Obsessive-Compulsive Disorder Workup

  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Dec 29, 2011
 

Approach Considerations

Imaging studies are normally considered research tools in the study of OCD, rather than diagnostic modalities for patients with the condition. However, tests for the assessment of symptom range and severity, as well as patient mental status, are valuable aids in the diagnosis and evaluation of OCD.

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Imaging Studies

Functional MRI and PET scanning have shown increases in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, caudate, and thalamus, with a trend toward right-sided predominance.

In some studies, these areas of overactivity have been shown to normalize following successful treatment with either SSRIs or CBT.[9] These imaging modalities, while of value for research, are not indicated for normal workups.

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Other Evaluations

Once the diagnosis is suspected, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)[23] is an important tool in defining the range and severity of symptoms and monitoring the response to treatment. The Y-BOCS consists of 10 items, including 5 for obsessions and 5 for compulsions, each of which is scored 0-4 (total score = 0-40). For obsessions and compulsions, these items rate time spent, interference with functioning, distress, resistance, and control.

In addition to use of the Y-BOCS, a complete Mental Status Examination should be performed. The patient should be evaluated for orientation, memory, disturbances of mood and affect, presence of hallucinations, delusions, suicidal and homicidal risk, and judgment (including whether insight into the irrational nature of their symptoms is still present).

Evaluate all patients with OCD for the presence of Tourette disorder or other tic disorders, as these comorbid diagnoses may influence treatment strategy. The findings on neurologic and cognitive examination should otherwise be normal. Focal neurologic signs or evidence of cognitive impairment should prompt evaluation for other diagnoses.

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Contributor Information and Disclosures
Author

William M Greenberg, MD  Director, Clinical Development, Forest Research Institute, Forest Laboratories, Inc; Visiting Scientist, Nathan S Kline Institute for Psychiatric Research; Private Practice

William M Greenberg, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Forest Laboratories, Inc. Salary Employment

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  2. Bienvenu OJ, Samuels JF, Wuyek LA, Liang KY, Wang Y, Grados MA, et al. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. Jan 2012;42(1):1-13. [Medline].

  3. Bartz JA, Hollander E. Is obsessive-compulsive disorder an anxiety disorder?. Prog Neuropsychopharmacol Biol Psychiatry. May 2006;30(3):338-52. [Medline].

  4. Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E. Epidemiologic and clinical updates on impulse control disorders: a critical review. Eur Arch Psychiatry Clin Neurosci. Dec 2006;256(8):464-75. [Medline]. [Full Text].

  5. Castle DJ, Phillips KA. Obsessive-compulsive spectrum of disorders: a defensible construct?. Aust N Z J Psychiatry. Feb 2006;40(2):114-20. [Medline]. [Full Text].

  6. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Arch Gen Psychiatry. Jan 1995;52(1):53-60. [Medline].

  7. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology (Berl). Apr 1998;136(3):205-16. [Medline].

  8. Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. Jul 2006;11(7):622-32. [Medline].

  9. Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. Sep 1992;49(9):681-9. [Medline].

  10. Pittenger C, Krystal JH, Coric V. Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx. Jan 2006;3(1):69-81. [Medline].

  11. van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive-compulsive disorder: a review. Twin Res Hum Genet. Oct 2005;8(5):450-8. [Medline].

  12. Carey G, Gottesman I. Twin and family studies of anxiety, phobic, and obsessive disorders. In: Klein DF, Rabkin JG. Anxiety: New Research and Changing Concepts. New York: Raven Press; 2000.

  13. Arnold PD, Rosenberg DR, Mundo E, Tharmalingam S, Kennedy JL, Richter MA. Association of a glutamate (NMDA) subunit receptor gene (GRIN2B) with obessive-compulsive disorder: a preliminary study. Psychopharmacology. August 2004;174:530-538.

  14. Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL. Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Arch Gen Psychiatry. Jul 2006;63(7):769-76. [Medline].

  15. Denys D, Van Nieuwerburgh F, Deforce D, Westenberg H. Association between the dopamine D2 receptor TaqI A2 allele and low activity COMT allele with obsessive-compulsive disorder in males. Eur Neuropsychopharmacol. Aug 2006;16(6):446-50. [Medline].

  16. Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee M, et al. Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Arch Gen Psychiatry. Jul 2006;63(7):778-85. [Medline].

  17. Lin PY. Meta-analysis of the association of serotonin transporter gene polymorphism with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. Apr 13 2007;31(3):683-9. [Medline].

  18. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. Dec 1988;45(12):1094-9. [Medline].

  19. Rapoport JL. The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. paperback. New York: Penguin Putnam; 2001.

  20. [Guideline] American Psychiatric Association Work Group on Obsessive-Compulsive Disorder. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007;164(suppl):1-56. [Full Text].

  21. Foa EB, Wilson R. Stop Obsessing!: How to Overcome Your Obsessions and Compulsions. Revis ed. New York: Bantam Dell; 2001.

  22. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research Department, New York State Psychiatric Institute; November 2002.

  23. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. Nov 1989;46(11):1006-11. [Medline].

  24. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial. Biol Psychiatry. Sep 1 2005;58(5):424-8. [Medline].

  25. Greenberg WM, Benedict MM, Doerfer J, Perrin M, Panek L, Cleveland WL, et al. Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults. J Psychiatr Res. Mar 2009;43(6):664-70. [Medline].

  26. Berlin HA, Koran LM, Jenike MA, et al. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. May 2011;72(5):716-21. [Medline].

  27. Grayson J. Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty. New York: Berkley Publishing Group; 2004.

  28. Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. Nov 2006;31(11):2384-93. [Medline].

  29. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. Nov 13 2008;359(20):2121-34. [Medline].

  30. Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotact Funct Neurosurg. 2006;84(4):184-9. [Medline].

  31. Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc; August, 2011. [Full Text].

  32. US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm. Accessed August 24, 2011.

  33. Komossa K, Depping AM, Meyer M, Kissling W, Leucht S. Second-generation antipsychotics for obsessive compulsive disorder. Cochrane Database Syst Rev. Dec 8 2010;12:CD008141. [Medline].

  34. FDA Public Health Advisory: Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. FDA Website. October 15, 2004;1-3. [Full Text].

  35. FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications. FDA Website. May 2, 2007;1-3. [Full Text].

 
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Table. Categorizing Obsessions and Compulsions
Obsessions Commonly Associated Compulsions
Fear of contaminationWashing, cleaning
Need for symmetry, precise arrangingOrdering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive thoughts or imagesChecking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked)Repeated checking behaviors
Concerns about throwing away something valuableHoarding
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