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Ocd

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Pk Doctors
Pk Doctors

1. Obsessive Compulsive Disorder (OCD) is characterized by recurrent, persistent obsessions (unwanted thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts). 2. OCD is believed to be caused by a combination of neurobiological factors like abnormal serotonin levels in the brain, genetic predispositions, and psychological and environmental factors like stressful life events or childhood trauma. 3. Treatment for OCD involves pharmacotherapy like SSRIs to target serotonin levels as well as psychotherapy like cognitive behavioral therapy with exposure and response prevention techniques.

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O BSESSIVE C OMPULSIVE D ISORDER (OCD) Dr. Aftab Asif MRCPsych, London Associate Professor of Psychiatry, Fatima Jinnah Medical College / Sir Ganga Ram Hospital, Lahore
Obsessions Recurrent, Persistent ideas, thoughts, images, or impulses that are ego dystonic i.e., they are not as voluntarily produced. Attempts are made to ignore or suppress them.
Compulsions Repetitive & seemingly purposeful behavior actions that are performed according to certain rule or is a stereotyped fashion
The obsessions or compulsions are a significant source of distress to the individual.
OCD Cycle OBSESSIONS COMPULSIONS BELIEF ANXIETY
Rate of Diagnosis of OCD Years 1970 1975 1980 1985 1990 OCD %
E PIDEMIOLOGY
General Population = 2-3% = Mean Age of Onset = 20 yrs. Adolescent = Adults. Unmarried, divorced / separate = 60-70% Life Time Prevalence 50-75% pt. with OCD
C LINICAL F EATURES
Contamination 45 % Pathological doubt 42 % Somatic 36 % Aggressiveness 28 % Sexual 26 % Obsessions Affective Disorder
Checking 63 % Washing 50 % Counting 36 % Symmetry & precision 28 % Compulsions Affective Disorder
Impulsions Meticulousness or perfectionism Pathologic atonement Repetitive displacement behavior Stereotypic behavior Self-injurious behavior Pathologic overinvolvement Pathologic persistence Hoarding Complex tics Anxous ruminations & excessive worries Pathologic guilt Degressive ruminations Fantasies Paranoid fears Flashbacks Pathologic attraction Rigid thinking Pathologic indecision Realistic fears or concerns   Differential Symptomatology Cognitive Differentiations Behavioral Differentiations
E TIOLOGY
Neurobiological Psychological Environmental Causes of OCD in short Neurobiological Psychological Environmental
Neurobiological factors Neurotransmitter Levels Serotonin C S F 5HIAA Platelet 5HT “ ocd.jpg” “ normal.jpg”
B . Brain Imaging Studies CT / MRI : Decrease size of caudate nuclei PET: Increased activity in frontal lobe & basal ganglia
C. Genetics 35% in first degree relation.
Psychological factors Cognitive appraisal of intrusive thoughts. Overestimation of danger. Inflated personal responsibility. Thought-action fusion. Thought-suppression. Cognitive deficits in selective attention.  Deficits in inhibiting irrelevant stimulI (particularly internal ones such as intrusive thoughts).
Environmental factors Early childhood conflicts: This is an early theory that suggests conflicts or problems during childhood are the roots of OCD. This is specifically looking at either permissive or mainly unengaged parenting techniques.
Major life transitions such as moving schools have been reported to contribute to triggering OCD symptoms. Stressful events, just as a traumatic event of losing a loved one, can trigger OCD. Major life transitions / Stressful events
Differential Diagnosis Tourette's disorder (TD) Motor or vocal tics disorder 90% of TD OCD 5-7 % OCD TD
Cont…. Schizophrenia Major Depression Personality Disorder Phobias Dysmorphic Disorder
Other Illnesses Close to OCD Obsessive compulsive personality disorder Generalized Anxiety disorder Anorexia Nervosa Hypochondriasis Pathologic skinpicking Trichotillomania
T REATMENT
Pharmacotherapy TCA/Clomipramine SSRI Adjunctive medications Sertraline Citalopram Fluoxetine etc.
Psychotherapy
Thought stopping Response prevention Exposure etc. Most effective for OCD. Supportive therapy is always helpful Cognitive Behavioral Therapy
Neurosurgery For chronic, uncontrollable,deteriorate patient only. Anterior cingulotomy Limbic leucotomy Anterior capsulotomy Subcaudate tractotomy Not used in Pakistan
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Ocd

