Psychiatrist in Obsessive-Compulsive Disorders Course

Lesson 1 • Epidemiology and Course of Illness

Prevalence, age of onset, sex differences, and longitudinal course data are presented. Understanding natural history informs prognosis discussions and early intervention rationale.

Lesson 2 • Defining Obsessions and Compulsions

Core phenomenological distinctions between obsessions, compulsions, and intrusive thoughts are examined. This anchors all subsequent diagnostic reasoning in precise symptom-level analysis.

Lesson 3 • Differential Diagnosis of OCD

Systematic differentiation from GAD, OCPD, body dysmorphic disorder, psychosis, and autism spectrum is taught. Misdiagnosis risks and their clinical consequences are highlighted.

Lesson 4 • OCD Symptom Dimensions and Subtypes

Empirically validated symptom dimensions—contamination, harm, symmetry, taboo thoughts—are mapped to clinical presentations. Subtype recognition guides treatment planning from the outset.

Lesson 1 • Cognitive and Learning Models

Cognitive appraisal models and fear conditioning frameworks explain symptom maintenance. These models form the theoretical basis for cognitive-behavioral interventions covered later.

Lesson 2 • Cortico-Striato-Thalamo-Cortical Circuitry

The CSTC loop's role in OCD symptom generation is detailed through neuroimaging and lesion data. Circuit-level understanding directly informs pharmacological and neuromodulation targets.

Lesson 3 • Serotonin and Glutamate Systems

Serotonergic and glutamatergic contributions to OCD pathophysiology are examined alongside treatment response data. This section bridges neuroscience to pharmacotherapy rationale.

Lesson 1 • Yale-Brown Obsessive Compulsive Scale

Administration, scoring, and interpretation of the Y-BOCS and CY-BOCS are practiced in detail. Reliable Y-BOCS use is essential for treatment monitoring throughout the course.

Lesson 2 • Clinical Interview Structure for OCD

A structured approach to eliciting obsessions, compulsions, avoidance, and reassurance-seeking is taught. Effective interviewing reduces underreporting of shame-laden symptoms.

Lesson 3 • Supplementary Rating Scales

Dimensional OCD scales, insight measures, and family accommodation tools are introduced. Multi-instrument assessment captures severity facets that the Y-BOCS alone does not address.

Lesson 4 • Case Formulation and Treatment Planning

Cognitive-behavioral and biopsychosocial formulation models are applied to synthesize assessment data. A structured formulation drives individualized, prioritized treatment plans.

Lesson 1 • Optimizing and Switching SRI Trials

Decision rules for dose escalation, adequate trial assessment, and switching agents are established. Systematic optimization prevents premature treatment failure declarations.

Lesson 2 • Special Populations: Pharmacotherapy

Pediatric, perinatal, elderly, and medically complex patients require modified pharmacological approaches. Safety, dosing, and monitoring adjustments for each population are specified.

Lesson 3 • Augmentation Strategies

Antipsychotic augmentation, glutamate modulators, and other adjunctive agents are reviewed with evidence grading. Augmentation is indicated when SRI monotherapy yields insufficient response.

Lesson 4 • Long-Term Pharmacological Management

Maintenance therapy duration, relapse prevention, and discontinuation criteria are addressed. Long-term planning integrates pharmacotherapy with psychotherapy outcomes.

Lesson 1 • Theoretical Basis of ERP

Inhibitory learning theory, habituation, and extinction models underpin ERP's mechanism of action. Understanding these models enables psychiatrists to explain ERP rationale to skeptical patients.

Lesson 2 • Response Prevention Techniques

Strategies for blocking overt and mental compulsions during and between sessions are detailed. Response prevention is the mechanism that prevents fear from being reinforced.

Lesson 3 • Monitoring and Troubleshooting ERP

Common ERP obstacles—avoidance, subtle rituals, therapist accommodation—are identified and addressed. Psychiatrists use this knowledge to support therapy adherence during medication management.

Lesson 4 • Cognitive Techniques in CBT for OCD

Cognitive restructuring targeting OCD-specific appraisals is integrated with behavioral techniques. Cognitive work enhances ERP engagement without replacing behavioral exposure.

Lesson 1 • Multidisciplinary Team Coordination

Coordinating care across psychiatry, psychology, neurosurgery, and social work in refractory cases is addressed. Effective team communication prevents fragmented care and conflicting treatment messages.

Lesson 2 • Novel and Emerging Pharmacotherapies

Ketamine, psychedelic-assisted approaches, and novel glutamate agents are examined with current evidence. Clinicians distinguish experimental from evidence-based options when counseling patients.

Lesson 3 • Intensive CBT and Residential Programs

Intensive outpatient, partial hospitalization, and residential ERP programs are reviewed for indications and outcomes. Stepped-care escalation criteria guide appropriate referral decisions.

Lesson 4 • Defining and Evaluating Treatment Resistance

Operational criteria for treatment resistance are established, distinguishing true refractoriness from inadequate trials. Systematic re-evaluation prevents premature escalation to invasive interventions.

Lesson 1 • Perinatal OCD

Onset, exacerbation, and unique symptom themes of OCD during pregnancy and postpartum are addressed. Harm obsessions about the infant require careful risk assessment and non-punitive management.

Lesson 2 • Pediatric OCD: Diagnosis and Assessment

Developmental modifications to OCD presentation, family involvement, and assessment tools in children are examined. Early accurate diagnosis prevents years of functional impairment and family disruption.

Lesson 3 • Pediatric OCD Treatment

CBT with family involvement and pediatric SRI protocols are detailed as first-line treatments. Family accommodation reduction is a critical and unique component of pediatric OCD treatment.

Lesson 4 • Geriatric OCD Presentations

Late-onset OCD, medical comorbidity, cognitive decline, and polypharmacy challenges in older adults are reviewed. Adapted assessment and treatment approaches address age-specific barriers.

Lesson 1 • OCD with Major Depression

Bidirectional relationships between OCD and depression, including sequencing and combined treatment, are addressed. Suicidality risk in this comorbid population requires heightened assessment vigilance.

Lesson 2 • OCD with Tic Disorders and Tourette Syndrome

Tic-related OCD's distinct phenomenology, sensory phenomena, and treatment modifications are examined. Antipsychotic augmentation and habit reversal are uniquely relevant in this subgroup.

Lesson 3 • Trichotillomania and Excoriation Disorder

Body-focused repetitive behaviors are distinguished from OCD compulsions and treated with habit reversal training. Clinicians recognize when pharmacotherapy adjuncts are warranted.

Lesson 4 • Hoarding Disorder

Hoarding disorder's distinct etiology, assessment, and treatment pathway are established as separate from OCD. Motivational and harm-reduction approaches address the unique treatment challenges of hoarding.