Podcast
Questions and Answers
Which of the following statements regarding the typical onset and prevalence of OCD in young people is most accurate?
Which of the following statements regarding the typical onset and prevalence of OCD in young people is most accurate?
- Onset typically occurs after the age of 18, affecting approximately 5% of children and adolescents.
- Onset typically occurs before the age of 18 in approximately 50% of cases, affecting 1-2% of children and adolescents. (correct)
- Onset is rare in childhood, usually presenting in adulthood, and prevalence is consistent across all age groups.
- Onset has a unimodal distribution, peaking in adolescence, and affects approximately 5-7% of children and adolescents.
A child presents with repetitive handwashing rituals. According to the DSM-5 criteria, which of the following conditions must be met to diagnose OCD rather than another disorder?
A child presents with repetitive handwashing rituals. According to the DSM-5 criteria, which of the following conditions must be met to diagnose OCD rather than another disorder?
- The behavior must be present for less than one hour per day.
- The handwashing must be directly caused by a known substance or medical condition.
- The symptoms must be better explained by symptoms of another mental disorder.
- The obsessions, compulsions, or both, must be time-consuming (more than 1 hour a day) and cause significant distress or impairment. (correct)
A young patient is diagnosed with OCD, primarily characterized by symmetry obsessions and ordering compulsions. According to the identified symptom dimensions of OCD, which dimension does this presentation fall under?
A young patient is diagnosed with OCD, primarily characterized by symmetry obsessions and ordering compulsions. According to the identified symptom dimensions of OCD, which dimension does this presentation fall under?
- Symmetry/Order/'Just Right' (correct)
- Contamination/Washing
- Hoarding/Saving
- Obsessions/Checking
What is the rationale behind exposure and response prevention (ERP) as a key component of CBT for OCD?
What is the rationale behind exposure and response prevention (ERP) as a key component of CBT for OCD?
In the treatment of OCD in young people, under what circumstances would combined CBT and SSRI medication be considered the first-line treatment?
In the treatment of OCD in young people, under what circumstances would combined CBT and SSRI medication be considered the first-line treatment?
According to research, what is the estimated rate of response to CBT for OCD in young people?
According to research, what is the estimated rate of response to CBT for OCD in young people?
Which of the following statements best describes the role of genetics in the etiology of OCD?
Which of the following statements best describes the role of genetics in the etiology of OCD?
A clinician is explaining the concept of 'anxiety habituation' to a young patient undergoing psychoeducation for OCD. Which statement best describes habituation in this context?
A clinician is explaining the concept of 'anxiety habituation' to a young patient undergoing psychoeducation for OCD. Which statement best describes habituation in this context?
A patient with OCD is undergoing Exposure and Response Prevention (ERP) therapy. Which of the following is a crucial element of ritual prevention?
A patient with OCD is undergoing Exposure and Response Prevention (ERP) therapy. Which of the following is a crucial element of ritual prevention?
Which of the following is NOT considered one of the four main symptom dimensions of OCD?
Which of the following is NOT considered one of the four main symptom dimensions of OCD?
According to the information, what percentage of children with OCD is estimated to experience spontaneous remission?
According to the information, what percentage of children with OCD is estimated to experience spontaneous remission?
In the context of CBT for OCD, how often are the therapy sessions typically conducted, and what additional component is crucial between these sessions?
In the context of CBT for OCD, how often are the therapy sessions typically conducted, and what additional component is crucial between these sessions?
When initiating SSRI medication for a young person with OCD, what is a crucial consideration for optimizing its efficacy?
When initiating SSRI medication for a young person with OCD, what is a crucial consideration for optimizing its efficacy?
A clinician is determining if a patient's symptoms align with OCD or another obsessive-compulsive related disorder. Which of the following conditions falls under the 'Obsessive-Compulsive and Related Disorders' category in the DSM-5, but is not OCD?
A clinician is determining if a patient's symptoms align with OCD or another obsessive-compulsive related disorder. Which of the following conditions falls under the 'Obsessive-Compulsive and Related Disorders' category in the DSM-5, but is not OCD?
What has been identified as a notable barrier to accessing OCD treatment, particularly affecting therapists?
What has been identified as a notable barrier to accessing OCD treatment, particularly affecting therapists?
Flashcards
OCD in Young People
OCD in Young People
Onset before 18 years in 50% of cases, affecting 1-2% of children/adolescents. Characterized by intrusive thoughts that lead to anxiety and compulsions.
Obsessions
Obsessions
Recurrent, persistent intrusive thoughts, images, or impulses causing marked anxiety/distress.
Compulsions
Compulsions
Repetitive behaviors or mental acts to reduce distress or prevent a dreaded event.
