Obsessive Compulsive Disorder

During the lecture …… What is obsessive compulsive disorder What are the clinical features Differential Diagnosis Aetiology Prognosis Management

What is an obsession ? Recurrent persistent thoughts, impulses, or images that enter the mind despite the person’s efforts to exclude them.

Patient resists the obsession. Recognizes them as his/her own. Regarded as untrue or senseless. Generally about matters which the patient finds distressing or unpleasant.

Several forms of obsessions Thoughts Ruminations Doubts Impulses Rituals

Compulsions Repetitive and seemingly purposeful behaviours performed in a stereotyped manner. Usually associated with obsessions Usually reduces the stress caused by the latter Feels they have to do it But also wants to resist

OBSESSIONS COMPULSIONS OBSESSIONAL SLOWNESS

Other Associated features Features of Anxiety Depression

Differential Diagnosis Generalized Anxiety Disorder Panic Disorder Phobic Disorder Depression Schizophrenia Organic cerebral disorders

How common is it ? Lifetime prevalence : 1.9 to 2.5 One year prevalence : 1.2 to 1.8

Aetiology Genetic Brain disorder Abnormal serotonergic function Early experiences

Management Assess Make a definite diagnosis Treat

Treatment Explain the symptoms Reassure Interview relatives encourage them to be firm with the patient.

Drug Treatment Clomipramine – A tricyclic with 5-HT uptake blocking effects. 200 – 250 mg daily side effects - anticholinergic May take six weeks to see desired effects

Selective Serotonin reuptake inhibitors - Flouxetine, fluvoxamine side effects are less Treat Associated depression if present.

Behaviour therapy Exposure and response prevention

Anxiety Time

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