OCD Obsessive Compulsive Disorder
OCD -Obsessive Compulsive Disorder
1) Diagnostic Features: Everyone has obsessions, that is recurrent thoughts and compulsions or rituals. What makes this a disorder is the following that the obsessions and compulsions are severe enough to a) be time consuming[taking more than one hour per day], or b) cause marked distress or impairment, and at some point c) the person realizes that they are excessive or unreasonable. Specify with poor insight if this is not present. Note this does not apply to children who may not have this insight. Either obsessions or compulsions may be present.
2) Exclusion Criterion: The OCD symptoms should not be better explained or be a part of another mental disorder, caused by a general medical condition, or the effects of a substance, like a drug of abuse or a medication.
3) Definition of Obsessions: Obsession are defined by the following four criterion.
A) Recurrent and persistent i)thoughts, ii) impulses, or iii) images, that are experienced as intrusive and inappropriate causing marked anxiety or distress
B) They are not simply excessive worries about real-life problems
C) The person attempts to ignore or suppress or neutralize them with some other thought or action
D) The person recognizes that they are a product of his own mind, not imposed from without like inserted
4) Definition of Compulsion: Compulsions are defined by the following two criterion.
A) Repetitive i) behaviors like hand washing, ordering, checking, or ii)mental acts such praying, counting, repeating word silently, that the person feels driven to perform in a response to an obsession, or according to rules that must be applied rigidly.
B) The behavior or mental acts are done to reduce anxiety or to prevent some feared event . Also the compulsion is clearly excessive and not realistically connected to the obsession.
5) Clinical Course: There are case reports of onset as early 5 years of age, with the mean age of onset being about 10 years of age, with symptoms existing 5 to 8 years before they reach clinical attention. It is an illness with waxing and waning symptoms and a long course with almost 50% of people still having symptoms 7 years after treatment. Listed below are other common disorders that may have OCD or its symptoms.
6) Obsessive-Compulsive Personality Disorder: Symptoms are stable ,not episodic and not problematic to the person, though may cause problems in social situations and relationships, may not share same biochemical basis.
7) Tic Disorders: At least 50% of people with tics & Tourette’s develop OCD/ symptoms ,& about 60% of children having OCD may also have tics, with significant overlap biochemically with both serotonin- dopamine likely involved.
8) Medical Conditions: Many medical conditions can cause or bring out OCD and symptoms, including carbon monoxide poisoning, viral encephalitis, head injury, and of special interest PANDAS- pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, neurological symptoms including tics.
9) Common symptoms: Obsessions include aggressive, sexual, contamination, hoarding, saving, religious, need for symmetry. Compulsions are washing, cleaning, repeating, counting, ordering, arranging, collecting.
10) Psychosocial interventions: Cognitive behavioral therapy is effective but is time consuming and there is a lack of qualified therapists especially for children and teens. It consists of actual- imagined graded exposure to feared obsessions and compulsions, learning new thinking and behavioral strategies to overcome the anxieties. Together with medication it offers the best hope for remission of symptoms and decreasing impairment.
11) Medications: Medications are about 40% effective in reducing about 40% of the symptoms and relieving impairment, and to the individual patient offers much relief and usually the ability to return to relatively normal functioning. The class usually started with is one of the SSRI/NRI medications like Prozac, preferred for those under 18 years or Zoloft. If there are tics or if there is lack of adequate effectiveness with the SSRI medication then the atypical neuroleptics like Risperdal are used either alone or adjunctively.