OBSESSIVE COMPULSIVE DISORDER

JURNAL READING PSIKIATRI

Introduction

Obsessive-Compulsive Disorder (OCD) is a common, chronic and longlasting disorder in which a person has uncontrollable, reoccurring
thoughts (obsessions) and behaviors (compulsions) that he or she feels
the urge to repeat over and over.

Patients with OCD experience recurrent, intrusive thoughts

(obsessions) and/or repetitive, stereotyped behaviors (compulsions)
that last for at least one hour per day and significantly interfere with
the individuals normal level of functioning .

Signs and Symptoms

Obsessionsare repeated thoughts, urges, or mental images that

cause anxiety. Common symptoms include:

Fear of germs or contamination

Unwanted forbidden or taboo thoughts involving sex, religion, and harm

Aggressive thoughts towards others or self

Having things symmetrical or in a perfect order

Signs and Symptoms

Compulsionsare repetitive behaviors that a person with OCD feels

the urge to do in response to an obsessive thought. Common
compulsions include:

Excessive cleaning and/or handwashing

Ordering and arranging things in a particular, precise way

Repeatedly checking on things, such as repeatedly checking to see if the

door is locked or that the oven is off

Compulsive counting

Touching/tapping objects

Hoarding

Confessing/seeking reassurance

Not all rituals or habits are compulsions. Everyone double checks

things sometimes. But a person with OCD generally:

Can't control his or her thoughts or behaviors, even when those thoughts
or behaviors are recognized as excessive

Spends at least 1 hour a day on these thoughts or behaviors

Doesnt get pleasure when performing the behaviors or rituals, but may
feel brief relief from the anxiety the thoughts cause

Experiences significant problems in their daily life due to these thoughts

or behaviors

Many patients with OCD have other psychiatric comorbid disorders,

and may exhibit any of the following:

Mood and anxiety disorders

Somatoform disorders, especially hypochondriasis and body dysmorphic

disorder

Eating disorders

Impulse control disorders, especially kleptomania and trichotillomania

Attention deficithyperactivity disorder (ADHD)

Obsessive-compulsive personality disorder

Tic disorder

Suicidal thoughts and behaviors

Diagnosis

Once OCD is suspected, the following should be performed:

Define the range and severity of OCD symptoms; the Yale-Brown Obsessive
Compulsive Scale (Y-BOCS)is a good tool for this purpose

Complete Mental Status Examination; look for comorbid symptoms and

disorders

TheDiagnostic and Statistical Manual of Mental Disorders, Fifth

Edition(DSM-5),released in 2013, includes a new chapter for OCD and
related disorders, including body dysmorphic disorder, hoarding disorder,
trichotillomania, and excoriation disorder. Previously, OCD was grouped
together with anxiety disorders.

The American Psychiatric Association defines OCD as the presence of

obsessions, compulsions, or both. Obsessions are defined by (1) and
(2) as follows:

Recurrent and persistent thoughts, urges, or images that are experienced,

at some time during the disturbance, as intrusive and unwanted, and
cause marked anxiety and distress

The person attempts to suppress or ignore such thoughts, impulses, or

images or to neutralize them with some other thought or action

Compulsions are defined by (1) and (2) as follows:

Repetitive behaviors (eg, hand washing, ordering, checking) or mental

acts (eg, praying, counting, repeating words silently) in response to an
obsession or according to rules that must be applied rigidly

The behaviors or mental acts are aimed at preventing or reducing distress

or preventing some dreaded event or situation; however, these behaviors
or mental acts either are not connected in a way that could realistically
neutralize or prevent whatever they are meant to address, or they are
clearly excessive

Treatment

Treatment for OCD includes cognitive behavioral therapy

(CBT) and medication management.

BEHAVIORAL TREATMENT OF OCD

The efficacy of behavioral and cognitive-behavioral therapies in the

treatment of OCD has been validated in more than 30 studies.

Exposure and response prevention (ERP) therapy is the best-proven

behavioral strategy.

During ERP, anxiety and obsession-inducing stimuli are systematically

presented in a controlled environment and patients are prevented
from engaging in their usual compulsions.

PHARMACOTHERAPY OF OCD

Clomipramine, the tricyclic antidepressant that is the most specific

inhibitor of serotonin reuptake, was first shown to be efficacious in
the treatment of obsessive compulsive symptoms in uncontrolled
trials.

First-line pharmacologic treatments consist of 5-HT reuptake

inhibitors, such as the SSRIs (fluoxetine, fluvoxamine, sertraline,
paroxetine, citalopram, escitalopram), and clomipramine (Anafranil),
a tricyclic antidepressant [TCA] with 5-HT and NE reuptake inhibition.

SSRIs and clomipramine in the treatment of OCD differs from the

treatment of depression and other anxiety disorders in two important
ways:

First, higher doses of SRI medications are typically required before

clinical improvement is seen.

Second, improvement in OCD tends to be gradual

And an adequate medication trial is considered to be at least 10 to 12

weeks in duration.

TREATMENT-RESISTANT OCD

Interventions for patients with treatment resistance include the

following:

Change or increase in medication (eg, increase dose or prescribe a

different SSRI or clomipramine)

More intensive CBT

A number of therapeutic strategies have been attempted in the

following three categories:

alternative monotherapies

augmentation strategies

invasive procedures.

REASONS FOR [OCD] TREATMENT FAILURE often include inadequate

dosage of SRI medication, less than a 12-week period of treatment on
SRIs, inappropriately applied CBT/ERP techniques, and failure to use
SRI and CBT treatments together.