  • 1. O BSESSIVE C OMPULSIVE D ISORDER (OCD) Dr. Aftab Asif MRCPsych, London Associate Professor of Psychiatry, Fatima Jinnah Medical College / Sir Ganga Ram Hospital, Lahore
  • 2. Obsessions Recurrent, Persistent ideas, thoughts, images, or impulses that are ego dystonic i.e., they are not as voluntarily produced. Attempts are made to ignore or suppress them.
  • 3. Compulsions Repetitive & seemingly purposeful behavior actions that are performed according to certain rule or is a stereotyped fashion
  • 4. The obsessions or compulsions are a significant source of distress to the individual.
  • 5. OCD Cycle OBSESSIONS COMPULSIONS BELIEF ANXIETY
  • 6. Rate of Diagnosis of OCD Years 1970 1975 1980 1985 1990 OCD %
  • 8. General Population = 2-3% = Mean Age of Onset = 20 yrs. Adolescent = Adults. Unmarried, divorced / separate = 60-70% Life Time Prevalence 50-75% pt. with OCD
  • 9. C LINICAL F EATURES
  • 10. Contamination 45 % Pathological doubt 42 % Somatic 36 % Aggressiveness 28 % Sexual 26 % Obsessions Affective Disorder
  • 11. Checking 63 % Washing 50 % Counting 36 % Symmetry & precision 28 % Compulsions Affective Disorder
  • 12. Impulsions Meticulousness or perfectionism Pathologic atonement Repetitive displacement behavior Stereotypic behavior Self-injurious behavior Pathologic overinvolvement Pathologic persistence Hoarding Complex tics Anxous ruminations & excessive worries Pathologic guilt Degressive ruminations Fantasies Paranoid fears Flashbacks Pathologic attraction Rigid thinking Pathologic indecision Realistic fears or concerns   Differential Symptomatology Cognitive Differentiations Behavioral Differentiations
  • 14. Neurobiological Psychological Environmental Causes of OCD in short Neurobiological Psychological Environmental
  • 15. Neurobiological factors Neurotransmitter Levels Serotonin C S F 5HIAA Platelet 5HT “ ocd.jpg” “ normal.jpg”
  • 16. B . Brain Imaging Studies CT / MRI : Decrease size of caudate nuclei PET: Increased activity in frontal lobe & basal ganglia
  • 17. C. Genetics 35% in first degree relation.
  • 18. Psychological factors Cognitive appraisal of intrusive thoughts. Overestimation of danger. Inflated personal responsibility. Thought-action fusion. Thought-suppression. Cognitive deficits in selective attention.  Deficits in inhibiting irrelevant stimulI (particularly internal ones such as intrusive thoughts).
  • 19. Environmental factors Early childhood conflicts: This is an early theory that suggests conflicts or problems during childhood are the roots of OCD. This is specifically looking at either permissive or mainly unengaged parenting techniques.
  • 20. Major life transitions such as moving schools have been reported to contribute to triggering OCD symptoms. Stressful events, just as a traumatic event of losing a loved one, can trigger OCD. Major life transitions / Stressful events
  • 21. Differential Diagnosis Tourette's disorder (TD) Motor or vocal tics disorder 90% of TD OCD 5-7 % OCD TD
  • 22. Cont…. Schizophrenia Major Depression Personality Disorder Phobias Dysmorphic Disorder
  • 23. Other Illnesses Close to OCD Obsessive compulsive personality disorder Generalized Anxiety disorder Anorexia Nervosa Hypochondriasis Pathologic skinpicking Trichotillomania
  • 25. Pharmacotherapy TCA/Clomipramine SSRI Adjunctive medications Sertraline Citalopram Fluoxetine etc.
  • 27. Thought stopping Response prevention Exposure etc. Most effective for OCD. Supportive therapy is always helpful Cognitive Behavioral Therapy
  • 28. Neurosurgery For chronic, uncontrollable,deteriorate patient only. Anterior cingulotomy Limbic leucotomy Anterior capsulotomy Subcaudate tractotomy Not used in Pakistan