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CC May 2016 Obessive-Compulsive Disorder (OCD)

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echoecho's version from 2016-09-15 23:55

Section

Question Answer
What is the lifetime prevalence of OCD? 1 year prevalence?2.5%; 0.7%
Is the prevalence of OCD similar in the many different cultures around the world?yes
What are the characteric features of OCD? What is the goal?1) reccurent, intrusive thoughts, impulses or images (obsessions) and repetitive behaviors or mental acts (compulsions) 2) goal is to reduce anxiety associated with these obsessions
OCD (while sometimes in children), begins when?in late adolescence or early adulthood
Comment on the ratio of men to women with OCD?equal ratio
In childhood OCD, 70% of patients are of what gender?male
What is the course of OCD?chronic, waxing and waning course
Exacerbations of OCD are sometime _____ related?stress
About _____% of OCD patients show progressive deterioration in occupational and social functioning, whereas about _____% have an episodic course with minimal or no symptoms?15; 5
What chemical plays a role in the etiology of OCD? In several studies, there have been implicated abnormalitie in what circuits?1) serotonin 2) orbitofrontal-limbic-basal ganglia circuits
OCD is commonly associated with other anxiety disorders, name these?1) specific phobia 2) social phobia 3) panic disorder
OCD is most often comorbid with major _______?depression
What is the estimated lifetime prevalence of major depressive disorder in patients with OCD?60%
*** The risk of ________ in OCD patients is high with some data suggesting > 60% and 25% have attempted itsuicide
What 3 disorders are associated with OCD?1) bipolar disorder 2) schizophrenia 3) eating disorders
Pateints often self-medicate their OCD symptoms with what?1) alcohol 2) anxiolytics 3) sedative meds
OCD has been reclassified in the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5) as part of what category? which includes what?1) obssessive-compulsive-related disorders category 2) body dysmorphic disorder, hoarding disorder, trichotillomania and excoriation (skin-picking) disorder
The clinical presentation of OCD is variable. Give examples?1) if the pt with OCD presents due to concern of a family member, the s/s of OCD may be presented directly to the provider 2) OCD patients are often embarrassed by or are fearful of their OCD s/s and reluctant to discuss them with anyone, so providers should be watchful of secondary s/s (dry skin resulting from repetitive hand washing or signs of skin picking)
If OCD is suspected what approach should be tried?supportive, nonthreatening approach
*** List 6 sample physician interview questions for patients suspected of having OCD?1) do you ever find that certain thoughts or images keep coming into your head, even though you try to keep them out? 2) do these thoughts make sense to you, or do they seem troublesome 3) what do you do to try to get rid of or counteract these thoughts? 4) do you sometimes feel like you have to do certain things over and over, even though you don't want to? 5) do certain thoughts or actions interfere with your daily routine? 6) do yo find yourself repeatedly checking the accuracy of things?
*** What techniques are the most effective forms of psychotherapy for OCD and include what treatment modalities?1) CBT (cognitive-behavioral therapy) 2) exposure and response prevention
Define exposure treatment?putting the patient into the very situation that heor she fears or obsesses about
Define response prevention treatment?prohibits patient from performing his usual rituals (thus breaking the cycle of reinforcement that reduces anxiety leading to increased frequency of compulsive behavior) that has built up for years
The exposure and response prevention treatments are difficult for patients and their families and are often best provided by whom?a mental health professional with specific training in this field
About _____% of patients who complete treatment will experience some improvement of their symptoms with behavior thearpy, but dropout rates may be substantial?75%
Therapy is more effective with treatment with what medication class?SSRIs
List the associations with poor outcomes?1) co-morbid depression 2) low motivation for treatment 3) greater initial OCD severity
There is evidence that what 2 types of therapy are as effective as medication in children and adolexcents?1) CBT 2) behavioral therapy
*** What are 4 medications are the first choice for OCD?1) fluvoxamine (Luvox) 2) fluoxetine (Prozac) 3) sertraline (Zoloft) 4) paroxetine (Paxil)
What tricyclic antidepressant used to be used for OCD but is only used now if other agents have failed? What are the side effects of this medication?1) Clomipramine (Anafranil) increases serotonin levels 2) side effects are dry mouth, blurry vision, orthostasis, sedation, cardiac toxicity
Are other TCAs other than Clomipramine (Anafranil) as effective for OSA?no because they have little effect on serotonin
In adults, the first choice medications for OCD have FDA approved labeling for children, except which medication?Paroxitine
The 4 first choice meds for OCD are as effective as Clomipramine but have an improved ____ ______ profile?side effect
All the SSRIs appear equally effective, with about ____% to ____% reduction in OCD rating scores?50-70
The doses of these medications for OCD are considerably higher than those used for ______?depression
*** What is the recommendation for course of therapy?continuation of treatment for a minimum of 8-12 weeks with 4-6 weeks as the highest tolerable dose recommended to assess efficacy
The choice to use pharmacotherapy, psychotherapy or both depends on what?on the patient
What is the treatment for mild OCD? for more severe OCD?1) behavioral therapy alone 2) combination therapy (psychotherapy and pharmacotherapy)
With pharmacotherapy, discontinuation of the med usually results in what?in the return of symptoms
Some patients may relapse after discontinuation of behavioral therapy, true or false?true
The best long-term results are obtained with a combination of what?cognitive behavioral therapy and medication
It is of great theoretical interest that after improvement of OCD with EITHER fluvoxamine or behavioral therapy, hyperactivation of the frontal lobe in OCD subjects may ______? (increase vs. decrease)decrease
This suggests that both kinds of treatment may affect critical brain systems involved in OCD, true or false?true
While not FDA approved for OCD, name 2 medications that have been used with success in OCD treatment?1) citalopram (Celexa) 2) escitalopram (Lexapro)
However in 2011, the FDA issued a warning for Celexa and Lexapro, what is the warning?risks of QT prolongation and associated arrhythmias with these drugs
In recent years, atypical antipsychotics (mainly what med) have been used to augment antidepressant treatment of OCD, though the risk of long-term metabolic and neurologic side effects must be carefully considered with this strategy?Risperiodone (Risperdal)
List the 7 medications for OCD with their dose ranges?1) Clompiramine (Anafranil) 150 - 300 mg (usually > 200 mg) 2) Fluoxamine (Luvox) 200-300 mg 3) Fluoxetine (Prozac) 40-80 mg 4) Sertraline (Zoloft) 50-200 mg (usually > 100 mg) 5) Paroxetine (Paxil) 20-60 mg (usually 40-60 mg) 6) Citalopram (Celexa) 20-40 mg 7)Escitalopram (Lexapro) 10-20 mg
*** SUMMARY = OCD is a potentially disabling disorder that has its onset most commonly when?in the late teens or early adult years
*** SUMMARY = OCD is manifested by?intrusive, repetitive thoughts (obsessions) and stereotypical actions or behaviors (compulsions)
*** SUMMARY = Treatment may be what?psychotherapeutic (cognitive behavioral therapy), pharmacologic or both
*** SUMMARY = What class of medications are the pharmacologic agents of choice? Doses required usually exceed the doses need to treat ______?1) SSRIs 2) depression
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