Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts and compulsive behaviors that impair everyday functioning. Common manifestations include repeated hand washing due to fear of contamination and germs, counting behaviors, and checking and rechecking actions, such as checking and rechecking whether a door is locked.

Obsessions and compulsions may be simple or complex and ritualized. Mild forms of the disorder are relatively common in the general population. It's more common in males and first-born children. Generally, an obsessive-compulsive disorder is chronic, often with remissions and exacerbations. In some cases, patients' psychosocial functioning steadily deteriorates. Tics are sometimes associated with OCD, usually beginning in early adulthood or childhood.

Causes

In OCD, there is an anatomic-physiologic disturbance that is thought to involve an alteration in the frontal­subcortical neural circuitry of the brain. The orbital frontal cortex, caudate nucleus, and globus pallidus are involved. There seems to be a decrease in caudate nucleus volume; this area of the brain is involved in learning or acquiring and maintaining habits and skills. Interventions that successfully reduce organic brain disease also decrease the caudate glucose metabolic rate, which is elevated in organic brain disease.

Symptoms

The main symptoms of OCD are the obsessions and compulsions. The content of these varies from person to person, but common themes are:

• dirt and contamination which leads to excessive washing and avoiding possible dirt
• doubt leading to checking that things have been done properly - like locks being locked and stoves turned off
• unusual or repulsive images. These may be about religion, sex, violence or suicide and may raise unrealistic fears about the safety of the person or their family or whanau.

Treatment

Fluoxetine and fluvoxamine, serotonin reuptake inhibitors, are as effective as clomipramine (a tricyclic antidepressant) and have milder adverse effects. However, only 50% to 60% of OCD patients show improvement solely with pharmacotherapy. In treatment­resistant cases, other serotohergic agents may be beneficial. Long-term maintenance is usually indicated.

Alert: Fluvoxamine inhibits the III A4 isoenzyme specifically and shouldn't be given with other medications that act on III A4 (terfenadine and astemizole); life-threatening cardiac arrhythmias could result.

Behavioral therapies - aversion therapy, thought stopping, thought switching, flooding, implosion therapy, and response prevention - have also been effective. For those with time-consuming obsessive­compulsive behaviors, behavior therapy results in as much improvement as that of medication. Effective techniques include increasing exposure to stressful situations, keeping a diary of daily stressors, and substituting new activities for compulsive behavior.

Prevention