1. OCD Questions and answers. Sources are DSM-IV-TR, APA Practice Guideline, or Sadock and Sadock, 10 th edition unless otherwise indicated. As of 1Sep08

2. OCD Q. DSM criteria?

3. OCD A. Has either compulsions or obsessions B. Person recognizes that the compulsions or obsessions are unreasonable or excessive (does not apply to children). C. Compulsions or obsessions are distressing or disabling D. Compulsions or obsessions are not within another disorder E. Not direct effect of substance

4. OCD – time requirements Q. Minimum time of obsessions/compulsions to meet DSM-IV criteria?

5. OCD - time Ans. > 60 minutes unless very disabling and then can be shorter

6. OCD Q. What if the person doesn’t recognize that the obsessions or compulsions are excessive or unreasonable?

7. OCD Ans. add specifier, “With poor insight.”

8. OCD - gender Q. Gender prevalence?

9. OCD - gender Ans. Boys more than girls, and equal in adults.

10. OCD Prevalence Q. What is prevalence in US?

11. OCD - Prevalence Ans. Lifetime, 2.5% One year: 0.5%, i.e., 1/200 have the disorder in any given year.

12. OCD - Onset Q. What is usual age of onset?

13. OCD - Onset Ans. Males: 6 – 15 years old Females: 20 -- 29.

14. OCD – Familial Pattern Q. What is familial pattern

15. OCD – familial pattern Ans. Concordance rate: Monozygotic [70%] > dizygotic twins [50%] First degree relative higher (35%) than normal population.

16. PANDAS Q. Stands for?

17. PANDAS Ans. Stands for: pediatric autoimmune neuroleptic disorder associated with streptococcal infections.

18. Obsessions Q. Most common obsession?

19. Obsessions Ans. Most common is fear of contamination.

20. Compulsions Q. Most common compulsion?

21. Compulsions Ans. Checking.

22. Neuroanatomy Q. Neuroanatomy of OCD?

23. Neuroanatomy Ans. While far short of being diagnostic, there is a tendency for more gray matter and less white matter than normals

24. Co-morbidity Q. What psychiatric disorders, other than substance-related disorders, are most commonly associated with OCD?

25. Co-morbidity Ans. Most common is MDD, 2/3 (67%). Social phobia: 25% Tourette’s disorder: 5 - 7% Tics: 20 - 30%

26. OCD Differential Diagnosis, list medical and psychiatric?

27. OCD - differential Ans. Medical: –Tourette’s disorder, –other tic disorder, –temporal lobe epilepsy Psychiatric: –Schizophrenia, –Obsessive-compulsive personality disorder, –phobias, –depressive disorders

28. Onset Q. Average number of years between onset and treatment of OCD?

29. OCD Ans. 17 years.

30. Outline of OCD treatment Q. What is basic treatment for OCD, speaking generally?

31. Outline of treatment Ans. Basically: SSRI/clomipramine and behavioral therapy

32. FDA approved for OCD Q. FDA has approved?

33. FDA Ans. FDA has approved: Clomipramine Fluoxetine Fluvoxamine Paroxetine Sertraline

34. Dosing Q. Typical doses of OCD with an SSRI?

35. OCD Ans. Typically, dosing is higher than with MDD.

36. OCD Q. Onset of effectiveness in OCD when using an SSRI – when it is effective?

37. OCD Ans. Should see improvement in 6 to 12 weeks.

38. OCD Q. If the SSRI is successful and then discontinued, what is likely to happen?

39. OCD Ans. Symptoms will return in two months.

40. Typical results Q. Typical results with an SSRI?

41. OCD Ans. About ½ have 1/3 improvement

42. OCD augmentation If partial response to an SSRI, what meds can you add that may make for further improvement?

43. Augmentation Ans. Atypical antipsychotic Buspirone Clomipramine Clonazepam Lithium Venlafaxine Valproate

44. Treatment of PANDAS Q. What is treatment?

45. PANDAS 1] plasmopheresis to clear antibodies AND 2] prophylactic antibiotics

46. Behavioral therapy for OCD Q. Behavioral therapies, three most common?

47. Behavioral therapy Ans. Three most common: 1. Exposure and response prevention 2. Imaginal flooding 3. Thought stopping

48. Exposure and response prevention Q. What is exposure and response prevention?

49. OCD Ans. Exposure and response prevention consist of asking the pt to endure, in a graduated manner, the anxiety of a specific obsession the pt fears – and refrain from the associated compulsion.

50. OCD Q. What is imaginal flooding?

51. OCD Ans. Imaginal flooding consists of having the pt provoked by the obsessions by continually repeating the thought to where the thought no longer provokes fearfulness.

52. OCD Q. What is thought stopping?

53. OCD Ans. Thought stopping consists of having a technique to stop the pt compulsive thought, e.g., the pt keeps needing to repeat a short prayer and one has the pt shout when that happens, or make a loud noise or snapping a rubber band on the wrist to where it stings.

54. OCD Q. Behavioral therapy helps what % of OCD pts?

55. OCD Ans. 3/5

56. OCD Q. Usefulness of relaxation techniques in OCD?

57. OCD Ans. Relaxation techniques have not been shown to be helpful

58. OCD Q. Pt only has obsessions, not compulsions. In addition to techniques already mentioned, what psychotherapy technique might be tried?

59. OCD Ans. The pt can try not resisting, “just let them pass through.” Also can audio tape and the pt can listen to the tape until no loner upsetting.

60. OCD Q. Typical length of time of behavioral therapy sessions?

61. OCD 90 minutes – and homework

62. OCD Q. Typically, how many sessions?

63. OCD 13 to 20 sessions

64. Families Q. What should you tell families of OCD pts as to how they should relate to the pt?

65. OCD Ans. Avoid condemnation And Avoid reassurance