ObsessiveCompulsive Disorder (OCD)

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

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.