QuestionSBA
QuestionChoice
This history does not suggest mania or any of the core features of depression.
10017224
d
Bipolar disorder
QuestionChoice
This would be unlikely to result in ritualistic behaviour. None of the core features of depression are mentioned (low mood, anhedonia or fatigue).
10017222
b
Depression
QuestionChoice
This also is unlikely to cause ritualistic behaviour in the same way, and intrusive thoughts would not necessarily lead to compulsions.
10017223
c
Generalised Anxiety
QuestionChoice
This describes the obsessions (intrusive unwanted thoughts) and compulsions (ritualistic or repetitive actions) which are classically worsened when the patient is stressed.
10017221
a
Obsessive compulsive disorder
QuestionChoice
This history does not mention any of the main features of EUPD, including impulsive behaviour or difficulty maintaining relationships.
10017225
e
Emotionally unstable personality disorder
QuestionComment
The stem doesn't describe the fact the 'compulsion' is required to dispel the negative feelings associated with the 'obsession' though? It describes it as two separate symptoms? idk
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# Summary

Obsessive-Compulsive Disorder (OCD) is a debilitating psychiatric condition characterized by intrusive thoughts and repetitive behaviors. According to both ICD-11 and DSM-V criteria, individuals with OCD experience distressing obsessions, leading to compulsive rituals that consume significant time and impair daily functioning. Affecting 1-3% of the population, OCD often emerges in adolescence, with a chronic course. Biological factors, including genetic and neurobiological elements, contribute to its etiology. While cognitive-behavioral therapy and pharmacotherapy prove effective in management, complications such as impaired quality of life underscore the need for comprehensive, early intervention. 

# Definition

Obsessive-compulsive disorder (OCD) is characterized by recurrent obsessional thoughts or compulsive acts or, commonly, both, which cause significant functional impairment and/or distress.

**ICD-11 Criteria:**

- Presence of obsessions, compulsions, or both.
- Time-consuming (more than one hour a day) or causes significant impairment.
- Not attributed to another medical or mental disorder.

**DSM-V Criteria:**

- Presence of obsessions, compulsions, or both.
- Time-consuming or cause significant distress/impairment.
- Not attributable to another medical or mental disorder.

# Epidemiology

- Affects approximately 1-3% of the population.
- Onset often in adolescence or early adulthood.
- Variable course, with chronicity common.

# Aetiology

- **Biological Factors:** Genetic predisposition, neurobiological abnormalities.
- **Psychological Factors:** Early life experiences, cognitive processes. Often co-exists with other mental health conditions.
- **Environmental Factors:** Trauma, stressors.

# Clinical Features

- **Obsessions:** Intrusive, unwanted thoughts or images causing distress.
- **Compulsions:** Repetitive behaviors or mental acts aimed at reducing anxiety.
- Significant time investment and interference with daily life.

Symptom severity can be assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). With scores: 8 - 15 = Mild OCD, 16 - 23 = Moderate OCD, 24 - 31 = Severe OCD, 32 - 40 = extremely severe OCD.


# Differential Diagnosis


- **Generalized Anxiety Disorder (GAD)**
  - *Similarity:* Intrusive thoughts.
  - *Difference:* GAD involves excessive worry across various domains, while OCD focuses on specific obsessive themes and compulsive rituals.

- **Major Depressive Disorder (MDD)**
  - *Similarity:* Intrusive thoughts and impaired daily functioning.
  - *Difference:* MDD primarily involves persistent low mood, whereas OCD centers on anxiety-provoking obsessions and compulsions.

- **Body Dysmorphic Disorder (BDD)**
  - *Similarity:* Preoccupation with appearance.
  - *Difference:* BDD centers on perceived flaws, while OCD involves intrusive thoughts unrelated to personal appearance.

- **Social Anxiety Disorder (SAD)**
  - *Similarity:* Avoidance behaviors.
  - *Difference:* SAD's avoidance stems from fear of social scrutiny, while OCD avoidance is driven by anxiety related to obsessions.

- **Trichotillomania (Hair-Pulling Disorder)**
  - *Similarity:* Repetitive behaviors.
  - *Difference:* Trichotillomania involves compulsive hair pulling, distinct from OCD's varied ritualistic behaviors.

- **Hoarding Disorder**
  - *Similarity:* Compulsive behaviors.
  - *Difference:* Hoarding focuses on difficulty discarding possessions, while OCD involves rituals unrelated to possessions.

- **Post-Traumatic Stress Disorder (PTSD)**
  - *Similarity:* Intrusive thoughts.
  - *Difference:* PTSD results from trauma exposure, whereas OCD involves persistent, non-trauma-related obsessions.

- **Autism Spectrum Disorder (ASD)**
  - *Similarity:* Repetitive behaviors.
  - *Difference:* ASD features repetitive behaviors related to restricted interests, distinct from OCD's varied rituals.

# Management

Management of OCD is stratified according to the severity of the condition:

* Mild functional impairment:
	* Low-intensity cognitive-behavioural therapy (CBT), including exposure and response prevention (ERP)
- Moderate functional impairment:
	- Offer a choice of intensive CBT including ERP **or** an SSRI
	- Escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline are all licensed for the treatment of OCD in adults
	- Clomipramine is an alternative to SSRI if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
- Severe functional impairment: 
	- Combined treatment with intensive CBT (including ERP) **and** an SSRI 
- If a medication is effective, it should be continued for a minimum of 12 months. Once they have taken an SSRI or clomipramine for 12 months after remission (symptoms are not clinically significant and the person is fully functioning for at least 12 weeks), review the need for continued treatment.


# NICE Guidelines

[NICE CKS - OCD](https://cks.nice.org.uk/topics/obsessive-compulsive-disorder/)
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Obsessive compulsive disorder (OCD)
Topic
18
Psychiatry
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Obsessive Compulsive Disorder is characterised by intrusive thoughts and ritualistic behaviours, often exacerbated by stress.
A 30-year-old PhD student is particularly stressed about her upcoming viva and would like to learn about therapy options.

On further history taking, she describes distressing images flashing into her mind and she often feels she is unable to leave the house without turning the lights on and off multiple times.

What is the most likely diagnosis?
a