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Psychiatry [OCD + RELATED DISORDERS]

Obsessive-Compulsive and Related Disorders share the same


common thread of an irrational, anxiety-provoking thought or
need that can only be alleviated by doing a particular anxiety-
reducing action or ritual. We use obsessive-compulsive as the
model for pathology and treatment for the rest, hence why we
spend the most time on it. The others are simply categorized by
their predominating obsession and compulsion. The goal is to
control the anxiety (the compulsion) or displace the compulsion
to something innocuous.

Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder


Patients have persistent, intrusive, unwanted thoughts (the Obsession Compulsion
obsessions) that provoke anxiety. The only way to relieve these Contamination Cleaning
obsessions is by performing repeated behaviors or mental acts Symmetry Order/Counting
(the compulsions) that neutralize the anxiety. The patient is Safety Lock Checking
painfully aware of the actions/thoughts and how irrational they
are; they’ll often seek help. Frequent distress (at least one hour a
day) is required for the diagnosis. Obsessive-Compulsive
disorder is a disorder when function becomes impaired: social
interactions, academic performance, or job performance. The CBT used is Exposure and Response Prevention (ERP)
Psychotherapy (CBT) is better than medications in treating
OCD. Therapy is directed either at controlling the anxiety Clomipramine is the TCA of choice
associated with the obsession (desensitization) or redirecting the
compulsion to something innocuous that also reduces the anxiety. SSRIs have lots of evidence, SnRIs have less
It’s a chronic anxiety disease, so treatment with SSRIs can be a
useful adjunct (TCAs, specifically clomipramine, are also shown
to work, but rarely is the right answer on the test). BZDs aren’t
for OCD – use them only in panic attack.
Disorder Obsessions Compulsions Effect
Hoarding Disorder Hoarding Distress about Retaining useless Unsafe Home
Patients have distress about the thought of losing items and thoughts of items: Trash,
therefore are unable to get rid of possessions, regardless of their ridding Trinkets
value. These patients often have cluttered homes with a lifetime possessions
of accumulated possessions that may compromise quality of life Body Perceived defects Appearance Excessive
or safety (fall risk, inability for emergency personnel to maneuver Dysmorphic in physical Checking cosmetic
around objects, etc.). The cluttering may be so pervasive that it Disorder appearance surgery
includes trash and or animal hoarding. Reassurance
Muscle Preoccupation Anabolic Steroids Rhadbo
Body Dysmorphic Disorder Dysmorphia with muscle size Roid Rage
Patients are disproportionately preoccupied with perceived Excessive “Copper”
defects or flaws in physical appearance, concerned they’re Exercise
unattractive or deformed. Focus usually centers on flaws of skin Trichot- Non-specifc Hair Pulling Hair in
(acne), hair, nose, breasts, or asymmetry of the body. In response illomania r/o Fungus different
to these concerns, patients excessively check their appearance lengths
in a mirror, engage in repetitive grooming, make comparisons or
seek reassurance about their appearance. Age of onset is during Bezoar
adolescence; many patients may resort to cosmetic surgery.

Muscle dysmorphia, (mostly in males), comprises a subset of


patients preoccupied with insufficient musculature, resulting in
patients using anabolic steroids or excessively weightlifting and
exercising.

Trichotillomania
Patients pull out their hair to reduce anxiety. If a patient has
alopecia we generally don’t jump to psych. But if it’s hair in
different lengths (vs a patchy alopecia) then it’s strongly
suggestive of trichotillomania vs medical disease. Take steps to
rule out hair loss disease (fungus in particular). If she presents
with a small bowel obstruction as well, think of a trichobezoar
(a hair ball).

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