OCD
definition
OCD is characterized by recurrent obsessional thoughts or compulsive acts or, commonly, both, which may cause significant functional impairment and/or distress.
symptoms
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Obsessions: persistent thoughts, pictures, urges or doubts
that appear in your mind again and again. They interrupt your
thoughts against your control, and can be really frightening,
graphic and disturbing. They may make you feel anxious,
disgusted or uncomfortable.
Compulsions: repetitive activities that you feel you have to
do. The aim of a compulsion is to try and deal with the
distress caused by obsessive thoughts.
complications
risk of self harm or suicide
)
risk of dermatitis due to increased hand washing.
reduce quality of life
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differential diagnosis
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Obsessive-compulsive personality disorder (OCPD).
Body dysmorphic disorder (BDD).
Somatic symptom disorder.
Illness anxiety disorder.
Delusional disorder.
Autism spectrum disorder.
Hoarding disorder.
Trichotillomania.
Excoriation disorder.
Substance-induced or medication-induced obsessive
compulsive disorder.
diagnosis
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Screen people with symptoms of depression, anxiety, alcohol
or substance misuse, body dysmorphic disorder, or an eating
disorder, and those reporting symptoms suggestive of OCD.
Diagnosis can be supported with use using criteria from the
International Classification of Disease and/or the Diagnostic
and Statistical Manual of Mental Disorders. Note: These
diagnostic criteria do not offer a minimum number of
symptoms or specific time period to support a definitive
diagnosis, and should therefore be used in conjunction with
clinical judgement.
Primary care presentations often dermatological, genital or
anal from excessive checking or washing. Stress may also be
a factor.
Suspicion of OCD would be escalated to GP or secondary
care for specialist assessment as per NICE Guidance and
local policy
management
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Assess severity of symptoms, effect on ADLs and quality of
life. Consider that OCD may exist with other mental health
disorders.
Assess risk of suicide or self-harm.
Refer for specialist treatment, secondary care specialist
service, secondary care mental health service or for
psychological treatment dependant on clinical judgement and
patient presentation/severity of symptoms
self help groups, medication, talking therapies, social care
support
Ask about effects on work/school/relationships/social life and quality of life. Gather more information on the initial six questions during diagnosis. Consider use of severity rating scale such as Yale-Brown Obsessive-Compulsive Scale.
If the person is exhibiting severe distress and/or functional impairment, co-morbid depression or another mental health disorder, or other concerns have been raised, assess their risk of suicide and self-harm.
For people being managed in primary care, provide written material about the nature of OCD and its treatment options.
SSRI: Escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline are all licensed for the treatment of OCD in adults. Discuss potential for adverse effects and withdrawal symptoms before drug treatment is initiated. Dose for treatment of OCD is higher and a longer duration (at least 12 weeks for an initial response).
Monitoring: be alert for suicidal ideation and assess risk. Monitor progress - including severity, duration of symptoms, degree of distress and functional impairment. Check adherence to treatment and any side effects from medication. If drug effective - advise the person to take it for at least a year. Re-evaluate the frequency required for follow up considering - person's preference, severity, comorbid conditions, change since last review, response to treatment and symptoms during treatment changes.