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Questions and Answers
Obsessive thoughts in OCD are perceived by the patient as appropriate and sensible.
Obsessive thoughts in OCD are perceived by the patient as appropriate and sensible.
False
The obsessional urge or idea in OCD is recognized as coming from within the self, yet still alien to the personality.
The obsessional urge or idea in OCD is recognized as coming from within the self, yet still alien to the personality.
True
Attempts to dispel unwelcome thoughts or urges in OCD typically do not lead to any significant anxiety.
Attempts to dispel unwelcome thoughts or urges in OCD typically do not lead to any significant anxiety.
False
Obsessive actions in OCD are always rational and practical in nature.
Obsessive actions in OCD are always rational and practical in nature.
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The feeling of subjective compulsion in OCD must be resisted and can involve ruminating on abstract topics.
The feeling of subjective compulsion in OCD must be resisted and can involve ruminating on abstract topics.
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ICD-9 provides a detailed and extensive description of Obsessive-Compulsive Disorder.
ICD-9 provides a detailed and extensive description of Obsessive-Compulsive Disorder.
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According to the DSM-5, OCD diagnosis requires both obsessions and compulsions to be present.
According to the DSM-5, OCD diagnosis requires both obsessions and compulsions to be present.
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The ICD-10 requires obsessional symptoms or compulsive acts to be present for at least 2 successive weeks for an OCD diagnosis.
The ICD-10 requires obsessional symptoms or compulsive acts to be present for at least 2 successive weeks for an OCD diagnosis.
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In DSM-5, obsessions and compulsions must take at least 2 hours per day to be clinically significant.
In DSM-5, obsessions and compulsions must take at least 2 hours per day to be clinically significant.
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Compulsive acts in OCD are intrinsically pleasurable according to the ICD-10 classification.
Compulsive acts in OCD are intrinsically pleasurable according to the ICD-10 classification.
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Obsessive-compulsive symptoms are uncommon in schizophrenia, which may require separate treatment.
Obsessive-compulsive symptoms are uncommon in schizophrenia, which may require separate treatment.
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Obsessional thoughts in OCD are recognized by patients as external and not their own.
Obsessional thoughts in OCD are recognized by patients as external and not their own.
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The female-to-male ratio of OCD in clinic populations is closer to 2.
The female-to-male ratio of OCD in clinic populations is closer to 2.
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Obsessional impulses often include urges to perform violent or embarrassing acts.
Obsessional impulses often include urges to perform violent or embarrassing acts.
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Obsessional ruminations involve internal debates about everyday actions.
Obsessional ruminations involve internal debates about everyday actions.
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Obsessional phobias typically occur in situations with no obvious triggers.
Obsessional phobias typically occur in situations with no obvious triggers.
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Some rituals in OCD are followed by a reduction in anxiety, while others can increase anxiety.
Some rituals in OCD are followed by a reduction in anxiety, while others can increase anxiety.
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Obsessional thoughts and rituals often lead to rapid and efficient performance in people with OCD.
Obsessional thoughts and rituals often lead to rapid and efficient performance in people with OCD.
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Freud believed that OCD symptoms occur when a person regresses to the genital stage of development.
Freud believed that OCD symptoms occur when a person regresses to the genital stage of development.
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People with OCD are less likely to perform well on 'set-shifting' tasks.
People with OCD are less likely to perform well on 'set-shifting' tasks.
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Compulsivity and impulsivity are completely opposing behaviors that cannot coexist.
Compulsivity and impulsivity are completely opposing behaviors that cannot coexist.
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Dysfunction in cortico-striatal-thalamic loops is associated with the development of OCD, involving areas like the ventral striatum and anterior cingulate cortex.
Dysfunction in cortico-striatal-thalamic loops is associated with the development of OCD, involving areas like the ventral striatum and anterior cingulate cortex.
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Cognitive theory suggests that people with OCD struggle primarily because of the intrusive thoughts themselves, not their inability to control these thoughts.
Cognitive theory suggests that people with OCD struggle primarily because of the intrusive thoughts themselves, not their inability to control these thoughts.
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Approximately one-third of OCD cases improve within one year.
Approximately one-third of OCD cases improve within one year.
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The concordance rate in twin studies was greater in dizygotic pairs than in monozygotic pairs.
The concordance rate in twin studies was greater in dizygotic pairs than in monozygotic pairs.
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Group A streptococcal infections have been linked to the development of OCD in some children.
Group A streptococcal infections have been linked to the development of OCD in some children.
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Functional imaging studies in OCD patients have shown increased activity solely in the striatum at rest.
Functional imaging studies in OCD patients have shown increased activity solely in the striatum at rest.
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A fourfold increase in the risk of OCD in first-degree relatives compared with control rates was observed.
A fourfold increase in the risk of OCD in first-degree relatives compared with control rates was observed.
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Structural imaging in OCD patients has consistently revealed a decrease in grey matter volume in the orbitofrontal cortex.
Structural imaging in OCD patients has consistently revealed a decrease in grey matter volume in the orbitofrontal cortex.
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Obsessive-compulsive symptoms were common among patients affected by encephalitis lethargica after the Spanish 'flu pandemic of 1918-1919.
Obsessive-compulsive symptoms were common among patients affected by encephalitis lethargica after the Spanish 'flu pandemic of 1918-1919.
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Dynamic psychotherapy is highly effective in treating OCD symptoms.
