What is Obsessive Compulsive Disorder and it's treatment
Obsessions are defined as recurrent, intrusive thoughts, impulses, or images, which can lead to anxiety. Patients consider them as a product of their own mind, like ‘Thought Insertion’ phenomenon. They find them excessive, irrational, and senseless, at some time during the illness like ‘Illusions’. Patient tries to resist or neutralise them. Compulsions are repetitive behaviours/mental acts performed in response to obsessions – reduce anxiety temporarily. They are Ego-dystonic (not acceptable to self), with good/poor/absent insight (delusional belief). Most common comorbidity associated with OCD is Depression.
Pathophysiology and Causes
- 1) Genetics: OCD is seen to run in families, suggesting that there may be a role of genetics. A number of studies found that several genes may be involved in the pathophysiology of the disorder.
- 2) Neurological factors: Abnormalities in ‘Cortico-striato-thalamico-cortical tract’, in short known as the CSTC pathway, along with orbitofrontal cortex, anterior cingulate cortex, and basal ganglia, have found to be associated with OCD. These regions of brain are involved in regulating emotions and behaviour and may be hypoactive or hyperactive in individuals with OCD. Serotonergic dysregulation is the followed theory worldwide. Associated with bilateral small caudate nucleus due to caudate atrophy.
- 3) Environmental factors: Stressful and traumatic life events, such as illness, abuse, or loss of a loved one, have been linked to the development of OCD in the population. In addition, certain infections or autoimmune disorders are also found to trigger the onset of OCD.
- 4) Cognitive factors: Patients with OCD may have certain thinking patterns, such as over-estimation of responsibility, over-estimation of threat, intolerance of uncertainty or perfectionism, that may potentiate the development of obsessions and compulsions.
A child is said to be diagnosed with PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections) if a child develops sudden OCD, tic disorder, or both precipitated by Group A Beta-haemolytic Streptococcus infection such as strep throat or scarlet fever. There is an autoimmune destruction to basal ganglia.
Symptom Patterns
- 1) Commonest of all patterns is Obsession of contamination with compulsion of washing and avoidance, followed by Pathological doubt with compulsions of checking.
- 2) Intrusive thoughts (usually with mental compulsions) – sexual, aggressive, and religious content.
- 3) Symmetry or precision with compulsion of slowness.
- 4) Magical thinking – Just because they thought about an event, it will occur.
- 5) Most common obsession – Contamination (e.g., dirty hands)
- 6) Most common compulsion – Checking (e.g., is the door locked or not?)
Course and Prognosis
- 1) Acute onset – 50%
- 2) Lifetime prevalence- 2-3%.
- 3) Chronic illness
- 4) Significant improvement – 20-30 %
- 5) Moderate improvement – 40-50%
- 6) No improvement – 20-40-%
Diagnosis
In DSM-IV, OCD was placed in ‘Anxiety disorders.’ But in DSM-V, it has been placed under – ‘Obsessive-Compulsive and related disorders.’ The obsessions and compulsions cause severe distress, are time consuming (more than 1 hour a day) or interfere significantly with normal routine, lifestyle, academic or occupational functioning, or social activities or relationships of the patient.
Treatment
Combination of Medical Treatment and Psychotherapy
- Medical treatment– Selective Serotonin Reuptake Inhibitors (SSRIs are the Drug of choice) and Clomipramine (most effective drug in OCD), Antipsychotics (augmentation with Haloperidol, Quetiapine, Risperidone and Olanzapine, Aripiprazole. Lithium, Valproate, Carbamazepine, Venlafaxine.
- Psychotherapy– Exposure and Response Prevention (ERP – kind of CBT/BT) is the BEST therapeutic tool. Other kinds of Psychotherapies include Desensitization, thought stopping, flooding, aversive conditioning, Psychodynamic psychotherapy, and family therapy.
Tulasi Healthcare a group of psychiatric hospital and rehabilitation centre provides holistic Ocd Treatment in Delhi. A team of 7 psychiatrists and 30 psychologists is available.
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