obsessivecompulsivedisorder- OCD presentation
- 1. OBSESSIVE COMPULSIVE DISORDER PRESENTED BY Dr. Shiksha Verma (PT) SRMS Institute Of Paramedical Sciences
- 2. INTRODUCTION Obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone. It’s treatment is done through a combination of psychiatric medications and psychotherapy. Obsessive compulsive disorder(OCD) is an anxiety disorder. The person has recurring thoughts or images(obsessions) and/or repetitive, ritualistic- type behaviors that the individual is unable to keep from doing(compulsions). The person may try to suppress these thoughts or behaviors but is unable to do so. The individual knows that the thoughts or behaviors are irrational but feels powerless to stop.
- 3. OBSESSIONS:- Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. These intrusive thoughts cannot be settled by logic or reasoning. Typical obsessions include excessive concerns about contamination or harm, the need for symmetry or exactness, or forbidden sexual or religious thoughts. DEFINITIONS COMPULSIONS:- Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over. Some of the common compulsions include cleaning, repeating, checking, ordering and arranging , Mental compulsions etc.
- 4. DEFINTION OF OCD Obsessive:- Compulsive Disorder (OCD) is a common, chronic and long-lasting 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. An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
- 5. EPIDEMLOLOGY CURRNT ESIMATES OF lifetime prevalence are generlly in the range of 1.7 - 4% . OCD appears to have a simillar prevalence in different races and ethnicities . Symptoms usually begin in individuals aged 10 -24 years . The overallprevalence of OCD is equal in males and females .
- 6. CAUSES OF THE DISORDER • GENETIC • INFECTIONS • OTHER NEUROLOGICAL CONDITONS • STRESS • INTERPERSONAL RELATIONSHIPS • BIOLOGICAL FACTORS • PSYCHOANLYTICAL THEORY • BEHAVIOR THEORY • NEUROANATOMICAL FACTORS
- 7. CAUSES OF THE DISORDER The cause of OCD is not Known ; however , the following factors are relevant : 1. Genetic : • twin studies have supported strong heritability for ocd , with a genetic influence of 45-65% in studies in children , and 27 – 47 % in adults . • monozygotic twins may be strikingly concordant for ocd (80-87 % , compared with 47-50 % concordance in dizygotic twins . • several genetic studies have supported linkages to a varity of serotonergic , dopam- inergic and glutamatergic genes . 2. Infections : It has been hypothesized that streptococal infections trigger a CNS autoimmune response that results in neuropsychiatric symptoms . 3. Other neurological conditions : rare reports exist of OCD presenting as a manifestation of neurologic insults such as brain trauma , stimulant abuse , carbon monoxide poisoning . 4. Stress : OCD symptoms can worsen with stress : however , stress does not appear to be an etiologic factor .
- 8. Count… 5. Interpersonal relationships : • OCD symptoms can interact negatively with interpersonal relationships , and families can become involved with illness in a counterproductive (opposite)way . • Parenting style or upbringing does not appear to be a causative factor in OCD . 6. Biological Factors: • People with a first degree relative (parent or sibling) with OCD have a 5 times greater risk of having the illness. • identical twins have more chances of developing OCD as compared to dizygotic twins. 7. Psychoanalytical Theory: According to the Frued’s psychoanalytical theory OCD arises when unacceptable wishes and impulses from the individual are only partially repressed. They cause anxiety. Ego defense mechanisms are used to reduce the anxiety. These defense mechanisms are used unconsciously in the form of acts, such as hand washing.
- 9. Count… 8. Behavior Theory: This theory explains Obsessions as a conditioned stimulus to anxiety. Compulsions have been described as learned behavior that decreases the anxiety associated with the Obsessions. This decrease in anxiety positively reinforces the compulsive acts and they become stable learned behavior. 9. Neuroanatomical Factors: • there is evidence of abnormal brain structure and activity in patients with OCD. • these abnormalities are found in the pathway linking the lobes (responsible for judgment) with the basal ganglia (which are part of the system frontal for planning behavior) . • Serotonin deficiency – OCD sufferers have too little serotonin for their nerve cells to communicate effectively .
- 10. CLASSIFICATION OF OCD ICD-10 classifies OCD into 3 clinical subtypes according to the symptoms: 1. Predominantly obsessive thought or rumination. 2. Predominantly compulsive acts. 3. Mixed Obsessional thoughts and acts.
