Obsessive-compulsive disorder: causes, symptoms, treatment

What is obsessive-compulsive disorder Obsessive-compulsive disorder is dominated by the presence of obsessions and compulsions that produce considerable anxiety or distress (obsessions), are time-consuming (more than one hour a day) and significantly interfere with normal routine and social activities . Obsessions are thoughts, impulses, rumors, doubts, obsessive phobias, or recurrent and persistent images that are perceived to be intrusive and inappropriate, parasiting thought and causing distress. Compulsions are mental acts (arithmomania, prayers, etc. ) or repetitive behaviors (hand washing, arranging, collecting, checking, rectification, etc. . ) used by the patient to reduce anxiety, suffering, or to prevent an event or a feared situation.

Most compulsions are correlated with the obsessions they are trying to cancel, but there are also compulsive compulsions not obsessed with obsessions, but only a high tension and discomfort that they try to reduce or cancel for the moment. Compulsions are repetitive, inappropriate, excessive, parasitic and occupy much of the time. The subject is aware of the morbid nature of the disorder and makes efforts to ignore and repress obsessions through mental or behavioral acts to oppose them. Obsessive experiences are correlated with a significant slowdown in mental health. The obsessive communicates a little and rarely to others, so contact with the specialists is long after the onset (5 to 10 years after the onset) and we have a subdiagnostic of this pathology.

Contents What is obsessive-compulsive disorder Symptoms and Diagnosis Treatment Up Symptoms and Diagnosis The onset of onset is considered to be between 20 and 35 years of age, with an earlier onset of male gender. However, cases and infancy were reported in the infant-juvenile period. OCD is not considered to be related to intelligence. Diagnosis correlates with organic pathology, including temporal lobe epilepsy, post-traumatic or postencephalitis complications. The psychiatric diagnosis to be discussed is represented by addictions, anxiety disorders, delusional disorders, schizophrenia, depressive disorders, impulse control disorders (trichotillomania, kleptomania, pyromania), paraphilia, eating disorders, dismorphophobic disorder,.

Also, the involuntary movements of tics (Tourette's syndrome) or neurological diseases (nuclei) are discussed, where we have the absence of obsessions and voluntary involvement (which in compulsions exist). Evolution and prognosis In many patients the onset of the symptomatology occurs after a stressful situation. The evolution of the disorder is variable, most frequently chronic. It may be episodic with complete or incomplete remission periods, either constant or progressive. Patients with OCD are frequently prone to depression or anxiety.

A frequently discussed problem is the interference between schizophrenia and obsessive-compulsive pathology, obsessions and compulsions being pre-existent, spontaneous in the course of psychosis, or precipitated or exacerbated by antipsychotic medication. Negative prognosis is indicated by young age onset, male gender, poor critical disease, initial severity of the disorder, compulsion failure, presence of tics and sympathetic / arranging compulsions, poor response to initial treatment, coexistence of depression or personality disorder . top Treatment The management of this condition involves a biological (pharmacological and non-pharmacological) and psychological approach. Pharmacology The main positive drug treatment is the one that stimulates serotonin transmission. The first treatment with 77 positive results was that of the tricyclic antidepressant Clomipramine (Anafranil), recommended at doses of 75-250 mg / day.

However, it should take into account the significant side effects. Anxiolytics are also recommended, among them efficacy demonstrating clonazepam, but the problem of addiction is raised, and the treatment should be of long duration. Beneficial effects were also observed by the combination of antipsychotics with serotonin antidepressant medication. These interact with dopaminergic neurotransmission. Patients with OCD should be maintained on medication for a long period of time, at least 1 year before attempting a gradual reduction of it with discontinuation.

Biological non-pharmacological Psychosurgery involves procedures that interrupt the connection between prefrontal cortex and basal ganglia. Cingulotomy is also practiced, which can help some nonresponsive patients, although in the short term the results are extraordinary, long-term prognosis is reserved. Psychotherapeutic Supporting psychotherapy with inspired confidence can help patients improve their functioning and adaptability. Cognitive-behavioral psychotherapy, which is a TOC individual therapy with variable duration and regular meetings. It goes into the interactive way of involving the patient by the psychotherapist in the active challenge of obsession (and / or compulsion) and voluntary resistance for a while (with delay or modeling of the experiences or behavior).

As techniques are used to stop thinking, habituation training, guided discovery, adverse conditioning. Repeating several times a day, for weeks or months (in the presence of the therapist or group), leads to the progressive and important diminishing of the disorder. Assessment of progress can be done with adapted psychometric scales, such as the Y-BOCS scale. Other approaches include psychodynamic psychotherapy and family therapy, but their results were inconclusive. The best therapeutic results were obtained by associating the drug therapy with psychotherapeutic techniques.

Source: General Psychiatry, VEst Publishing House, Timisoara, 2014