Obsessive Compulsive Disorders

Obsessive Compulsive Disorders
Violina Huzuri(huzuriviolina@gmail. com) Over the past three decades, Obsessive Compulsive Disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. First of all, Obsessive Compulsive Disorders refer to a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions.
Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviours an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress. Now, what are obsessions and compulsions?According to the International OCD Foundation, obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person's control.
Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don't make any sense. Common sets of obsessions and compulsions in patients with OCD include concerns about contamination together with washing or cleaning, concerns about harm to self or others together with checking, intrusive aggressive or sexual thoughts together with mental rituals, and concerns about symmetry together with ordering or counting.
Failing to discard items is characteristic of hoarding disorder, but hoarding to prevent harm, for example, can also be seen in OCD. These symptom dimensions have been observed around the world, indicating that in some ways OCD is a seemingly homogenous disorder. Nevertheless, OCD can present with a range of less common symptoms, including scrupulosity, obsessional jealousy and musical obsessions.
Avoidance is another key feature of OCD; individuals might curtail a range of activities to avoid obsessions being triggered. OCD typically starts early in life and has a long duration. In the National Comorbidity Survey Replication (NCS-R) study, nearly a quarter of males had onset before 10 years of age.
In females, onset often occurs during adolescence, although OCD can be precipitated in the peripartum or postpartum period in some women. Consistent with the early age of onset, the strongest socio-demographic predictor of lifetime OCD is age, with the odds of onset highest for individuals, 18?29 years of age. However, a few onsets do occur in individuals older than 30 years of age.
Longitudinal clinical and community studies have demonstrated that OCD symptoms can persist for decades, although remission can occur in a considerable number of individuals. Steps to help diagnose obsessive-compulsive disorder may include: Psychological evaluation - This includes discussing your thoughts, feelings, symptoms and behaviour patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends.
Diagnostic criteria for OCD: Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders, which was published by the American Psychiatric Association. Physical exam: This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications. There are both pharmacological and psychological treatments for OCD.
Overall, pharmacology with serotonin reuptake inhibitors (SRIs) shows large effect sizes in adults, but only moderate effect sizes in youth. Unfortunately, even with effective medication, most treatment responders show residual symptoms and impairments. SRIs can be successfully supplemented with adjunctive antipsychotics, but even then only a third of patients will show improvements and there are serious health concerns with their long-term usage.
Meta Analysis and reviews have not shown that the five selective SRIs (including fluoxetine, paroxetine, fluvoxamine, sertraline, and citalopram) or the non-selective SRI clomipramine differ among each other in terms of effectiveness in either adults or pediatric patients. Across subtypes of OCD, however, there are medication differences seen. For example, the presence of tics appears to decrease selective SRI effects in children, but it is unclear if it has the same effect in adults.
Another known difference is that patients who have OCD with comorbid tics respond better to neuroleptic drugs than those who have OCD without tics. The psychological treatment of choice for OCD, in both adults and children and backed by numerous clinical trials, is cognitive-behavioral therapy (CBT), particularly exposure with response prevention. It is superior to medications alone.
While there is a lower relapse rate than in medications (12% vs 24%-89%), it is important to note that up to 25% of patients will drop out prior to completion of treatment due to the nature of treatment. The course of therapy generally lasts between 12-16 sessions, beginning with a thorough assessment of the triggers of the obsession, the resultant compulsions, and ratings of the distress caused by both the obsession and if they are prevented from performing the compulsion. A series of exposures are then carefully planned through collaboration between the therapist and client and implemented both in session and as homework between sessions.
As in the medication research, differences in response to CBT have been found across populations. For instance, it has been seen that those with hoarding cluster symptoms respond less well to CBT, in part due to reluctance to engage in exposures and poor insight. Accommodation by family members in pediatric clients has been found to be predictive of poorer treatment response as well.
For persons with mild OCD, computer-assisted self-treatment has been shown to be very effective. .