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OCD (Development & Course (mean age of onset: 19.5 (25% start by 14…
OCD
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Obsessions
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thoughts, impulses, images
intrusive, cause great anxiety
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eg. harming loved ones, being contaminated
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most common: doubt, contamination
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Functional Consequences
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difficult family relationships, less likely to be married
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developmental issues for children: avoiding peer interactions, lacking autonomy
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Compulsions
repetitive behaviors or mental acts e.g.. hand washing, ordering, counting
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aimed at preventing, reducing distress
most common: control, washing
young children may not be able to articulate the aims of the compulsions (in children, you can still diagnose even if they are not aware)
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Cognitive Confidence: distrusting perception, attention, memory
confidence in attention uniquely related to checking behavior --> repeated checking caused increased levels of distrust
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interaction: experiences of personal responsibility + biased assessment of harm + reduced confidence
Method of the study
patients with OCD, psychiatric controls, nonclinical controls
- repeated actions task
- questionnaire assessment: self-report scale, Meta Cognition, Cognitive Confidence, Beck Depression
Results
OCD patients had higher scores for Cognitive confidence & general negative beliefs sub scales (in comparison with clinical controls)
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OCD group had lower levels of confidence in general memory, reality monitoring, attention
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Treatment
CBT
best long term effects, low relapse, best if CBT done alone (effects last at least 2 years)
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combination with medication is complicated but you would rather give medication if: comorbidity with depression, if obsessions are not visible
Medication
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long term side effects: weight increase, sexual dysfunction
short term side effects: nausea, headache, sleep disturbance, sweating
New Therapies
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Neurosurgery
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Risks: Infection, bleeding, epilepsy, delirium, personality changes, neuropsychological dysfunction --> IRREVERSIBLE
Effect: hard to tell because the studies are too old, selection bias, not blind, no evaluation of personality, no reliable outcome measures, recent studies: 25-32% success rate (quite good)
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maybe not necessarily looking at specific obsession but looking more broadly at other symptoms, traits etc. (more subtle signs)
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Biopsychosocial etiology
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Belief Coeffect Model
interact, reinforce each other
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