Obsessive-Compulsive Disorder (OCD): Causes, Symptoms & Treatment
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| Obsessive-Compulsive Disorder (OCD) |
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) comes under the classification of anxiety disorders. So, first, you have to understand what anxiety and anxiety disorder are.
Anxiety is a common, protective, psychological response to an undesirable or compromising circumstance. Mild to moderate anxiety can improve performance.
But, excessive or long-term anxiety can be disabling or crippling. This can lead to severe distress, and pain, and impairs social functioning.
In anxiety disorders, there is no actual threat & anxiety interferes with daily functioning. Both medical and medication-related factors can cause or exacerbate anxiety.
Obsessive-compulsive disorder (OCD) manifests chronic obsessions or compulsions. Obsessions and compulsions can be disabling and usually consume at least an hour a day.
Obsessive-compulsive disorder (OCD) once was a rare disorder. But it affects 2-3% of the world's population. The lifetime prevalence is higher in women. The onset of illness tends to be earlier in men in comparison to women.
The onset of OCD in men is between the ages of 6-15 years and in women between the ages of 20-29 years. You may have mild symptoms for many years before full OCD emerges. Approximately a third to one-half of patients have onset during childhood or adolescence.
OCD is three times more common in boys before puberty than in girls. In women, pregnancy can cause or even worsen OCD symptoms. Yet, stress can worsen OCD to the next level in both genders.
OCD is often joined by mental comorbidity. People with other mental issues are more prone to the development of OCD. For example, social phobias, GAD, panic disorder, schizophrenia, bipolar disorder, and dietary issues. The danger of OCD in these patients is high, above and beyond.
The connection between tic disorder and OCD is especially striking. Tic disorders happen in 20% to 30% of OCD patients. Likewise, 5% to 7% have full Tourette disorder, while 35% to half of Tourette patients show OCD symptoms.
Obsessive-compulsive disorder (OCD) can improve with medications, including SSRIs, clomipramine, or venlafaxine. Additionally, CBT combined with exposure therapy can treat OCD. Psychotherapy is also an effective option with drug treatment for optimal therapy. Although up to 40% of patients may experience disabling symptoms even with optimized treatment.
Augmentation strategies are effective in OCD patients owing to incomplete remission of symptoms. Augmentation strategies involve the combination of antidepressants or antidepressants with antipsychotics.
Causes Of Obsessive-Compulsive Disorder (OCD)
There are different causes for different subtypes of Obsessive Compulsive Disorder. 5-HT dysfunction plays an important role in obsessive-compulsive disorder. This is because serotonergic drugs are effective and used for the treatment of OCD. But, the exact role of 5-HT dysfunction in OCD is still not determined.
Abnormal hyperactivity is also found in certain frontal lobe and basal ganglia regions. This hyperactivity is particularly found in the orbital frontal cortex, cingulate cortex, and head of the caudate nucleus. We can find this abnormal hyperactivity in patients with OCD by comparing them with normal human beings.
The interesting fact about these regional brain metabolic abnormalities is that they normalize after successful treatment of OCD. If the above-mentioned etiology of OCD is correct, then we can say that OCD is a neurologic disorder.
Genetics also plays an important role in the development of OCD. People with a family history of OCD have an early onset of the disease, particularly before the age of 18.
An association has also been found between OCD and specific polymorphisms in the serotonin transporter, 5-HT type 1Dβ, and 5-HT type 2A receptor genes. But, we cannot conclude whether it is true or not.
Likewise, an association between obsessive-compulsive disorder with functional polymorphisms in the catechol-O-methyltransferase, dopamine D4-receptor genes, and a high-affinity neuronal/epithelial excitatory amino acid transporter gene is also reported. But still, there is no evidence.
Symptoms Of Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) manifests in both obsessions and compulsions. You may have either obsessive symptoms or compulsive symptoms or in some cases both.
Compulsive symptoms may include monotonous practices that you feel headed to perform. These monotonous practices or mental demonstrations are intended to decrease nervousness identified with your fixations or keep something awful from occurring. In any case, participating in the impulses brings no delight and may offer just a brief help from nervousness. You may make up rules or customs to follow that help control your uneasiness when you're having fanatical considerations. These impulses are unreasonable and frequently are not practically identified with the issue they're proposed to fix.
