Obsessive Compulsive Disorder - NEET PG Psychiatry

Obsessive Compulsive Disorder (OCD) is a commonly encountered mental health condition that affects a significant proportion of the population. It is a complex and multi-dimensional disorder that requires a thorough understanding of its various aspects, such as the nature and causes of obsessions and compulsions, and the impact it has on the individual's daily life. 

Furthermore, OCD is often comorbid with other psychiatric conditions, such as depression and anxiety disorders, which further highlights the importance of understanding the disorder for medical professionals. Studying OCD for the NEET PG exam can help aspiring psychiatrists to develop the skills necessary to diagnose and manage the disorder.

Read this blog post further to get a quick overview of this important psychiatry topic for NEET PG exam preparation.

Overview

In OCD, patients usually present with Obsessions and Compulsions.

• Obsessions are 
  • Recurrent, intrusive thought, images or impulses, which cause anxiety
  • Patient considers them as a product of their own mind (d/d- thought insertion)
  • Patient finds them excessive, irrational and senseless (D/d delusions - patient insists that his hands are dirty in spite of giving reasons and explaining that his hands are not dirty)
  • Patient tries to resist or neutralize the thought (but is usually unsuccessful)
• Compulsions are 
  • Repetitive behaviors/mental acts performed in response to obsessions (Mental acts to try to neutralize the thought)
  • They reduce anxiety temporarily 

Both obsessions and compulsions are Ego dystonic (not agreeable to self, they don’t want to do it but are compelled to do it)

Also Read :  Schizophrenia: History, Etiology, Symptoms For NEET PG

Etiology 

• Serotonergic dysregulation (Depression m/c comorbidity associated with this)
  • Dysregulation of serotonergic transmission
  • Dysfunction occurs in the CSTC Tract (Cortico-Striatal-Thalamic-Cortical)
• In patients with OCD, the bilateral caudate nucleus is smaller than the control groups.

Most Common Types

• Obsession of contamination with compulsion of washing: Most Common
• Pathological doubt with compulsions of checking: 2^nd most common

Treatment 

• Combination of pharmacotherapy and psychotherapy is most effective.
• Pharmacotherapy
  • SSRIs > Clomipramine: 1^st line (as SSRIs have better side effect profile)
  • Antipsychotics used as adjuvants in patients not responding to earlier treatment 
    • To enhance/improve the efficacy of SSRIs and Clomipramine
    • If given alone in patients of OCD, it will not help
• Psychotherapy: Exposure and response prevention (type of CBD) most effective therapy for OCD
  • Example, 
    • Exposure: First ask the patient to touch the floor: Thought that his hands are dirty increases significantly 
    • Response prevention: Stop the patient from washing his hands

Also Read :  All About Panic Disorder and Phobias

BODY-FOCUSED REPETITIVE BEHAVIOR DISORDERS

In this there is repetitive behavior which is focused on the body.

Trichotillomania

• Patient has an urge to pull out the hair
• Symptoms: Loss of scalp hair, eyebrow hair, etc

Important Information

• Some patients swallow the hair: Trichophagy
• Repeated swallowing of the hair causes accumukation of bundles of hair in the intestine and stomach: Trichobezoar 

Previous Year Questions from Psychiatry 

Q. A patient underwent surgery and a mass of hair found in her stomach. Which specialist should be consulted with? (FMGE 2022)

A. Dermatologist

B. Cardiologist

C. Psychiatrist

D. Neurologist 

Ans C

Excoriation disorder

• Patients usually keep on picking or removing small parts of the skin.
• Symptoms: Lesions are present usually on the fingers

Treatment

• SSRIs
• Cognitive behavior therapy

BODY DYSMORPHIC DISORDER

• Preoccupation with an imagined defect in body appearance
• Example, the patient says his nose is deformed, but in reality, no abnormality or minor insignificant abnormality is there

Multiple Choice Questions on OCD

Q. Continuous rigorous washing of hands is suggestive of: (FMGE 2022)

A. Obsessive compulsive

B. Generalized anxiety disorder

C. Adjustment disorder

D. Panic disorder

Ans. Obsessive compulsive

Q. Excessive fear of getting contaminated, repeated washing, repetitive Checking behavior and excessive doubts are features of? (FMGE Aug 2020)

A. Panic attack. 

B. Agoraphobia

C. Obsessive compulsive Disorder

D. Generalized anxiety Disorder

Ans. Obsessive compulsive disorder

Q. Most common symptom associated with adult OCD? (AIIMS May 2018)

A. Pathological doubt

B. Need for symmetry

C. sexual

D. Aggressive 

Ans. Pathological doubt

To study OCD in detail along with other Psychiatry topics for NEET PG exam preparations, download the PrepLadder app.