2. Assess the patientâ??s symptoms.

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2. Assess the patientâ??s symptoms.

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TABLE 1. Example Obsessive-Compulsive Disorder Screening Questions

TABLE 2. Symptoms of Other Psychiatric Disorders to be Differentiated From the Obsessions, Compulsions, and Rituals of Obsessive-Compulsive Disorder (OCD)

Use DSM-IV-TR criteria for diagnosis.
Consider using screening questions to detect commonly unrecognized symptoms (Table 1).
Differentiate OCD obsessions, compulsions, and rituals from similar symptoms found in other disorders (Table 2).

TABLE 1. Example Obsessive-Compulsive Disorder Screening Questions

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TABLE 1. Example Obsessive-Compulsive Disorder Screening Questions

Do you have unpleasant thoughts you canât get rid of?

Do you worry that you might impulsively harm someone?

Do you have to count things, wash your hands, or check things over and over?

Do you worry a lot about whether you performed religious rituals correctly or have been immoral?

Do you have troubling thoughts about sexual matters?

Do you need things arranged symmetrically or in a very exact order?

Do you have trouble discarding things, so that your house is quite cluttered?

Do these worries and behaviors interfere with your functioning at work, with your family, or with social activities?

TABLE 2. Symptoms of Other Psychiatric Disorders to be Differentiated From the Obsessions, Compulsions, and Rituals of Obsessive-Compulsive Disorder (OCD)

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TABLE 2. Symptoms of Other Psychiatric Disorders to be Differentiated From the Obsessions, Compulsions, and Rituals of Obsessive-Compulsive Disorder (OCD)

Disorder	Symptom	How the Symptom Differs From Symptoms of OCD
Bipolar disorder	Manic delusions	The content of the delusions is usually related to grandiosity.
Body dysmorphic disorder	Recurrent and intrusive preoccupation with a perceived bodily defect	The preoccupation is limited to the body.
Depressive disorders	Depressive ruminations	Unlike OCD obsessions, depressive ruminations are experienced as consistent with oneâs self-image and usually concern self-criticism, failures, guilt, regret, or pessimism about the future. Unlike obsessions, depressive ruminations do not lead to compulsive rituals.
Eating disorders	Intrusive thoughts and unhealthy behaviors regarding weight and eating	The thoughts and behaviors are limited to weight and eating.
Generalized anxiety disorder	Worry	Unlike with OCD, worry does not lead to compulsive rituals.
Hypochondriasis	Fear or belief regarding serious disease	In OCD, such fear arises from an external stimuli (e.g., that causes contamination) rather than misinterpretation of an ordinary bodily sign or symptom.
Obsessive-compulsive personality disorder (OCPD)	Hoarding, scrupulosity, perfectionism, preoccupation with rules and order	In OCD, obsessions and compulsions usually focus on specific feared events; in OCPD, thoughts and behaviors are globally colored by traits such as perfectionism and preoccupation with rules.
Paraphilias	Intrusive sexual thoughts and urges	OCD obsessions are resisted, are morally abhorrent to the individual, and lead to avoidance.
Postpartum depression	Urges to harm an infant	OCD thoughts and urges do not emerge from depressed mood or psychosis and are resisted.
Posttraumatic stress disorder	Intrusive thoughts and images	The thoughts replay actual events rather than anticipate future events as in OCD.
Schizophrenia	Schizophrenic delusions	The content is usually bizarre or related to persecution, grandiosity, passivity experiences, or ideas of reference.
Touretteâs disorder	Complex vocal or motor tics	Tics, unlike compulsions, are not preceded by thoughts nor aimed at relieving anxiety or preventing or undoing an event.

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Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.

All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.

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2. Assess the patientâ??s symptoms.

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TABLE 1. Example Obsessive-Compulsive Disorder Screening Questions

TABLE 2. Symptoms of Other Psychiatric Disorders to be Differentiated From the Obsessions, Compulsions, and Rituals of Obsessive-Compulsive Disorder (OCD)