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OBSESSIVE
COMPULSIVE
DISORDER (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 egodystonic i.e., they are not asvoluntarily produced. Attempts aremade to ignore or suppress them.
Compulsions
Repetitive & seemingly purposefulbehavior actions that are performedaccording to certain rule or is astereotyped fashion
The obsessions or compulsions are asignificant source of distress to theindividual.
OCD Cycle
OBSESSIONS
COMPULSIONS
BELIEF ANXIETY
1970 1975 1980 1985 1990
OC
D
%
Rate of Diagnosis of OCD
Years
EPIDEMIOLOGY
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
CLINICAL FEATURES
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
Cognitive Differentiations
BehavioralDifferentiations
•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
ETIOLOGY
Neurobiological
PsychologicalEnvironmental
Neurobiological
PsychologicalEnvironmental
Causes of OCD in short
Neurobiological factors
A. Neurotransmitter Levels
Serotonin
“ocd.jpg”
“normal.jpg”
C S F 5HIAA
Platelet 5HT
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
TREATMENT
Pharmacotherapy
1. TCA/Clomipramine 2. SSRI3. Adjunctive medicationsSertralineCitalopramFluoxetine etc.
Psychotherapy
Thought stopping Response prevention Exposure etc.
Most effective for OCD.
Supportive therapy is always helpful
Cognitive Behavioral Therapy
Neurosurgery
For chronic, uncontrollable,deterioratepatient only. Anterior cingulotomy Limbic leucotomy Anterior capsulotomy Subcaudate tractotomy
Not used in Pakistan