-OCD- NOTES

Definition - Unwanted thoughts, impulses, or images that cause anxiety. No only worries about every life, personal attempts to ignore, suppress, or neutralize. Usually from one's own mind. Neutralization central part, drives obsession, divided between psychosis and neurosis. Majority don't distinguish reality from internal thoughts of the mind. I.e. delusions. Few know what the obsession comes from. Common obsessions: contamination, fear of harming, doubting, symmetry, somatic, sexual, hosting unacceptable urges, religious. Pathological doubts - things related to somatic - i.e. body. Useless to something thrown away Sin - against neurology Very wide range of obsessions. Blurry line between psychosis and neurosis. OCD - repetitive, specific function, prevent stress or bad things. person does not have an observable symptom - i.e. counting, praying, compensation. can be mental or physical. Compulsions - checking, cleaning, repeat actions, ordering, mental compulsions, collecting, touching, reassurance seeking, wanting things evenly. Reassurance, prominent in children, also adults e.g. contamination. we must understand the function. OCD is the 4th most common disorder, phobia, depression, alcohol are top. OCD - roughly as prevalent as diabetes SOCIAL IMPACT - lowered self esteem, problems with relationships, difficulty maintaining relationships, lowered standers for academic achievement, lower career expectations - 13% of OCD have attempted suicide. - ONLY B/C OF OCD ALONE. OCD is among top 10 causes of years lived with a disability depressions is highest. Many are in the psychological and psychiatric disorders seems to differ by gender. Boys - 13-15, girls develop 20-24 Treatment delayed, avg 17 years.

it is common, chronic, poorly understood and diagnosed patients try to hide symptoms, thus not being diagnosed or treated failure to screen for OCD. Difficulties in diagnosis Healthcare barriers co morbidity COMORBIDITY - rule rather than exception. co morbid condition becomes more prevalent, although it is the minority. YALE - brown OCD scale, Y-BOCS Evaluation - time, interference with function, distress, resistance, control. Attempts to resist degree of control, probability they could resist. That is the scale. DIFFERENTIAL DIAGNOSIS! - Delusions, depressive nominations, other anxiety disorders, OCD; the personality disorder, stereotypes, impulse control disorders. THERE IS MUCH CONFUSION - primary - recurrent, unwanted, mental activity and recurrence, mal-adaptive behavior - only 2 symptoms, primarily very broad, obsessive thought. OCPD is not like OCD OCPD favors rules and regulations STERIOTYPES - autistic, must look at functions with obsession obsessive eating - does not meet criteria for OCD. not being done by illicit _____, not for reassurance not to prevent obsess ional distress COMPULSIONS -eating, drinking, gambling, - - for feeling goal, not for keeping from bad. fears are maintained through avoidance AVOIDANCE - passive avoidance - staying away from specific threads. i.e. touching something dirty, ACTIVE AVOIDANCE- trying to was off whatever is on a hand compulsions prevent habituation - e.g. cant get used to something. failure to habituate prevents the realism thread appraisal valve. i.e touching door knob can't correct the mistake. He cant get aids from a door knob. - i.e. compulsions drive the obsessions COGNITIVE FACTORS exaggerated sense of responsibility importance of thoughts need to control thoughts, threat overestimation, intolerance of uncertainty, perfectionism, infallible, actually horrible, can't deal with ambiguity. OCD is a neuropsychiatric disorder. deficits in behavioral inhibition deficits in cognitive inhibition

-growing belief that OCD is in the front or stratus thermo frontal cortex. great degree of empirical support. THOUGHT SUPRESSION leads to increased thought frequency OCD thinks about repressed thoughts more than frequently. normal people can think about differences. OCD-ers when they try not to think of something, they think about it more. TREATMENT - clomipramine is superior to placebo., selective SRIs are superior to placebo. eg fluvoxamine, sertaline, paroxetine. high doses of sri meds 20250mg of various SRIs OCD does not have a large placebo response. medication is helpful, but does not reduce significantly, still can apply for more medicine. clamipromine may pack a better punch. HEVAVIORAL TREATMENT If someone is afraid, gradual form of exposure. can't overcome without confrontation. most prevent avoidant behaviors. however, anxiety increases and forms habituation over correction ensures coping with situations. most practice at high levels - our correction. Must tolerate something worse than natural situations. Exposure and ritual precautions for ocd exposure in real life - prolonged confrontation with anxiety invoking stimuli. eg contact with contaminates. IMAGINAL EXPOSURE - prolonged imagined exposure and confrontation with feared disasters. e.g. becoming ill with the contamination. Ritual prevention - blocking of compulsions. e.g. leaving the bathroom without washing hands. THESE THINGS ARE TOLERABLE! people will generally listen to suggestions which may help them. more response to behavioral therapy, but not always. this is average. if you allow leeway, abstinence is the optimal result. experience things with the patient. SRI medications work sometimes quickly, for people who have never had treatment. is OCD really caused by the brain?

educate the patient, develop hierarchy, some situations alone, monitor rituals, objective view, e.g. spouse, friend, relative, family, friend, boss, etc. much encouragement, discussion of risk. recognize risk, the imminent risk. SUMMARY OCD is common, chronic, and disabling. - Major threat to public health. OCD is biological, behavioral, and a cognitive disorder. SRI medications can be effective/are effective. CBT is effective and may be an optimal first line treatment - some evidence of first line treatment, also where SRI fails.