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Obsessive Compulsive Disorder. Features of OCD. Obsessions Recurrent and persistent thoughts; impulses; or images of violence, contamination, and the like intrusive and distressing Individual tries to ignore, suppress, or neutralize Compulsions

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Presentation Transcript
features of ocd
Features of OCD
  • Obsessions
    • Recurrent and persistent thoughts; impulses; or images of violence, contamination, and the like
    • intrusive and distressing
    • Individual tries to ignore, suppress, or neutralize
  • Compulsions
    • Repetitive behaviors individual feels driven to perform
    • Ritualistic/need to follow a set of rules
    • Intended to prevent or reduce distress or some dreaded event
dsmiv
DSMIV
  • See webpage:
  • http://anxiety.psy.ohio-state.edu/ocd1.htm
ocd features
OCD Features
  • Data from the Epidemiological Catchment Area (ECA) survey found a 6-month point prevalence of 1.6% and a lifetime prevalence of 2.5% in the general population
  • Sex ratio is 1:1.1 (men to women)
  • Mean age of onset is 20.9 years (SD=9.6)
    • Males is 19.5 years (SD = 9.2)
    • Females is 22.0 years (SD = 9.8)
  • Most develop their illness before the age of 25
  • Symptoms can be remembered as far back as the onset of puberty.
comorbidity
Comorbidity
  • Major depression is the most common comorbid disorder
    • 1/3 have concurrent MDD
    • 2/3 have a lifetime history of MDD
  • Other Axis I disorders include panic disorder with agoraphobia, social phobia, generalized anxiety disorder, Tourette’s syndrome, trichotillomania, schizophrenia
  • Axis I comorbid disorders can effect the severity and treatment of OCD.
comorbidity1
Comorbidity
  • Obsessive-compulsive personality disorder (OCPD) is an Axis II disorder. OCPD differs from OCD by the lack of true obsessions and compulsions.
more features
More features
  • Types of Obsessions
    • Aggressive obsessions
    • Contamination obsessions
    • Sexual obsessions
    • Hoarding/saving obsessions
    • Religious obsessions
    • Symmetry/exactness
    • Somatic obsessions
slide8
Types of compulsions
    • Cleaning/washing compulsions
    • Checking compulsions
    • Repeating rituals
    • Counting compulsions
    • Ordering/arranging
    • Hoarding/collecting
    • Mental rituals
is ocd experienced by the normal population
IS OCD Experienced by the Normal Population??
  • Most people experience intrusive thoughts throughout their life
  • Individuals who develop OCD may react more negatively to their intrusions
neurobiology physiology
Neurobiology/physiology
  • No chronic hyperarousal
  • Over activation of the orbitofrontal cortex (thought generation) and under activation of the caudate nuclei (thought suppression)
psychosocial
Psychosocial
  • Learning
    • Animal models
      • High stress or repeated frustration leads to increase in ritualistic-like behaviors
      • Fixed action pattern- innate and adaptive behavioral sequences to specific stimuli
    • Biological preparedness
      • Washing and checking may have once promoted survival
slide12
Cognitive deficits
    • Increased attention allocated to fear related stimuli
    • Tend to encode negative stimuli more indepth than neutral and positive stimuli, leading to better memory for negative stimuli
    • Overattention to detail
cognitive theory of ocd
Cognitive theory of OCD
  • Obsessional thoughts:
    • If obsessions occur frequently in normal populations, why don’t most people suffer from OCD?
    • It’s not the thought itself that is disturbing, but rather the interpretation of the thought.
      • Example: having an unacceptable sexual thought leads to beliefs that the person is depraved, perverted, abnormal, evil, etc…., which leads to affective states such as anxiety and depression.
    • The issue of responsibility is believed to be a core belief or cognitive distortion of people with OCD.
slide14
There are three main consequences of neutralizing behavior
    • It results in reduced discomfort, which leads to the development of compulsive behavior as a tool for dealing with stress. This reinforcing behavior may result in a generalization of this strategy
    • Neutralizing will be followed by non-punishment, and can lead to an effect on the perceived validity of the beliefs (NAT)
    • The neutralizing behavior itself becomes a powerful and unavoidable triggering stimulus. The neutralizing behavior serves to reinforce the belief that something bad may happen
pharmacotherapy
Pharmacotherapy
  • Serotonin (5-HT) neurotransmission abnormalities have been implicated in the pathophysiology and treatment
  • Antidepressant medications of the Serotonin Reuptake Inhibitor classification and specific tricyclic antidepressants (Clomipramine) have been proven to be effective in the treatment of OCD
slide16
Currently there are 6 SSRIs that are FDA approved for the treatment of OCD
    • Clomipramine (Anafranil)
    • Fluoxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Citalopran (Celexa)
    • See Graybiel article for hypotheses regarding neural etiology of disease state!!
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