Refers to intrusive, anxiety, repetitive, ritualized behaviors.
A chronic psychiatric process with familial, social and work complications.
A neuro psychiatric disorder characterized by obsessions, compulsions, or both, that are stressing, time-consuming or substantially impairing of the quality of life.
Affects up to 1 in 50 people, and is the fourth most common psychiatric illness.
Lifetime prevalence 1-3%.
A leading global cause of non-fatal illness.
The disorder typically develops in childhood or adolescence and tends to run a chronic course.
Primary manifestations are the presence of obsessions, conpulsions, or both.
Obsessions refers to repetitive and persistent thoughts, images, or urges.
Obsessions are unwanted thoughts causing distress or anxiety.
Characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images and/or by repetitive behaviors or mental acts that patients feel driven to do to try to lessen or prevent the anxiety that obsessions cause.
Characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images and/or by repetitive behaviors or mental acts that patients feel driven to do to try to lessen or prevent the anxiety that obsessions cause.
The presence of symptoms will usually cause marked distress or anxiety.
Diagnosis is based on history.
Treatment consists of psychotherapy, drug therapy or, especially in severe cases, both.
Slightly more common among women than men.
Affects about 1 to 2% of the population.
Up to 30% of people also have a past or current tic disorder.
Obsessive thoughts may be harmful, associated with risk to self or others, danger, contamination, doubt, loss, or aggression.
Obsessions are not pleasurable.
Patients try to ignore and/or suppress the thoughts, urges, or images, or
neutralize them by performing a compulsion.
Compulsions are excessive, repetitive, purposeful behaviors that individuals feel they must do to prevent or reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions.
The obsessions or compulsions must be time-consuming or cause clinically significant distress or impairment of functioning.
Compulsions include:
Washing
Checking
Counting
Ordering environment
Most rituals are observable.
Some mental rituals are not.
Compulsive rituals must be done in a precise ways, and may or may not be connected realistically to the feared event.
When connected realistically compulsions are clearly excessive.
Obsessions and/or compulsions are time-consuming of greater than 1 h/day, but often much more.
Obsessions and/or compulsions may cause significant distress or impairment in functioning; which at their extreme may be incapacitating.
Obsessions are intrusive, unwanted thoughts, images, or urges that usually cause marked distress or anxiety.
Most patients with OCD recognize that the beliefs underlying their obsessions are not realistic.
Occasionally, insight is completely lacking.
Individuals often conceal their obsessions and rituals for fear of embarrassment.
Relationships often deteriorate, and depression is a common secondary feature.
Diagnosis is a clinical one, based on the presence of obsessions,
compulsions, or both.
Treatment by exposure and ritual prevention is often effective.
Treatment by exposure and ritual prevention refers to the gradual exposure of patients to situations or people that trigger the anxiety-provoking obsessions and rituals while requiring them not to perform such rituals.
Antidepressants, including SSRIs and clomipramine are often very effective.
Some believe that combining exposure and ritual prevention with drug therapy is best, especially for severe cases.
Patients attempt to suppress or ignore the obsessions with a compulsion, an another thought or action.
Compulsions are repetitive ritualistic behaviors the patients are driven to perform in response to an obsession.
Compulsions are an attempt to reduce and individual’s discomfort to prevent a dreaded event.
Because all individuals obsess at some point, the diagnosis requires that obsessive thoughts occur more than 1 hour day.
Obsessions are not started or stopped by any specific event.
Many variations of OCD exist.
Most patients with OCD have multiple obsessions and compulsions.
Cultural factors influence the content of obsessions.
Subtypes of OCD vary by age or the developmental stage of the patient.
Occurs equally among the sexes.
The age of onset is bimodal: onset during childhood with a mean age of approximately 10 years, or during adolescence or young adulthood, with a mean age of onset of approximately 21 years.
Onset after age 30 is unusual.
Onset is usually earlier in boys than girls.
Onset in childhood is more common among boys, whereas among those during or after puberty, females onset is more common.
Childhood onset is estimated to be 45-65% related to hereditary factors.
Onset during adolescence or adulthood is related to inheritable factors and 27-47% of cases.
Data shows increased activity in the orbitofrontal cortex and caudate regions of the brain.
Other areas of the brain that have been implicated in OCD include the anterior cingulate cortex, the thalamus, amygdala, and parietal cortex.
Cognitive impairments linked to the function of the frontal lobe in the frontal subcortical structures have deficits including executive functioning impairment, impulsivity and motor function and cognitive inflexibility.
The course of untreated disease is chronic with waxing and waning symptomatology.
Without treatment adult remission rates are approximally 20%.
Treatment results in higher remission rates with shorter duration of illness, suggesting early diagnosis and treatment may lead to improved outcomes.
Approximately one third of patients receive appropriate pharmacological therapy.
Fewer than 10% receive evidence-based psychotherapy.
Often misdiagnosed as an anxiety or depression disorder.
First line management includes exposure and response prevention, which uses repeated and prolonged exposures to fear eliciting stimuli, combined with abstinence from compulsive behaviors, and selective serotonin reuptake inhibitors.
Treatment consists of serotonin-reuptake inhibitors and cognitive behavioral therapy.
Guidelines typically recommend in person cognitive behavioral therapy (CBT) as the first line treatment for mild to moderate OCD due to its favorable adverse effect profile and greater acceptability.
Risperidone may be useful for obsessive–compulsive disorder.
Exposure and response prevention refers to the use of repeated and prolonged exposures to fear eliciting stimuli or situations, combined with attempt at strict abstinence from compulsive behaviors.
The above is an attempt to reduce the fear response, to recognize these processes as not high-risk, and to learn anxiety will subside naturally if there is no effort made by the patient to avoid it.
60-85% of patients with OCD report reduction in symptoms with use of exposure and response prevention, and the improvement that can be maintained for up to five years after the discontinuation of treatment in the majority of the patients.
Present treatment leaves 25-40% of patients with persistent symptoms and functional limitations.
14-31% of patients with OCD have poor insight into their illness and this is associated with worse treatment outcomes.
Up to 30% of patients with OCD suffer with a tic disorder which is also associated with poor response to drug therapy in children and adolescents.
A double-blind cross over study of stimulation of the subthalamic nucleus decreased symptoms in patients with severe refractory obsessive compulsive disorder (Mallet).
Subthalamic stimulation does not effect measures of depression, anxiety, neuropsychological processes or self-assessment of disability.
Associated with significant dysfunction and psychiatric comorbidity.
Cognitive behavior therapy involves exposure and response prevention.