Overview

• OCD → obsessional thoughts and/or compulsive activities, present on most days for ≥2 consecutive weeks that impact normal functioning.
  • Obsessions → repetitive, unwanted, and intrusive thoughts repeatedly enters the person’s mind.
  • Compulsions → repetitive behaviours or mental acts that the person feels driven to perform, caused by the obsession.
• Prevalence is 1-3%.
• Risk Factors → family history, age between 10-20 years old, pregnancy/postnatal period, history of abuse/bullying/neglect.

Making Diagnosis

Clinical Features

<aside> 💡 MAINTAINED AWARENESS AND INSIGHT INTO THOUGHTS AND ACTIONS.

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Investigations

• Classification of OCD Severity → Yale-Brown OCD Scale. Classify into mild, moderate or severe.

Management Plan

• 1st Line (if mild functional impairment) → low-intensity psychological therapies.
  • CBT with ERP (Exposure and Response Prevention).
    • ERP is a central technique within cognitive-behavioural therapy (CBT) designed to treat obsessive-compulsive disorder (OCD). This modality is rooted in the concept of habituation: by exposing an individual to the trigger of their obsessive thoughts or behaviours without permitting the ensuing compulsion, the anxiety or urge usually diminishes over time.
• 2nd Line (if moderate functional impairment - ie. lost job, not functioning) → SSRI (fluoxetine). Continue for at least 12 months after remission of symptoms.
  • When treating OCD, compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response.
  • If <12 weeks and ineffective, try increasing dose. Only move onto 3rd line after 12 weeks.
• 3rd Line → clomipramine or alternative SSRI.
  • Considered if first SSRI is ineffective after 12 weeks.
  • TCAs (Antimuscarinic Side-Effects) → dry mouth, blurred vision, constipation, urinary retention, tachycardia. (Can’t see, can’t pee, can’t spit, can’t shit).

Severe Functional Impairment → refer to secondary care mental health team for assessment. Whilst awaiting assessment start SSRI + CBT.

Complications → may have comorbid depression and eating disorders.