Obsessive-compulsive disorder

Obsession:Obsession is a recurrent and intrusive thought,emotion,impulse and idea that comes into patients mind against his or her will.
It may be unrealistic.It will produce anxiety.

Compulsion:It is an act or ritual which patient does not get relief from anxiety e.g washing of hand when patient thought it is dirty.
Compulsion always follows obsession.There may be obsession only.

Epidemiology:

2-3% life time prevalence
1% seriously disabling(hampering normal life)
Peak age:25-30yrs.
Female:Male=2:1
In clinical practice F:M=1:1

Causes:

1.Biological factors:
5-HT hormone is responsible for obsession.Decrease 5-HT level produce obsession.
2.Psychological fctor:
      a)Psychoanalytic:Fraudian theory
      b)Behavioural:learning theory
3.Genetic factors:genetic transmission-not strongly suggested,but having some weak relation.

Clinical features:

Some obsession is compatible with life process.Some ritual follows by some people. They do not come for the patient of moderate and severe feature usually come for treatment>

1.Compulsion:
a)Cleaning-most compulsion seen
b)Counting:pt 2,4,6,8 count as like during passing chowkat,to see lamppost and count birds
c)Checking:After locking the key,is it locked
d)Dressing:Wear definite cloth after collecting all cloths

2.Obsession:
a)Thought-

• Religious:God does not exist in those who prayer
• Sexual

3.Impulse:To destroy the patient or others e.g.to kill child by pressing neck,desire to jump from balcony
4.Image:That are dirty e.g vomitus,stool-memorise during eating and vomiting
5.Feeling:Dirty feeling about beloved person and emotion.

If obsession persists for longtime,the patient develops depressive illness and may commit suicide.
Sometimes the patients are so occupied with obsession that he neglect personal hygiene and develops-

• Wt loss,cachexia
• Insomnia
• Low libido
• Loss of appetite

Anorexia nervosa:
The patient does not eat or become so busy that did not get any time for eating.

Management of Obsessive-compulsive disorder:

1.Pharmacotherapy-
TCA-

• Chlomipramine:50-200mg/day
• Fluoxetine:40-80mg/day to be taken in the morning

Antipsychotic drugs may be added such as
Trifluperazine:5-15mg/day

2.Psychotherapy:
Behavioural therapy:

• Systemic desensitisation:done for response prevention
• Thought stopping:disturbing thought think about that and stop that.

Response is >95% if both methods are used.Alone therapy<80%
If fails-Psychosurgery
Sometimes before psychosurgery,electroconvulsive therapy.
If treated early -good prognosis
Discontinuation of therapy may lead to relapse of disease.
But when untreated for 5 years ,it may run for life long.
Good response if treated within 1-2 years. Patient may have co-morbid disorder with obsessive-compulsive disorder e.g.schizophrenia