- 11. SIGNS & SYMOTOMS Common obsessions include the following : • Contamination . •Safety . •Doubting one ‘ s memory or perception . •Need for order or symmetry . •Unwanted intrusive sexual / aggressive thought . Common compulsions include the following : Cleaning / washing Checking ( checking locks , stove ,iron ,safety of children . Arranging objects . Touching / tapping objects . Hoarding (to collect and store large quantities of something , often secretly)
- 12. Symptoms of Obsessions Repeated thoughts about contamination(e.g. may lead to fear of shaking hands or touching objects). Repeated doubts(e.g. repeatedly wondering if they locked the door or turned off an appliance).
- 13. A need to have things in a certain order(e.g. feels intense anxiety when things are out of place).
- 14. Obsessions cont… Thought of aggression (e.g. to hurt a loved one). Sexual imagery.
- 16. Symptoms of Compulsion Washing and cleaning(e.g. excessive hand washing or house cleaning). Counting (e.g. counting number of times that something is done).
- 17. Checking (e.g. checking something that one has done, over and over). Requesting or demanding assurances from others.
- 18. Compulsion cont… Repeating actions(e.g. going in and out of door or up and down from a chair). Ordering(e.g. arranging and rearranging cloths or other items).
- 19. Note : the obsessions and compulsions seem to be worse in the face of emotional stress.
- 20. DIAGNOSIS OF OCD • Suggested by demonstration of realistic behavior that is irrationl or excessive. • MRI and CT shows enlarged Basal Ganglia in some patients. • PET(Positron emisaion Tomography) shows incresed glucose metabolism in part of the basal ganglia. • ICD-10 criteria .
- 22. PET can of a OCD
- 23. 1. Psychotherapy • Psychodynamic psychotherapy • Cognitive Behavior therapy • Supportive therapy 2. Phrmcologicl treatment 3. ECT 4. Self help and coping 5. Psychosurgery TREATMENT
- 24. BRAIN SURGERY
- 25. TREATMENT 1 . PHARMACO THERAPY :- • 5 – HT reuptake inhibitors , such as the SSRIs ( fluoxetine , fluvoxamine , sertraline , paroxetine , citalopram , escitaloparm ). • clomipramine ( Anafranil ) , with possible alteratives including veniafaxine , a sero- fonin norepinephrine reuptake inhibitor (SNRI ) . • Addition of an NE reuptake inhibitor , such as desipramine , to an SSRI , or trail of venlafaxine . • Addition of a typical or atypical antipsychotic , especially in patients with a history of tics . • Augmentation with buspirone . • Addition of inositol . • Sole or augmented use of selected glutamtergic agents .
- 26. Count… 2. BEVIOR THERAPY :- • This is a frist – line treatment that should be underrtaken . • Exposure and respo prevention( ERP ) is the important and specific core element in behavior therapy for OCD . 3. MEDITATION & RELAXATION THERAPY 4. PSYCHODYNAMIC PSYCHOTHERAPY :- This can be used for the patients who are psychologically oriented. The therapy is based on psychoanalysis in which the patient is made conscious about their unconscious thoughts and motivations thus gaining insight.
- 27. COGNITIVE BEHAVIOR THERAPY :- During treatment sessions, patients are exposed to the situations that create anxiety and provoke compulsive behavior or mental rituals. Through exposure, patients learn to decrease and then stop the rituals that consume their lives. They find that the anxiety arising from their obsessions lessens without engaging in ritualistic behavior. This technique works well for patients whose compulsions focus on situations that can be re-created easily.
- 28. PHARMACOLOGICAL TREATMENT 1. Benzodiazepines:- • Alprazolam(0.5-1mg/day) • Clonazepam(0.25-0.5 mg/day) 2. Antidepressants :- Clomipramine(75-300mg/day) Fluoxetine(20-80mg/day) Fluvoxamine(50-200mg/day) 3. Antipsychotics :- these are occassionally used in low doses in the treatment of severe anxiety e.g. Haloperidol,Risperidine, Olanzepine.
- 29. ELECTRO-CONVULSIVE THERAPY Electroconvulsive Therapy (ECT)In the presence of severe depression with OCD, ECT may be needed. ECT is particularly indicated when there is a risk of suicide and/or when there is a poor response to the other modes of treatment. SELF-HELP AND COPING Keeping a healthy lifestyle and being aware of warning signs and what to do if they return can help in coping with OCD and related disorders. Also, using basic relaxation techniques, such as meditation, yoga, visualization, and massage, can help ease the stress and anxiety caused by OCD
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