Sami Adil / Psychiatrist 1st nov. 2015 Ocd lecture of 2 hours Sami Adil / Psychiatrist 1st nov. 2015

1. obsessive-compulsive disorder, 2. body dysmorphic disorder, 3. trichotillomania (hair-pulling disorder), 4. hoarding disorder and 5. excoriation (skinpicking) disorder.

References Kaplan Medical Lectures from youtube.com Iraqi studies

OCD Anxiety provoking intrusive thought which tends to be repetitive: Contamination, Doubt, Guilt, Aggression, Sex.

The most common type of obsession ideas in the west is regarding contamination. Iraq religious obsessions are the most common followed by contamination, and the Iraqi study found also a delay to consult a psychiatrist measured as average of about 5 years (1). (1) Ahmed Jefer AL- Karagully. Symptoms profile of obsessive compulsive disorder in Baghdad. 2009. A non-published thesis.

Compulsions Peculiar behaviors that tend to be repetitive and time-consuming, and reduce anxiety, such as: Hand washing, Organizing, Checking, Counting, Praying. The patient can have obsessions only, compulsions only, or both.

Risk Factors / Etiology: Abnormalities of serotonin metabolism. Genetics: a family study done in Iraq found that OCD is present in about 6% in the first degree relatives of patients of OCD while present in 2.5% in the control group (2). (2) Ali A. Al-Saaidi. Family study of OCD in Iraq. 2002. A non-published thesis.

Presenting Symptoms: Prevalence: 2% of population. The Iraqi Mental Health Survey (IMHS) estimated the lifetime prevalence of OCD in Iraq to be 1.4% in the general population (3). Occurs at a 1:1 male to female ratio.

Onset: insidious; occurs during childhood, adolescence or early adulthood. Course: usually chronic; symptoms worsen with stress. Symptoms usually wax and wane. Associated problems: Depression and substance abuse.

Treatment: The pharmacotherapy is the first choice. It is better than behavioral therapy. But ideally both of them should be used. Pharmacology: SSRIs 4 are FDA approved, TCA (Clomipramine).

Behavioral therapy: Relaxation training; Guided imagery; and Exposure and response prevention.

Body dysmorphic disorder

Preoccupation with imagined defect, not delusional Epidemiology poorly studied 13-30 yr of age, more women, unmarried

etiology Unknown High comorbidity with depression and OCD Respond to serotonin specific drugs

Clinical features Face, nose St. vague Hair, breast, genitalia Muscle mass

Ddx. Normal Modd congruent cognition Avoidant PD, social phobia OCD Delusional disorder Anorexia nervosa Gender identity disorder

Tr. Surgical, dermatological, dental … unsuccessful SSRIs and clomipramine

trichotillomania Risk factors/ epidemiology: Affects women more than men. Lifetime prevalence rate of 1-2% Associated with OCD, Obsessive compulsive PD, Tourette’s syndrome, depressive disorders, and autism.

Hair loss is significant over all areas of the body (usually involves the scalp, but may include eyelashes, eyebrows, axillae, pubic, and any other body regions.) Exacerbated by stress or relaxation (e.g. reading, watching T.V.) Area most affected is the scalp. May eat the hair  may cause intestinal obstruction. Head banging, nail biting. Examination of the scalp reveals short, broken hairs along with long hairs (helps differentiate from alopecia).

Behavioral modification techniques Behavioral modification techniques. Pharmacotherapy: there is some evidence of use of SSRIs, clomipramine, pimozide, risperidone, and lithium.  

Medical: alopecia areata or tineacapitis. Psychiatric: OCD, or factitious disorder.

Hoarding disorder is characterized by the persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. Must cause dysfunction or distress to diagnose it as a disorder, otherwise, it is normal and can be a beneficial hobby.

Excoriation (skin-picking) disorder is characterized by recurrent skin picking resulting in skin lesions.

Definition: excessive, poorly controlled anxiety about life circumstances that continues for longer than 6 months. There are psychological and physiological symptoms.

DSM-VI criteria for GAD: Excessive anxiety or worry, occuring most of the days at least for 6 months. Difficulty controlling worry. Associated with three of the following six symptoms: Muscle tension, Fatigue, Concentration difficulty, Restlessness or feeling on edge, Irritability, and Sleep disturbance.

Risk Factors / Etiology: Genetic predisposition for anxiety trait.

Presenting Symptoms: Prevalence: 5% of the population. Occurs at a 2:3 male-to-female ratio. Onset: occurs mainly during childhood. Course: chronic, symptoms worsen with stress. Associated problems: depression, somatic symptoms, and substance abuse.

Treatment Behavioral psychotherapy: relaxation training, and biofeedback. Pharmacotherapy: Venlafaxine, other antidepressants, buspirone, benzodiazepines. (Buspirone is better than benzodiazepines). (SSRIs are better than Buspirone).

The choice independent (is dependent) on response and on the individual.