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.

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.^[19]These imaging modalities, while of value for research, are not indicated for normal workups.

Other Evaluations

Once the diagnosis is suspected, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)^[2]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.

Treatment & Management

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Obsessions	Commonly Associated Compulsions
Fear of contamination	Washing, cleaning
Need for symmetry, precise arranging	Ordering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive thoughts or images	Checking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked)	Repeated checking behaviors
Concerns about throwing away something valuable	Hoarding

Obsessive-Compulsive Disorder Workup

Approach Considerations

Imaging Studies

Other Evaluations

References

Tables

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