OCD Diagnostic Criteria (DSM-5)
OCD Diagnostic Criteria (DSM-5)
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Common Obsessions in OCD
Common Obsessions in OCD
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Common Compulsions in OCD
Common Compulsions in OCD
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Symptom Dimensions of OCD
Symptom Dimensions of OCD
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Aetiology of OCD
Aetiology of OCD
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NICE Guidelines for OCD Treatment
NICE Guidelines for OCD Treatment
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Key Components of CBT for OCD
Key Components of CBT for OCD
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Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP)
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Barriers to OCD Treatment
Barriers to OCD Treatment
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SSRI Medications for OCD
SSRI Medications for OCD
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Study Notes
- OCD typically develops during youth
- It has a bimodal distribution, peaking in late childhood
- Onset occurs before the age of 18 in 50% of cases
- Affects 1-2% of children and adolescents
- Presents with a slight male preponderance in youth
- OCD is highly disabling
- Has a chronic nature, with spontaneous remission estimated at 4%
Ethnicity and OCD
- Prevalence is stable across ethnic and cultural groups
- People from ethnic minorities are underrepresented in mental health services
- Children from ethnic minorities respond equally well to treatment
Obsessions
- Characterized by recurrent and persistent thoughts, images, or impulses
- These are experienced as intrusive and inappropriate
- Cause marked anxiety or distress
- Individuals attempt to ignore or suppress such thoughts, impulses, or images
- Alternatively, individuals try to neutralize them with some other thought or action
- Obsessions are intrusive thoughts which can be common
- In OCD, these thoughts lead to anxiety
Compulsions
- Repetitive behaviors like handwashing, ordering, or checking
- Can also include mental acts like counting or praying
- The person feels driven to perform these in response to an obsession
- Compulsions follow rules that must be applied rigidly
- Behaviors or mental acts aim to prevent or reduce distress
- They also try to prevent some dreaded event or situation
- These behaviors/mental acts aren't realistically connected to what they're designed to neutralize/prevent, or are clearly excessive
- Compulsions temporarily relieve anxiety, perpetuating the OCD cycle
DSM-5 Criteria for OCD
- Presence of obsessions, compulsions, or both
- Symptoms are time-consuming, taking up more than 1 hour per day
- Cause distress or impairment in functioning
- Not due to substance use
- Not better explained by symptoms of another disorder
Obsessive-Compulsive and Related Disorders (DSM-5)
- Obsessive-Compulsive Disorder (OCD)
- Body Dysmorphic Disorder: preoccupation with a perceived flaw in physical appearance
- Hoarding Disorder: persistent difficulty discarding or parting with possessions, regardless of their actual value
- Trichotillomania: hair-pulling disorder
- Excoriation: skin-picking disorder
Obsessive-Compulsive and Related Disorders (ICD)
- OCD
- Body dysmorphic disorder
- Hoarding disorder
- Olfactory reference disorder: preoccupation with body odor
- Hypochondriasis: now known as illness anxiety disorder - preoccupation with having or acquiring a serious illness
- Body-focused repetitive behavior: repetitive behaviors such as nail biting, lip biting, or cheek chewing
Frequency of Symptoms in OCD
- Obsessions:
- Aggressive: 69%
- Contamination: 59%
- Sexual: 19%
- Hoarding: 22%
- Religious: 27%
- Symmetry: 45%
- Somatic: 30%
- Compulsions:
- Checking: 71%
- Cleaning: 60%
- Repeating: 50%
- Counting: 35%
- Ordering: 34%
- Hoarding: 21%
Heterogeneity of OCD
- Four main symptom dimensions exist
- Obsessions/checking
- Contamination/washing
- Hoarding/saving
- Symmetry/order/’just right’
Etiology of OCD
- Genetic risk
- Environmental risk
Genetics of OCD
- Adults with OCD: 24-47% heritability
- Children with OCD: 45-65% heritability
- Unique environmental effects are equally important
- Shared environmental effects are negligible
- GWAS studies haven't convincingly demonstrated specific genes involved
- OCD is highly polygenic, involving many genes
- Gene x environment (G x E) interactions are likely
Environmental Factors in OCD
- Perinatal insults
- Childhood trauma
- Stressful life events
- Autoimmune factors like streptococcal infections
- Punitive parenting (negative/harsh) = genetic confounding
- Stressful life events were prospectively associated with OCD symptoms
OCD Treatment: NICE Guidelines
- CBT with or without SSRI medication
- CBT is the first-line treatment in mild-moderate cases
- Combined CBT + SSRI is the first-line treatment in severe cases
- CBT should involve exposure with response prevention
CBT for OCD
- Over 25 RCTs to date of CBT for OCD in young people
- Effective in children as young as 5 and in a wide range of formats
- Response rate = 70%
- Remission rate = 55%
- Key components:
- Psychoeducation: understanding OCD and anxiety, developing a hierarchy, and setting targets
- Exposure and response prevention
- Relapse prevention
- Format:
- 14 sessions on a weekly basis
- Homework tasks to complete in between sessions
- Parent involvement
- Regular measurement of progress
Psychoeducation in CBT
- Typically involves 1 or 2 sessions depending on age, cultural background, and IQ
- Focus on understanding anxiety
- Normalizing anxiety
- Understanding anxiety as a protective factor
- Anxiety habituation
ERP (Exposure and Response Prevention)
- Exposure: deliberate exposure to avoided and anxiety-provoking situations
- Ritual prevention: preventing any rituals or strategies aimed at neutralizing anxiety
- Therapists are guided by an exposure hierarchy
- Feared situations ranked by associated anxiety level, from easiest to most difficult
Barriers to Treatment
- Long waitlists
- Limited availability of trained therapists
- Geographical disparities
- Difficulty attending in-person clinics
SSRI for OCD
- 10 RCTs to date, involving sertraline, paroxetine, and fluoxetine
- Response rate: 50%
- Remission: 30%
- Achieving optimal doses for a sufficient amount of time is crucial
- Higher doses often correlate with greater efficacy
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