavior Therapy
• Longer lasting
• The principal behavioral approaches in OCD are
exposure and response prevention.
Psychotherapy
• insight-oriented psychotherapy
For extreme cases that are treatment resistant
and chronically debilitating, electroconvulsive
therapy (ECT) and psychosurgery are
considerations

23. References

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