28/9/2014 Obsessive-Compulsive Disorder Workup

http://emedicine.medscape.com/article/1934139-workup 1/3
Obsessive-Compulsive Disorder Workup
Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD more...
Updated: Apr 24, 2014
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.
[17]
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.
Contributor Information and Disclosures
Author
William M Greenberg, MD Medical Director, Mental Health Association of Rockland County; Professor, St
George's University School of Medicine; Private Practice
William M Greenberg, MD is a member of the following medical societies: American Medical Association and
American Psychiatric Association
Disclosure: Nothing to disclose.
Chief Editor
David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, 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: Wolters Kluwer Royalty Author
Additional Contributors
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
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