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OCD
This document provides an overview of obsessive compulsive disorder (OCD). It defines OCD as a psychiatric condition characterized by recurrent obsessions and/or compulsions. The document discusses the epidemiology, etiology, pathophysiology, classification, clinical presentation, diagnosis, and management of OCD. It describes common obsessions and compulsions seen in OCD and reviews pharmacological and non-pharmacological (cognitive behavioral therapy) treatment approaches.
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OCD
- 1. OBSESSIVE COMPULSIVE DISORDER Presentationby M. Jagadeesh, Pharm.D, Intern.
- 2. CONTENTS • Definition • Epidemiology •Aetiology • Pathophysiology • Classification • Clinical Presentation • Diagnosis • Management • Pharmacological therapy • Non Pharmacological therapy
- 3. DEFINITION It is aPsychiatric condition characterized by the recurrent Obsessions or Compulsions or both. OBSESSIONS 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion). COMPULSIONS 1. Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
- 4. EPIDEMIOLOGY The lifetimeprevalence rate of OCD is estimated at( USA) 2.3% in adults and around 1%-2.3% in children and adolescents under 18 Sub-clinical” cases of OCD (around 5% of the population) Few epidemiological differences across different countries and even between European and Asian populations Notably, 30-50% of patients develop OCD starting in childhood
- 5. Aetiology & Pathophysiology Genetic SLC1A1Gene -Encoding the neuronal glutamate transporter. -Mutations of SLC1A1 in people with OCD which appear to increase uptake of glutamate. hSERT Gene Mutation s in this gene significan tly less serotonin available within the synapse. Neurological -Key areas of the brain that have demonstrated unusual activity in sufferers that may be involved in the development of symptoms of OCD include the: -Orbitofrontal cortex -Anterior cingulate cortex -Striatum -Thalamus -Anterior cingulate gyrus -Caudate nucleus -Basal ganglia. Behavioural Fear Cognitive -Exaggerated responsibility -Exaggerated importance of thoughts -Control of thoughts -Exaggerated danger limitation -Exaggerated perfectionism -Intolerance of uncertainty Environmental -Abuse -Changes in living situation -Illness -Death of a family member or friend -Changes or problems in school or work -Relationship worries.
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- 8. Contamination •Body fluids (examples:urine, feces) •Germs/disease (examples: herpes, HIV) •Environmental contaminants (examples: asbestos radiation) •Household chemicals (examples: cleaners solvents) •Dirt Losing Control •Fear of acting on an impulse to harm oneself •Fear of acting on an impulse to harm others •Fear of violent or horrific images in one’s mind •Fear of blurting out obscenities or insults •Fear of stealing things Harm •Fear of being responsible for something terrible happening (examples: fire burglary) •Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself) Obsessions Related to Perfectionism •Concern about evenness or exactness •Concern with a need to know or remember •Fear of losing or forgetting important information when throwing something out •Inability to decide whether to keep or to discard things •Fear of losing things COMMON OBSESSIONS IN OCD
- 9. Washing and Cleaning •Washinghands excessively or in a certain way •Excessive showering, bathing, tooth-brushing, grooming ,or toilet routines •Cleaning household items or other objects excessively •Doing other things to prevent or remove contact with contaminants Checking •Checking that you did not/will not harm others •Checking that you did not/will not harm yourself •Checking that nothing terrible happened •Checking that you did not make a mistake •Checking some parts of your physical condition or body Repeating •Rereading or rewriting •Repeating routine activities (examples: going in or out doors, getting up or down from chairs) •Repeating body movements (example: tapping, touching, blinking) •Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number) Mental Compulsions •Mental review of events to prevent harm (to oneself others, to prevent terrible consequences) •Praying to prevent harm (to oneself others, to prevent terrible consequences) •Counting while performing a task to end on a “good,” “right,” or “safe” number •“Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out) Other Compulsions •Putting things in order or arranging things until it “feels right” •Telling asking or confessing to get reassurance COMMON COMPULSIONS IN OCD
- 11. DSM-5 DIAGNOSTIC CRITERIAFOR OBSESSIVE-COMPULSIVE DISORDER A.Presence of obsessions, compulsions, or both B. The obsessions or compulsions are time-consuming (e.g. take >1 h/d) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects. D.The disturbance is not better explained by the symptoms of another mental disorder.
- 12. MANAGEMENT NON PHARMACOLOGICAL THERAPY •Cognitive- Behavioural therapy (CBT) The psychological treatment of choice for OCD Effective in both adults and children Particularly exposure with response prevention
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- 15. Charles Darwin LeonardoDicaprio Billy Bob Thornton Jessica Alba Donald Trump Howard SternDavid Beckham FAMOUS PEOPLE WITH OCD
- 16. REFERENCES 1. Lack CW, World J Psychiatry. 2012 Dec 22;2(6):86-90. 2. Dilip V. Jeste et all, DSM-V, American Psychiatric Association, 2013. 3. NICE Guidelines for OCD, 2015. 4. Hall, Justin_ Premji, Azra-Toronto notes 2015 _ comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam part 1 and the United States Medical Licensing Exam. 5. http://www.medicalnewstoday.com/articles/178508.php 6. http://primarypsychiatry.com/issue/2005/