Dynamic psychotherapy is highly effective in treating OCD symptoms.
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Neurosurgery for OCD often leads to significant and long-lasting improvement in symptoms.
Neurosurgery for OCD often leads to significant and long-lasting improvement in symptoms.
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Deep Brain Stimulation is a well-established and widely used treatment for OCD.
Deep Brain Stimulation is a well-established and widely used treatment for OCD.
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Exposure and Response Prevention is a long-term treatment that can be challenging for patients with severe symptoms.
Exposure and Response Prevention is a long-term treatment that can be challenging for patients with severe symptoms.
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Patients treated with medication for OCD never experience relapses when the medication is stopped.
Patients treated with medication for OCD never experience relapses when the medication is stopped.
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First-line medications for OCD include SSRI's, and if they are ineffective, clomipramine or an antipsychotic drug might be considered.
First-line medications for OCD include SSRI's, and if they are ineffective, clomipramine or an antipsychotic drug might be considered.
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A thorough search for a depressive disorder should be made in every patient who presents with OCD.
A thorough search for a depressive disorder should be made in every patient who presents with OCD.
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Repeated reassurances about obsessive ruminations are considered helpful in treating OCD.
Repeated reassurances about obsessive ruminations are considered helpful in treating OCD.
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Long-term maintenance treatment may be necessary for patients with OCD.
Long-term maintenance treatment may be necessary for patients with OCD.
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Clomipramine is currently used as a first-line treatment for OCD.
Clomipramine is currently used as a first-line treatment for OCD.
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The prognosis for OCD is worse when the onset occurs in childhood.
The prognosis for OCD is worse when the onset occurs in childhood.
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Selective serotonin uptake inhibitors (SSRIs) appear to have similar efficacy to clomipramine in treating OCD.
Selective serotonin uptake inhibitors (SSRIs) appear to have similar efficacy to clomipramine in treating OCD.
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Cognitive therapy aims to increase the patient's attempts to suppress obsessional thoughts.
Cognitive therapy aims to increase the patient's attempts to suppress obsessional thoughts.
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Anxiolytic drugs should be prescribed continuously for more than 2-4 weeks at a time.
Anxiolytic drugs should be prescribed continuously for more than 2-4 weeks at a time.
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Exposure and response prevention for OCD is effective for about two-thirds of patients with moderately severe rituals.
Exposure and response prevention for OCD is effective for about two-thirds of patients with moderately severe rituals.
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Study Notes
Obsessive-Compulsive Disorder (OCD)
Definition and Clinical Picture
- Characterized by obsessional thinking, compulsive behavior, and varying degrees of anxiety, depression, and depersonalization
- Obsessional symptoms: thoughts, ruminations, impulses, and phobias
- Compulsive rituals: mental activities and repeated behaviors to relieve anxiety
Obsessional Symptoms
- Thoughts: recognized as one's own, intrusive, and usually unpleasant
- Ruminations: internal debates, reviewing arguments for and against everyday actions
- Impulses: urges to perform acts, usually violent or embarrassing
- Phobias: obsessional thoughts and compulsive rituals worsen in certain situations
Diagnostic Criteria
- DSM-5: presence of obsessions or compulsions, or both
- Time-consuming: obsessions and/or compulsions take at least 1 hour per day
- Clinically significant: cause distress, impairment in social or occupational function
- Not attributable to substances or medical conditions
- Degree of insight: patients can possess insight ranging from 'good or fair' to 'absent' or 'delusional'
ICD-10 Criteria
- Obsessional symptoms or compulsive acts: present on most days for at least 2 successive weeks
- Distress and/or interference: source of distress and/or interference with usual activities
- Recognized as own: thoughts or impulses recognized as the person's own
- Resisted unsuccessfully: at least one thought or act resisted unsuccessfully
- Not intrinsically pleasurable: compulsive acts may relieve tension, but are not intrinsically pleasurable
Aetiology
- Genetic component: concordance rate greater in monozygotic than dizygotic pairs
- Familial studies: increased risk of OCD in first-degree relatives
- Molecular genetic studies: associations with genes coding for glutamate and serotonin transporters, 5-HT2A receptor, and brain-derived neurotrophic factor
Brain Disorder
- Associations with conditions that have known effects on brain function: encephalitis lethargica, Gilles de la Tourette syndrome
- Brain imaging studies: abnormalities in orbitofrontal cortex, caudate, anterior cingulate cortex, and thalamus
Abnormal Serotonergic Function
- Response to drugs that increase 5-HT function: suggests abnormal 5-HT mechanisms in OCD
- Late effects of 5-HT uptake inhibitors: complex and not fully understood
Treatment
- Medication: clomipramine, selective serotonin uptake inhibitors (SSRIs), anxiolytic drugs
- Cognitive Behaviour Therapy (CBT): exposure and response prevention, cognitive therapy
- Behavioural treatment: exposure and response prevention
- Neurosurgery: for severe cases
- Deep Brain Stimulation (DBS): for severe cases
Prognosis
- About two-thirds of cases improve to some extent within one year
- Some cases continue for more than a year, with some following a fluctuating course
- Prognosis is better with a precipitating event, social and occupational adjustment, and episodic symptoms
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Description
Quiz on the key symptoms and features of Obsessive-Compulsive Disorder (OCD), including feelings of compulsion and unwanted thoughts.
