Ocd pathophysiology & updated treatment

1. OBSESSIVE-COMPULSIVE
DISORDER
DR. T. K.

2. CELEBRITIES WITH
OCD

3. TO KNOW WHAT IS OCD.
HOW TO DIAGNOSE OCD
TO BE ABLE TO DEAL WITH
PATIENT HAS OCD

4. CONTENT
• DEFINITION
• EPIDEMIOLOGY
• CLINICAL MANIFESTATIONS
• DSM 5
• DEFERENTIAL DIAGNOSIS
• MANAGEMENT
• SUMMARY & RECOMMENDATION

5. OBSESSIVE-COMPULSIVE
DISORDER (OCD)
• CHARACTERIZED BY RECURRENT INTRUSIVE THOUGHTS,
IMAGES, OR URGES (OBSESSIONS) THAT TYPICALLY CAUSE
ANXIETY OR DISTRESS, AND BY REPETITIVE MENTAL OR
BEHAVIORAL ACTS (COMPULSIONS) THAT THE INDIVIDUAL
FEELS DRIVEN TO PERFORM, EITHER IN RESPONSE TO AN
OBSESSION OR ACCORDING TO RULES THAT HE OR SHE
BELIEVES MUST BE APPLIED RIGIDLY.

6. EPIDEMIOLOGY OF OCD
● THE 12-MONTH PREVALENCE (OCD) AMONG ADULTS
IN THE UNITED STATES 1.2 PERCENT & AN ESTIMATED
LIFETIME PREVALENCE OF 2.3 PERCENT.
• OCD TYPICALLY STARTS IN CHILDHOOD OR
ADOLESCENCE, PERSISTS THROUGHOUT A
PERSON’S LIFE, AND PRODUCES SUBSTANTIAL
IMPAIRMENT IN FUNCTIONING.
• FEMALE VS MALE

7. • COMORBIDITIES AT RATES HIGHER THAN IN THE GENERAL
POPULATION, INCLUDING MAJOR DEPRESSIVE DISORDER
AND OTHER ANXIETY DISORDERS.
• GENETIC AND ENVIRONMENTAL FACTORS CONTRIBUTE TO
THE ETIOLOGY OF OCD.
• CORTICO-STRIATO-THALAMO-CORTICAL (CSTC) CIRCUITS
IN THE PATHOPHYSIOLOGY OF THE DISORDER.

8. CLINICAL MANIFESTATIONS
• THE MAJORITY OF PATIENTS EXPERIENCED BOTH
OBSESSIONS AND COMPULSIONS, RATHER THAN ONE OR
THE OTHER.

9. OBSESSIONS
• 1. RECURRENT AND PERSISTENT THOUGHTS, URGES, OR
IMAGES THAT ARE EXPERIENCED, AT SOME TIME DURING
THE DISTURBANCE, AS INTRUSIVE AND UNWANTED, AND
THAT IN MOST INDIVIDUALS CAUSE MARKED ANXIETY OR
DISTRESS.
• 2. THE INDIVIDUAL ATTEMPTS TO IGNORE OR SUPPRESS
SUCH THOUGHTS, URGES, OR IMAGES, OR TO NEUTRALIZE
THEM WITH SOME OTHER THOUGHT OR ACTION (IE, BY
PERFORMING A COMPULSION).

10. COMMON OBSESSIONS IN OCD
Obsession % of Sample(N-200)
contamination 45
Pathological doubt 42
somatic 36
symmetry 31
aggressive 28
sexual 26
others 13
Multiple obsessions 60

11. COMPULSIONS
• 1. REPETITIVE BEHAVIORS (EG, HAND WASHING, ORDERING,
CHECKING) OR MENTAL ACTS (EG, PRAYING, COUNTING,
REPEATING WORDS SILENTLY) THAT THE INDIVIDUAL 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 ANXIETY OR 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.

12. COMMON COMPULSIONS IN OCD
Compulsion % of Sample (N = 200)
Checking 63
Washing and cleaning 50
Counting 36
Need to ask and confess 31
Symmetry and precision 28
Hoarding 18
Multiple compulsions 48

13. LINKING OBSESSIONS AND
COMPULSIONS

14. DSM-5 DIAGNOSTIC CRITERIA
• A. PRESENCE OF OBSESSIONS, COMPULSIONS, OR BOTH.
• B. THE OBSESSIONS OR COMPULSIONS ARE TIME-
CONSUMING OR CAUSE CLINICALLY SIGNIFICANT DISTRESS
OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER
IMPORTANT AREAS OF FUNCTIONING.

15. DSM-5 DIAGNOSTIC CRITERIA
• C. THE OBSESSIVE-COMPULSIVE SYMPTOMS ARE NOT
ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A
SUBSTANCE (EG, A DRUG OF ABUSE, A MEDICATION) OR
ANOTHER MEDICAL CONDITION.
• D. THE DISTURBANCE IS NOT BETTER EXPLAINED BY THE
SYMPTOMS OF ANOTHER MENTAL DISORDER.

