Obsessive Compulsive Disorder (OCD)

Recurrent thoughts and/or compulsive acts

Aetiology

  • Mean age of onset - 20
    • Peak incidence for males - 13-15
    • Peak incidence for females - 24-25

Clinical presentation

Obsessional thoughts

  • Unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore
  • Examples include an overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind

Compulsive acts

  • Repetitive actions the person feels they must do, generating anxiety if they are not done
  • Often these compulsions are a way for the person to handle the obsessions e.g. checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down
    • This is a normal behaviour, but in OCD the person may check every plug in the house 10 times before being able to go to sleep or leave

Investigations

Diagnostic criteria

  • Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and
    interference with activities
  • Obsessions must be individuals own thoughts
  • Resistance must be present
  • Rituals are not pleasant
  • Obsessional thoughts/images/impulses must be repetitive

Management

  1. Low intensity psychological intervention - CBT and ERP
  1. More intensive psychological intervention or SSRI
    1. If effective continue for 1 year
  1. Consider increase in dose after 4-6 weeks
  1. SSRI plus CBT and ERP
  1. Clomipramine (tricyclic antidepressant)
  1. Augmentation with antipsychotic or clomipramine plus citalopram