OCD and case

• not graded exposure?

• THE THOUGHTS, IMPULSES, OR IMAGES AREN’T SIMPLY EXCESSIVE WORRIES ABOUT LIFE PROBLEMS

• THE PERSON RECOGNIZES THAT THE OBSESSION ARE A PRODUCT OF HIS/HER OWN MIND AND SENSELESS

• REPEATED THOUGHTS ABOUT CONTAMINATION (PUBLIC RESTROOMS OR SHAKING HANDS)

• REPEATED DOUBTS (LEAVING LIGHTS ON OR LEAVING THE DOOR UNLOCKED)

• COMPULSIONS AS DEFINED BY:

• REPETITIVE BEHAVIORS OR MENTAL ACTS THAT THE PERSON FEELS DRIVEN TO PERFORM IN RESPONSE TO AN OBSESSION OR ACCORDING TO RIGIDLY APPLIED RULES

• THE BEHAVIORS OR ACTS ARE AIMED AT REDUCING DISTRESS OR PREVENTING SOME DREADED SITUATION HOWEVER THESE ACTS OR BEHAVIORS ARE NOT CONNECTED IN A REALISTIC WAY WITH WHAT THEY ARE DESIGNED TO NEUTRALIZE OR PREVENT.

• REPETITIVE BEHAVIORS (E.G., HAND WASHING, ORDERING, CHECKING) OR MENTAL ACTS (E.G., PRAYING, COUNTING, REPEATING WORDS SILENTLY) THAT THE PERSON FEELS DRIVEN TO PERFORM IN RESPONSE TO AN OBSESSION, OR ACCORDING TO RULES THAT MUST BE APPLIED RIGIDLY.

• CLEANING (SPOTS ON WINDOWS)

• COUNTING (HOW MANY CARDS IN A DECK, OVER AND OVER AGAIN).

• CHECKING (LIGHTS TO MAKE SURE THEY’RE OFF; LOCKED DOORS FREQUENTLY)

• (CLOTHES)-DRESSING REQUEST/DEMAND ASSURANCES

• REPEAT ACTIONS & ORDERING.

• 2% OF GENERAL POPULATION

• MEAN ONSET 19.5 YEARS

• 25% START BY AGE 14

• MALES HAVE EARLIER ONSET THAN FEMALES

• FEMALE: MALE 1:1

• >60% HAVE LIFETIME DX OF A MOOD DISORDER MDD BEING THE MOST COMMON

• >70% HAVE LIFETIME DX OF AN ANXIETY DISORDER SUCH AS

• UP TO 30% HAVE A LIFETIME TIC DISORDER

• 15 % ALCOHOL AND OTHER SUBSTANCE DIS.

• 12% OF PERSONS WITH SCHIZOPHRENIA/ SCHIZOAFFECTIVE DISORDER

• EATING DISORDERS (ANOREXIA/BULIMIA NERVOSA)

• PERSONALITY DISORDERS: (OBSESSIVE COMPULSIVE PERSONALITY DISORDER, AVOIDANT PERSONALITY DISORDER, DEPENDENT PERSONALITY DISORDER)

• SCHIZOPHRENIA/ SCHIZOAFFECTIVE DISORDER

• OTHER ANXIETY DISOREDERS

• DEPRESSIVE DISORDER

• ALCOHOL AND OTHER SUBSTANCE DIS.

• TIC DISORDER

• LEARNING DISORDERS

• DISRUPTIVE BEHAVIOR DISORDERS

• HYPOCHONDRIACAL CONCERNS: MAKE REPEATED VISITS TO THE DOCTOR FOR REASSURANCE.

• COGNITIVE BIAS

• AVOIDANCE OF SITUATIONS; KEEP TO THEMSELVES MOSTLY; STAY AT HOME (SO OTHERS DON’T SEE ODD BEHAVIORS).

• THOSE WITH MILD CASES MAY BE QUITE SUCCESSFUL IN LIFE BECAUSE THEY ARE OVERLY CONSCIENTIOUS AND ARE PERFECTIONISTS.

• OCD AFFECTS NOT ONLY THE SUFFERER, BUT THE WHOLE FAMILY

• IDENTIFIED AS SENSELESS- BELIEVE THAT PT CAN STOP THOSE BEHAVIORS

• FAMILY MEMBERS MAY SHOW ANGER OR RESENTMENT, RESULTING IN AN INCREASE IN THE OCD BEHAVIOR

• OTHER TIMES, TO KEEP THE PEACE, THEY MAY ASSIST OR ENABLE THE RITUALS

• EDUCATION THE FAMILY ABOUT OCD IS ESSENTIAL !!!!

• MAY EXPERIENCE A WAXING AND WANING COURSE

• ABOUT 5% HAVE AN EPISODE COURSE WITH MINIMAL OR NO SYMPTOMS BETWEEN EPISODES.

• PROGRESSIVE DETERIORATION IN OCCUPATIONAL AND SOCIAL FUNCTIONING

• 90% OF PATIENTS CAN EXPECT TO HAVE MODERATE TO MARKED IMPROVEMENT WITH OPTIMUM TREATMENT.

• OCD TENDS TO LAST FOR YEARS, EVEN DECADES. THE SYMPTOMS MAY BECOME LESS SEVERE FROM TIME TO TIME, AND THERE MAY BE LONG INTERVALS WHERE SYMPTOMS ARE MILD

• FOR MOST, THE SYMPTOMS ARE CHRONIC

• WITH A COMBINATION OF PHARMACOTHERAPY AND BEHAVIOR THERAPY, SYMPTOMS CAN BE CONTROLLED

• PAEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS

• PAEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME)

• PENICILLIN

• 40-60% TREATMENT RESPONSE

• SEROTONERGIC ANTIDEPRESSANTS

• BEHAVIOR THERAPY

• ADJUNCTIVE ANTIPSYCHOTICS

• PSYCHOSURGERY

• BREAKING THE VICIOUS CYCLE

• ERP- EXPOSURE AND RESPONSE PREVENTION

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Casebook

Casebook

2019