16. • SPECIFIERS FOR OCD IN DSM-5 — SPECIFIERS FOR THE
DISORDER INCLUDE ASSESSMENTS OF THE PATIENT’S
INSIGHT AND PRESENCE/HISTORY OF A TIC DISORDER.

19. DIFFERENTIAL DIAGNOSIS
• ANXIETY DISORDER DUE
TO A GENERAL MEDICAL
CONDITION
• SUBSTANCE INDUCED
ANXIETY DISORDER
• BODY DYSMORPHIC
DISORDER
• SPECIFIC OR SOCIAL
PHOBIAS
(TRICHOTILLOMANIA)
• MAJOR DEPRESSIVE
EPISODE
• GENERALIZED ANXIETY
DISORDER
• HYPOCHONDRIASIS
• SPECIFIC PHOBIA
• DELUSIONAL DISORDER
• PSYCHOTIC DISORDER
NOT OTHERWISE
SPECIFIED

20. TREATMENT
• PHARMACOTHERAPY
• COGNITIVE-BEHAVIORAL THERAPY
• PSYCHOSURGERY
• DEEP BRAIN STIMULATION

21. PHARMACOTHERAPY
• SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)
ANTIDEPRESSANTS: FLUOXETINE, FLUVOXAMINE, SERTRALI
NE, PAROXETINE
• CLOMIPRAMINE: A TRICYCLIC ANTIDEPRESSANT THAT
INHIBITS THE REUPTAKE OF SEROTONIN AND
NOREPINEPHRINE.
• VENLAFAXINE: A SEROTONIN NOREPINEPHRINE REUPTAKE
INHIBITOR (SNRI) ANTIDEPRESSANT

22. SUMMARY AND
RECOMMENDATIONS
• WE RECOMMEND THAT PATIENTS WITH (OCD) BE TREATED
WITH (CBT), (SSRI) MEDICATION, OR BOTH (GRADE 1A).
• FOR MOST PATIENTS WITH OCD, WE SUGGEST FIRST-LINE
TREATMENT WITH EXPOSURE AND RESPONSE PREVENTION
(A TYPE OF CBT) RATHER THAN TREATMENT WITH AN SSRI
MEDICATION (GRADE 2B).

23. • FOR PATIENTS WITH OCD AND A SEVERE, CO-OCCURRING
DISORDER THAT IS TYPICALLY RESPONSIVE TO SSRI
TREATMENT, WE SUGGEST INITIAL TREATMENT OF BOTH
DISORDERS WITH AN SSRI (GRADE 2C).
• DOSES OF CITALOPRAM ABOVE 40 MG/DAY ARE NO
LONGER RECOMMENDED BY THE FDA DUE TO THE RISK OF
QTC INTERVAL PROLONGATION.

24. • IF AN ADEQUATE TRIAL OF THE SSRI RESULTS IN NO
RESPONSE, WE SUGGEST TREATMENT WITH A DIFFERENT
SSRI, CLOMIPRAMINE, OR VENLAFAXINE (GRADE 2C).
• IF A TRIAL OF AN SSRI OR SNRI RESULTS IN A PARTIAL
RESPONSE, BUT THE PATIENT CONTINUES TO EXPERIENCE
CLINICALLY SIGNIFICANT SYMPTOMS, WE SUGGEST
AUGMENTING THE ANTIDEPRESSANT WITH CBT BEFORE
TRYING AN ANTIPSYCHOTIC MEDICATION
(EG, RISPERIDONE 0.5 TO 3 MG/DAY) (GRADE 2B).

25. • SSRIS AND CLOMIPRAMINE GENERALLY LEAD TO
IMPROVEMENT IN 40 TO 60 PERCENT OF PEOPLE WITH
OCD. WHEN PATIENTS HAVE AN ADEQUATE RESPONSE,
PRACTICE GUIDELINES RECOMMEND THAT THEY BE
MAINTAINED ON THE MEDICATION FOR AT LEAST ONE TO
TWO YEARS

27. OCD EXPERIENCES
OCD Not OCD
A man who washes his hands 100
times a day until they are red and
raw
A woman who unfailingly
washer her hands before every
meal
A women who locks and relocks her
door before going to work every day
– for half an hour
A woman who double-checks
that her apartment door and
windows are locked each night
before she goes to bed.
A college student who must tap on
the door frame of every classroom 14
times before entering
A musician who practices a
difficult passage over and over
again until its perfect
A man who stores 19 years of
newspapers “just in case” – with no
system for filling or retrieving
A woman who dedicates all her
spare time and money to
building her record collection

28. REFERENCE