What is Obsessive–compulsive disorder (OCD) ?

Obsessive-Compulsive Disorder

• 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.

How to define OCD?
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
• 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.

Cortico-Striatal-Thalamo-cortical loops
> Orbitofrontal cortex
   Personality, emotion, response inhibition, and social behavior
> Dorsolateral cortex
   Executive functioning, planning, attention, working memory
> Anterior cingulate cortex
   Initiative, motivation

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

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 
> 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