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Obsessive Compulsive Disorder

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Blank Obsessive Compulsive Disorder

Post by Bob on 11/11/2015, 9:27 pm

Obsessive Compulsive Disorder


Obsessive-compulsive disorder: A psychiatric disorder characterized by obsessive thoughts and compulsive actions, such as cleaning, checking, counting, or hoarding. Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home.
The obsessions are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
The old belief that OCD was the result of life experiences has been weakened by the growing evidence that biological factors are a primary contributor to the disorder. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis.
OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.
Treatment is by cognitive behavioral therapy and/or medication. One patient may benefit significantly from behavior therapy, while another will benefit from pharmacotherapy. Some others may use both medication and behavior therapy. Others may begin with medication to gain control over their symptoms and then continue with behavior therapy.
The neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first serotonin reuptake inhibitor (SRI) specifically approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (AnafranilR). It was followed by fluoxetine (ProzacR), fluvoxamine (LuvoxR), and paroxetine (PaxilR). Large studies have shown that more than three-quarters of patients are helped by these medications. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Indeed, even after symptoms have subsided, most people will need to continue with medication indefinitely, perhaps with a lowered dosage.
Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time the patient is strongly encouraged to refrain from ritualizing, with support and structure provided by the therapist, and possibly by others whom the patient recruits for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.
Studies of behavior therapy for OCD have found it to be a successful treatment for the majority of patients who complete it. For the treatment to be successful, it is important that the therapist be fully trained to provide this specific form of therapy. It is also helpful for the patient to be highly motivated and have a positive, determined attitude. The positive effects of behavior therapy endure once treatment has ended.


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Blank Re: Obsessive Compulsive Disorder

Post by Bob on 11/11/2015, 9:28 pm

Obsessive compulsive disorder (OCD) facts




  • Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by irresistible thoughts or images (obsessions) and/or rigid rituals/behaviors that may be driven by obsessions (compulsions).
  • OCD occurs in a small percentage of populations worldwide across cultures and has been known to the field of medicine for at least 100 years.
  • The average age of onset of OCD is 19 years of age, and it usually begins by 30 years of age.
  • OCD sufferers are more likely than those who do not have the disorder to also suffer from other anxiety disorders.
  • While there is no known specific cause for OCD, the presence of the illness in other family members and an imbalance of the brain chemical serotonin are thought to increase the likelihood of OCD developing.
  • OCD is diagnosed by the practitioner looking for signs and symptoms of this and other emotional problems, as well as ensuring that there is no medical condition that could be contributing to development of OCD.
  • OCD tends to respond most to a combination of behavior therapies (exposure and ritual prevention), group or individual cognitive behavioral therapy, and medications.
  • Although not as effective in treating OCD as clomipramine, SSRIs are the group of medications that are most often used to treat this illness since the SSRIs tend to cause fewer side effects.
  • SSRIs are thought to work by increasing the activity of serotonin in the brain.
  • When the combination of psychotherapy and SSRI treatment is not sufficiently effective, neuroleptic medications may be added to improve the treatment outcome.
  • For some people with severe OCD symptoms, deep brain stimulation can be helpful, and the use of hallucinogen medication as a treatment modality continues to be researched.
  • Although the symptoms of OCD may last indefinitely, its prognosis is best when the sufferer has milder symptoms that have been present for a short time, and the person has no other emotional problems.
  • Without treatment, OCD can worsen to the point that the sufferer has physical problems, becomes emotionally unable to function, or experiences suicidal thoughts. About 1% of OCD sufferers complete suicide. Continue Reading


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Blank Re: Obsessive Compulsive Disorder

Post by Bob on 11/11/2015, 9:33 pm

What are the treatments for OCD?



Most individuals with OCD experience some symptoms of the disorder indefinitely, with times of improvement alternating with times of difficulty. However, the prognosis is most favorable for OCD sufferers who have milder symptoms that last for less time and who have no other problems before developing this illness.
Treatments include cognitive behavioral psychotherapy, behavioral therapies, and medications. Behavioral therapies for OCD include ritual prevention and exposure therapy. Prevention of rituals involves a mental-health professional helping the OCD sufferer to endure longer and longer periods of resisting the urge to engage in compulsive behaviors. Exposure therapy is a form of behavior modification that involves the individual with OCD getting in touch with situations that tend to increase the OCD sufferer's urge to engage in compulsions, then helping him or her resist that urge. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with the anxiety involved with obsessive compulsive disorder.
Selective serotonin reuptake inhibitors (SSRIs) are the medications that are most commonly used to treat OCD. These medications increase the amount of the neurochemical serotonin in the brain. (Brain serotonin levels are thought to be low in OCD.) As their name implies, the SSRIs work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) are connected to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.
The SSRIs work by keeping serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the nerve cell that is transmitting an impulse. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. It is thought that this, in turn, helps arouse (activate) cells that have been deactivated by OCD, thereby relieving the symptoms of the condition.
SSRIs have fewer side effects than clomipramine, an older medication that is actually thought to be somewhat more effective in treating OCD and might cause orthostatic hypotension (a sudden drop in blood pressure when sitting up or standing) and heart-rhythm disturbances. Therefore, SSRIs are often the first-line treatment for this illness. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro). When the improvement that people with OCD experience is not optimal when an SSRI is the only medication prescribed, the addition of a neuroleptic medication like risperidone (Risperdal), olanzapine (Zyprexa), or aripiprazole (Abilify) can sometimes be helpful.
SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart-rhythm disturbances. This condition is very rare and has been reported only in very ill psychiatric patients taking multiple psychiatric medications.
Newer, often called atypical, neuroleptic medications like the ones named above tend to cause fewer side effects than many of the older medications in this class. The most common side effects of atypical neuroleptics include sleepiness, dizziness, dry mouth, and weight gain. Sometimes, people can be more sensitive to the effects of the sun while taking these medications and therefore should take care to wear adequate sunblock whenever exposed to the sun. Less commonly, side effects of atypical neuroleptic medications can result in painless, although abnormal, muscle movements like tremors, stiffness, and very rarely permanent muscle twitches called tardive dyskinesia.
Mood stabilizers like carbamazepine (Tegretol), divalproex sodium (Depakote), and lamotrigine (Lamictal) are sometimes used to treat OCD, particularly in individuals who also suffer from bipolar disorder. The side effects that professionals look for tend to vary depending on which medication is being prescribed. Professionals tend to watch for mild side effects like sleepiness when using Depakote or Tegretol or stomach upset when using any of these medications. Professionals also monitor patients for serious side effects like severely low white blood cell count with Tegretol or severe autoimmune reactions like Steven Johnson's syndrome with Depakote or Lamictal.
Studies on the effectiveness of treatment of OCD in adults have variable results. Some indicate that medications, response prevention, and CBT are equally, although only mildly to moderately, effective in treating this problem. Cognitive behavioral group therapy (CBGT) has also been found to be an effective treatment for OCD.
Research on treating OCD in children and adolescents suggests that while medications are clearly effective in treating this disorder, the improvement that is experienced as a result is quite mild. However, clomipramine tends to be more effective than the SSRIs, and the individual SSRIs tend to be equally effective. As in adults, people under 18 years of age tend to improve more significantly when treated with a combination of medication and CBT. There is increasing evidence that deep brain stimulation may be effective in treating severe OCD that has not responded to other treatments.   Continue Reading


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