You will do repetitive things to control the recurrent attacks of anxiety such as washing and cleaning, checking, deliberateness, following an exacting everyday practice, and requesting consolation.
Diagnosis Of Obsessive-Compulsive Disorder (OCD)
The criteria used for the diagnosis of OCD is DSM-IV-TR. This criterion is explained below,
Presence of either obsession or compulsion.
Obsession
- Recurrent and constant thoughts are capable, at some time during the aggravation
- Thoughts, driving forces, or pictures are not inordinate concerns about genuine issues
- Person endeavors to disregard or kill the thoughts with some other idea or activity
- A person understands that fixations are the result of their mind
Compulsion
- Repetitive and deliberate practices or mental demonstrations
- Behavior intends to forestall or diminish the trouble
- Behavior to forestall some feared occasion
Sooner or later during the unsettling influence, the individual understands that the compulsion and obsessions are inordinate or nonsensical (not essential in youngsters).
Compulsion and obsessions cause stamped trouble, are tedious (>1 h/d), or meddle with some viewpoint of day-by-day working.
The substance of the indications isn't identified with another mental jumble, and the aggravation isn't inferable from the immediate impacts of a substance, medicine, or general clinical ailment.
Treatment Of Obsessive-Compulsive Disorder (OCD)
The standard treatment plan used for obsessive-compulsive disorder incorporates both medications and behavioral therapies. Behavioral therapy is very effective for the treatment of obsessive-compulsive disorder (OCD). The combination of medications with behavioral therapy provides the most optimal response to treatment.
The best medicines for the treatment of OCD are potent serotonin reuptake inhibitors. These incorporate clomipramine and SSRIs, for example, fluvoxamine, fluoxetine, paroxetine, and sertraline.
Paroxetine is still used for the treatment of kids with obsessive-compulsive disorder. Other SNRIs, for example, duloxetine, desvenlafaxine, or milnacipran additionally show adequacy in the treatment of OCD.
Clomipramine was the primary medication with demonstrated adequacy in treating OCD, and it was viewed as the standard first-line treatment for quite a while until the SSRIs acquired ubiquity. Clomipramine has more strong impacts on 5-HT reuptake inhibition contrasted and other TCAs.
Clomipramine is considered an SRI (serotonin reuptake inhibitor) instead of SSRI (selective serotonin reuptake inhibitor). The fundamental dynamic metabolite of clomipramine is desmethyl clomipramine which is a powerful inhibitor of NE reuptake. It additionally impedes the histaminergic, cholinergic, and adrenergic receptors.
Specific serotonin reuptake inhibitors (SSRIs) are the only first-line medication treatments for OCD. Among SSRIs, fluvoxamine, fluoxetine, paroxetine, and sertraline are the most effective for the treatment of OCD. Citalopram and escitalopram are also proven to be effective in treating OCD.
The doses of SSRIs should be low to reduce the incidence of side effects. The dose of fluvoxamine is 200 mg/day, fluoxetine 40 mg/day, paroxetine 40 mg/day, and sertraline 100 mg/day.
Benzodiazepines are generally not beneficial in treating OCD but clonazepam is found to be very effective as adjunctive therapy or monotherapy. Clonazepam has serotonergic effects in OCD patients. The MAOI phenelzine was also found to be very effective in treating OCD patients.
Non-pharmacologic therapy merges strong supportive psychotherapy, dynamic psychotherapy, psychological treatment, intellectual treatment, cognitive therapy, and relaxation training. Psychotherapy like cognitive behavioral therapy (CBT) can correspondingly be utilized alone or in the mix with the medication treatment.
Cognitive-behavioral therapy (CBT) is based on the level of anxiety sensitivity in these patients and asserts that physical anxiety sensations misinterpret as life-threatening. The aim is to perceive the negative idea designs inciting, instigating, or decaying or deteriorating apprehension/nervousness. Then, at that point, psychological treatment changes these negative thoughts into positive musings. Other terms used for psychotherapy are talk therapy or psychological counseling.
Neurosurgical treatment is considered an option of last resort in the treatment of OCD. Deep brain stimulations are also used for the treatment of OCD which is refractory to medications and psychotherapy. Anterior cingulotomy and anterior capsulotomy are the most commonly used surgical procedures.