Obsessive-compulsive disorder

Alan

Definition

• Obsessive-compulsive disorder is an anxiety disorder characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions).

Introduction

• affects almost 3% of world’s population. • Start anytime from preschool to adulthood

– Typically between 20-24.• many different forms of OCD – differ from person to

person. • cause of OCD is still unknown.• Better when diagnosed early.

Specific criteria to be clinically diagnosed

• Anxiety disorder with presence of obsessions or compulsions.

• ego dystonic – realize thoughts and actions are irrational or excessive.

• Must take up more than 1 hour a day.• Must disrupt daily routine.• Symptoms can’t result from effects of other medical

conditions or substances.

Obsessions

• repetitive and constants thoughts, images or impulses that cause anxiety or distress.

• thoughts, images, or impulses not about real-life problems.

• Try to ignore or counter act thoughts, images, or impulses.

• thoughts, images, or impulses “recognized as a product of one’s own mind and not imposed from without”.

Compulsions

• Repetitive behaviors or mental acts person does in reaction to obsessions.

• behaviors or mental acts done to avoid or decrease distress.

• behaviors or mental acts are clearly excessive or not realistic.

History

• 14th & 15th century thought people were possessed by the devil and treated by exorcism

• 17th century thought people were cleansing their guilt

• 18th century finally considered medical issue• 20th century began treating with behavioral

techniques

Theories

• Scientist split into 2 groups

– Psychological disorder where people are responsible for feelings they have

– Abnormalities in the brain

Causes

• Serotonin is involved in regulating anxiety• Abnormality in the neurotransmitter serotonin

– In order to send chemical messages serotonin must bind to the receptor sites located on the neighboring nerve cells

– OCD suffers may have blocked or damaged receptor sites preventing serotonin from functioning to full potential

• Possible genetic mutation – Some people suffering have mutation in the human

serotonin transporter gene

OCD and the Brain

• PET scans show people with OCD have different brain activity from others

• Another theory: miscommunication between the orbital frontal cortex, the caudate nucleus, and the thalamus– Caudate nucleus doesn’t function properly and

causes thalamus to become hyperactive and sends “never-ending” worry signals between OFC and thalamus OFC responds by increasing anxiety

PET scans indicate differences in brain activity of OCD patients versus normal

Comorbidity

• Has excessive comorbidity with other diseases• Common diseases: Depression, Schizophrenia, Tourette

Syndrome • Depression is the most common

– Many people with OCD suffered from depression first– 2/3 of OCD patients develop depression makes OCD

symptoms worse and more difficult to treat

• People with OCD common diagnosed as Schizophrenic hard to separate obsessions from delusions

Treatment

• Only completely curable in rare cases• Most people have some symptom relief with

treatment• Treatment choices depend on the problem and

patients preferences• Most common treatments:

– Behavioral Therapy– Cognitive Therapy– Medication

Cognitive-Behavioral Therapy

• Cognitive: change the way they think to deal with their fears• Behavioral: change the way they react to “anxiety-provoking”

situations• Exposure and Response Prevention

– Slowly learning to tolerate anxiety associated with not performing ritual behavior

• Psychotherapy– Talking with therapist to discover what causes the anxiety

and how to deal with symptoms• Systematic Desensitization

– Learning cognitive strategies to deal with anxiety then gradual exposure to feared object

Cognitive-Behavioral Therapy cont…

• Should be done when people are ready for it• Must be customized for each person’s specific form of OCD

and their needs• No side affects except increased anxiety with exposure to

fear• Often lasts about 12 weeks• Positive effects off CBT last longer than those of

medication• If OCD returns can successfully treat again with same

therapy• Best treatment approach for most is CBT combined with

medication

Medication

• Anxiolytic benzodiazepine such as chloradiazepoxide or diazepam give temporary relief from anxiety but not really effective on obsessions and compulsions

• Antidepressants because of common depression• Selective Serotonin Reuptake Inhibitors (SSRIs): alter the levels of

neurotransmitter serotonin in the brain which helps brain cells communicate with one another – Prevents excess serotonin from being pumped back into

original neuron that released it– Then can bind to receptor sites of nearby neurons and send

chemical message that can help regulate anxiety and obsessive compulsive thoughts

– Most effective drug treatment helping about 60% of patients– Ex: Prozac, Zoloft, Lexapro, Paxil

Conclusion

• OCD is a complicated issue• Most cases are incurable • Best form of treatment is CBT in combination with

medication• Most important thing that can be done to discover

more about OCD and its treatments is to research the brain