Obsessive Compulsive Disorder (OCD) Abdulaziz S. Alsultan

Objective What is OCD? Epidemiology of OCD. OCD Comorbidities. Etiology of OCD. Manifestations of OCD. Themes of OCD. Diagnostic criteria and differential diagnosis. Management and Prognosis.

Definition OCD classified as an anxiety disorder in which the person have recurrent and persistent ideas, thoughts, images(obsession) or repetitive behaviors or mental acts in response to this obsession to reduce the distress (compulsion). OBSESSIONS: Recurrent and persistent ideas, thoughts and images. (the patient found them silly)

Epidemiology Affect 1-3% of the general population. There is an equal distribution of males and females that suffer from OCD. 4th most common psychiatric disorder in one USA study. 10th most disabling of all medical disorders in WHO. Mean onset 19.5 years, 25 % start by age 14. Males have earlier onset than females.

OCD Comorbidities >70% have lifetime diagnosis of an anxiety disorder such as PD, SAD, GAD, phobia. 63% have lifetime diagnosis of a mood disorder, MDD being the most common. Between 23 to 32% have obsessive- compulsive personality disorder.

Etiology The exact etiology of OCD is still not known but a few theories are listed below. Neurochemical Hypothesis: There is evidence that SSRIs are effective in the treatment of OCD while there is no evidence suggests serotonin dysfunction. Genetics factors: Twin and family studies suggest that there is a genetic contribution to OCD

Psychosocial theory: The onset of OCD is triggered by a stressful life event in approximately 60% of patients.

Manifestations of OCD Psychiatric disorder characterized by: Obsession or compulsion or both. Time consuming (< 1 hour a day). Avoidance behavior. The persons recognized that the obsession or compulsion is excessive or unreasonable. Patients with OCD have a significant risk for suicide, which increases with the severity of symptoms and the number of concurrent psychiatric diagnoses. Avoidance behavior: avoid people, places, or things that trigger obsessions and compulsions.

Pattern(themes) of OCD Contamination. Self-doubt associated with guilt and followed by checking. Religious wrong beliefs. Accuracy concerning. Forbidden or taboo thoughts: include aggressive or sexual obsession. Harmful thoughts. Accuracy concerning. (Need for order or symmetry (Arranging objects)) /// Harmful thoughts (urges (eg, to stab someone). .

Diagnosis DSM-5 diagnostic criteria for obsessive- compulsive disorder: Obsession or compulsion or both. Time consuming (< 1 hour a day). Cause Marked distress or significant impairment. The disturbance is not better explained by the symptoms of another mental disorder or physiological effects of a substance.

Differential Diagnosis Major depressive disorder. Generalized anxiety disorder. Panic or phobia disorder. Obsessive compulsive personality disorder. Medical condition or substance use. The most common medical pitfall in the treatment of OCD is a failure to make the diagnosis. Clinicians should be familiar with the diagnostic criteria and consider OCD in their differential when evaluating tics, mood and anxiety disorders, or other compulsive behaviors, such as trichotillomania or neurodermatitis.

Management Search for depression and treat it. Explain the nature of the disorder to the patient and his family. Pharmacotherapy. Behavioral Therapy. Psychosurgery.

Pharmacotherapy Antidepressants: selective serotonin reuptake inhibitors (SSRI): sertraline, Paroxetine or citalopram. Bring improvement to 50–80% of those with OCD. Relapse occurs if medication is stopped. Tricyclic antidepressant (TAC): clomipramine. SSRIs are generally preferred over clomipramine,

Behavioral Therapy Cognitive-Behavioral Therapy. Exposure and response prevention. Thought distraction or thought stopping. Relaxation techniques to manage the anxiety. // Relaxation techniques are employed to help the patient manage the anxiety that occurs when the compulsion is prevented /In combination whit SSRI

Prognosis About 30% of patients showing significant improvement with treatment. 40 to 50% of patients have moderate improvement. 20 to 40% remain significantly impaired or experience worsening of symptoms. Approximately 5% of patients have a complete remission of symptoms.

Summary Obsession, compulsion, time consuming and marked distress . Affect 1-3% of the general population. Anxiety and mood disorder the most common comorbidity. The exact etiology of OCD is still unknown. Pharmacotherapy and behavioral therapy. 5% of patients have a complete remission of symptoms.

Thank you

Reference Basic Psychiatry 2nd edition 2011. First Aid for Psychiatry Clerkship 3rd edition. Medscape: Obsessive-Compulsive Disorder Treatment & Management. Uptodate: Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Relaxation techniques are employed to help the patient manage the anxiety that occurs when the compulsion is prevented