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Tiffany Wang

on 2 May 2014

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Transcript of OCD

Chau Tran
Jessica Trinh
Tiffany Wang Obsessive
Intrusive and irrational thoughts, impulses, or images that are experienced at some time during the disturbance
"my hands must be contaminated"
Compulsions are defined as:
Repetitive behaviors or mental acts that the person feels driven to perform in response to
an obsession in order
to reduce stress or
prevent a dreaded
situation TYPES OF OCD Behavioral
Due to learned behavioral-related habits
Conditioned response to reduce anxiety
Fraternal twins: 40-50%
Identical: 80%
PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Abnormalities in the brain Background
Cortico-Basal Ganglia Connections
Serotonin Dysfunction
Behavioral Therapy
AREAS: OCD PATHWAY Orbitofrontal cortex - cognitive processing of decision making
Caudate nucleus - regulates "automatic" behaviors (such as brushing teeth and walking)
Thalamus - screens caudate information and signals back to the frontal cortex Information from the frontal cortex flows into the indirect & direct pathways of the basal ganglia:
Direct Pathway – excitatory
Facilitates thalamic stimulation of the cortex
Indirect Pathway – inhibitory
Inhibits the thalamas, allowing the cortex to respond to novel stimuli
In OCD there is an imbalanced stimulation of the direct pathway and indirect pathway which contributes to the compulsive and repetitive behaviors. Overstimulation of the caudate nucleus increases activity of the thalamus which sends a flood of signals back to the frontal cortex to cause repetitive behavior DYSREGULATION OF
SEROTONIN Serotonin is a neurotransmitter that's involved in regulating anxiety, mood, sleep
In OCD, some receptors are thought to block serotonin from entering the cell
In one study, lower levels of serotonin are associated with OCD involving disinhibited approach behaviors (recurrent violent thoughts), and higher than normal levels are associated with OCD involving avoidance behaviors (washing and checking) Treatment by SSRI's Most studies show that patients with OCD have lower levels of serotonin
Studies show that reduced serotonin transporters availability in the mibrain may reflect the low serotonin levels
SSRI - selective serotonin reuptake inhibitor
Block reuptake to make serotonin more available in the synapse for other neurons EXPOSURE AND RITUAL PREVENTION (ERP) Components:
Exposure in vivo : patient confronts cues that trigger obsessive thoughts
Imaginal exposure: patient imagines distressing thoughts/situations
Ritual Prevention: patient is instructed to abstain from performing the behavior produced by the obsession
Processing: discuss the patient’s experience Checking rituals - patients feel like they didn't perform a task correctly so they repeatedly perform it over and over until it's "just right"
Ex. checking to see if the door is closed right
Cleaning - patients avoid contact with contaminated objects
Ex. washing the dishes over and over
Obsessive thoughts - patients have recurrent and unwanted thoughts that are not expressed as behavioral rituals
Ex. thinking that you murdered someone
Other types - ordering rituals, obsessional slowness where patients are "stuck" performing a routine task Jenike et al. (1986) Jenike et al. (1986)
Walitza et al. (2011) orbitofrontal cortex caudate nucleus EARLY BEHAVIORAL THERAPY Systematic Desensitization
Gradual exposure to anxiety-provoking stimuli while the patient is in a relaxed state
Aversion Therapy
“Rubber-band snapping technique”
The patient is instructed to snap the rubber band on their wrist every time they have an obsessive thought
The therapist or patient shouts “stop” immediately after an obsessive thought
These two methods were not effective in reducing OCD symptoms. DIAGNOSIS Criteria:
Individual must have obsessions or compulsions that are present for most days for at least 2 successive weeks
Symptoms are not a result of outside influences
Individual must realize that obsessions or compulsions are excessive and unreasonable
Individual tries to resist them but at least one obsession or compulsion is unsuccessfully resisted
Obsessions and compulsions significantly interfere with daily activities
They are unpleasantly repetitive OVERVIEW: OCD is classified as illogical obsessions that lead to uncontrollable repetitive behaviors
OCD can be caused by hyperactivity of the caudate nucleus, which thereby causes an imbalance of the direct and indirect pathways
Deficiency in serotonin contributes to the anxious nature of OCD, which can be treated with antidepressants such as SSRI’s or psychotherapy References http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181954/





http://ocd.standord.edu/about/understanding.html Mac Master (2010)
Rosenberg & MacMillan (2002) OCD is one of the more common mental illnesses of children and adolescents, with a prevalence of 1% to 3%. Walitza et al. (2011) Obsessive-compulsive disorder (OCD) is a psychiatric condition first described 100 years ago. Nedstadt et al. (2010) Walitza et al. (2011) Jarry & Vaccarino (1995) Stengler-Wenzke et al. (2003) Foa (2010) "Textbooks of Anxiety Disorders" by Dan J. Stein
"Obsessive Compulsive Disorders: Theory and Management" by Jenike
"The Boy Who Couldn't Stop Washing" by Rapoport Foa (2010) thalamus Thank you for your attention! THE
END Now let's watch a video... PET and fMRI studies of OCD patients showed increased regional cerebral blood flow and brain activation in the caudate nucleus and orbitofrontal cortex. Rosenberg et al. (2012) OCD patients who responded to treatment with SSRI paroxetine demonstrated a significant reduction in glucose metabolism in the right caudate nucleus and right anterior orbital frontal cortex. Rosenberg et al. (2012) Comparable reductions in right caudate glucose metabolism correlated with reduction in OCD symptom severity were noted before and after 10 weeks of treatment with either a SSRI or CBT. Rosenberg et al. (2012) http://proxylib.csueastbay.edu/login?url=http://digital.films.com/PortalPlaylists.aspx?aid=2033&xtid=41333 Hesse et al. (2005) MRI (left) and co-registered SPECT images with regions of interest for (B) thalamus & hypothalamus, (C) midbrain, and (D) brainstem Hesse et al. (2005) Using SPECT , SERT radiotracers, and MRI-based co-registration, scientists found significantly reduced SERT availability in the thalamus/hypothalamus Hesse et al. (2005) Hesse et al. (2005) 5:50-6:22 and 27:25
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