1. Obsessive-Compulsive Disorder

2. Obsessions as defined by
Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
The thoughts, impulses, or images are not simply exces­ sive worries about real-life problems
The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

3. Typical Obsessions
Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)
Fears that someone else has been hurt or killed
Fears that one has done something criminal
Fears that one may accidentally injure someone
Worry that one has become dirty or contaminated
Blasphemous or obscene thoughts

4. Compulsions as defined by
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
The behaviors or mental acts are aimed at preventing or reducing 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

5. Typical Compulsions Checking Cleaning/washing
Doing things a certain number of times in a row
Doing and then undoing things
Doing things in a certain order, with symmetry
Mental acts such as praying, counting, etc.

6. Obsessive-Compulsive Disorder
Either obsessions or compulsions
The person has recognized that the obsessions or compulsions are excessive or unreasonable
There is significant distress or an impairment in functioning due to the obsessions or compulsions
The disturbance is not due to a GMC or substance

8. OCD Distribution
80% of normal people report obsessions; 54% report compulsions
Lifetime prevalence 2 - 3%
No gender difference
Begins either before age 10 or 18-30
Less common among African Americans and Mexican Americans
More common in divorced, separated, or unemployed people

9. Aetiology of OCD
Psychoanalytical theories: attempt to suppress instinctual drives – sexual and aggressive – arising from the anal stage
Biological theories: Brain injury/trauma/acute disease and/or neurochemical (serotonin); Genetic factors
Behavioural and Cognitive theories: conditioning; modelling; memory deficits

12. OCD - Management Behaviour therapy CBT - less useful Pharmacotherapy
Exposure and response prevention
Paradoxical injunctions
CBT - less useful
Pharmacotherapy
SSRIs, Clomipramine
Augmentation with risperidone
Clonazepam

13. OCD Psychosurgery - indicated rarely for severe intractable cases
Outcome 60% respond to SSRIs but relapse is common on cessation of tx
Predictors of poor outcome are male sex, early onset and obsessional slowness