Obsessive Compulsive Disorder |
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Obsessive Compulsive Disorder
Characteristics
Causes
Genetic
86% concordance monozygotic
50% concordance dizygotic
Insult
rare
encephalitis
head injury
streptococcal infection
developmental
>grey matter than controls
< white matter than controls
Prevalence
2-3%
equal gender distribution
Associations
Depression
30% of OCDs
25% w depression have obsessions
Schizophrenia
3-5%
Organic brain disease
frontal lobe syndromes
Sydenham's chorea
Tourette's syndrome
Course
9 years before diagnosis average
17 years before appropriate Rx
Onset
22-36 years old
earlier in men
S&S
Obsessions
Involuntary thoughts
recurrent
persistent
absurd to patient
insight
mostly
Resisted
generate anxiety
Compulsions
Ritualized behaviour
Irresistible impulse
triggered by obsession
Reduces anxiety
positive feedback
Interfere
work/routine/etc...
>1hr/day
Biopsychosocial managment
Physical
Antidepressants
SSRIs
>90% relapse if discontinued
combine with CBT
Antipsychotics
small doses added to SSRIs
good results
Psychosurgery
most severe cases
types
anterior cingulotomy
anterior capsulotomy
subcaudate tractotomy
limbic leucotomy
Transcranial magnetic stimulation
Psychological
CBT
combined with behavioural
Group CBT available
cheaper
Behavioural therapy
exposure
>90 mins ideal
Compulsion prevention
10-20 sessions
85% improve
Future
plasmapheresis
streptococcal antibodies
gamma knife trials
Prognosis
Worse if family very critical
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