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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Exp 50 years

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Article Home Mental and Behavioural Disorders ObsessiveCompulsive Disorder (OCD)

ObsessiveCompulsive Disorder (OCD)

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Obsessive compulsive disorder is an anxiety disorder and is characterized by unwanted intrusive thoughts (obsessions) that produce anxiety, by repetitive behaviors? (compulsions) which is aimed at reducing the anxiety, or combinations of such thoughts and behaviors.

 

What are obsessions?  

  • Obsessions are images, ideas and impulses which run through the person's mind over and over again.
  • The thoughts, impulses and ideas are not simply excessive worries about real life problems.
  • The person attempts to suppress or ignore such thoughts and impulses with some other action or thought.
  • The person recognizes that obsessional thought and impulses are products of own his or her own mind ( not imposed from without).

 What are compulsions?

 These behaviors are called compulsions. (Compulsive behaviors are also called as rituals.)

  • The person here performs repetitive behaviors like hand washing, ordering, checking or mental acts (eg, praying, counting, repeating words silently) in response to an obsession.
  • These repetitive behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event.
  • These behaviors or mental acts are not connected in a realistic way with what they are meant to neutralize or prevent or they are clearly excessive.

 Examples

Fear of contamination with bacteria

Hand washing and cleaning

Precise arranging and need of symmetry

Ordering, arranging and balancing until its right

Unwanted sexual images and thoughts

Checking, praying and asking for reassurance

Doubts (gas, jets off, door locked)

Repeated checking behaviors’

Concerns about throwing valuable things

Hoarding

 

Causes of OCD

  • Genetic influence: there is a strong hereditability for OCD, with 45- 65% genetic influence in children.
  • Infections: group A streptococcal infection and herpes simplex.
  • Neurological conditions: Brain insult by brain trauma, stimulant abuse, and carbon mono dioxide poisoning.
  • Stress: stress can worsen the symptoms of OCD
  • Interpersonal relationship: OCD symptoms can interact negatively with interpersonal relationship.

 Symptoms of OCD

Compulsions- repetitive or ritualized behavior

  • Rituals
  • Repeated hand washing
  • Repeated touching
  • Counting
  • Repeated checking
  • Rearranging the things
  • Awareness that rituals are abnormal

Obsessions- disturbing thoughts and images

  • Anxious thoughts
  • Frequent thoughts of violence
  • Fear of causing harm
  • Unwelcomed sexual thoughts
  • Fantasies
  • Fear of becoming contaminated
  • Fear of being poisoned

 Tests and diagnosis

  • Functional MRI and PET scanning

 Treatment

  • Medical line of management
  • Behavioral therapy
  • Education and family intervention
  • Neurosurgical treatment in extremely refractory cases

Medications- potent selective serotonin re uptake inhibitors: Fluoxetine, Fluoxamine, Sertraline, Citalopram.

Behavioral therapy- exposure and response prevention

Intervention in treatment resistance cases

  • Intensive behavioral therapy
  • Increase the dose of medications (SSRI) or change to tricyclic antidepressants

 Surgical care

 The most common surgeries performed are on specific small lesion (eg, cingulotomy) or deep brain stimulation.