Obsessive-compulsive disorder
This topic has been prepared by committees of medical doctors network one of the networks of the center of the specialized medical advice, Kingdom of Bahrain, this information is only for education and not for treatment, and is treated better than the doctor. Copyright, in the case of quotation, please refer to the network. www.medicalcom.net
Introduction:
Obsessive-compulsive disorder (OCD) is a type of anxiety Anxiety disorder, is characterized by Ptsult a specific idea on the mind, such as ß not clean the hands and the attendant repeat a particular action unnecessarily, such as ß repeated hand washing for several times in a row with the patient fully aware of what he does and sometimes he feels that he You do not need to repeat such an act, but he finds himself driven to repeat it.
It consists of two main parts:
Dominant obsessions Obsessions: characterized by four things ß
- The idea of a certain control of the thinking.
- These ideas are not relevant to the problems experienced by the patient.
- Try to ignore the nafs of these ideas and forget about it and not to repeat the act which constitutes a psychological pressure it (where the patient is aware that these obsessive thoughts do not unfounded Unlike patients with schizophrenia who believed the health of his ideas).
- The patient fully aware of these ideas that stem from it is and not to any other person with income.
Compulsory act (compulsive) Compulsions:
- Repeat this action several times in spite of the desire of the patient to stop this action but that the desire to repeat the act stronger than him, such as repeated hand washing several times in spite of cleanliness or repeat count a specific number in mind and return to many times without the need for it.
- The patient tries to get rid of these thoughts constantly and the more forced himself to stop this action is being subjected to intense psychological pressure, which leads him to re-act again.
Among the most famous obsessions, which controls the rights:
- Doubt in things clean.
- A sense of insecurity.
- Uncertainty in the forgetting something, or loss of something or someone.
- The fear of committing sin.
- Commitment to love a specific system and not change whatever the circumstances.
- Frequent thinking about issues related to sex.
Accompanied by the repetition of certain actions such as:
- Frequency of washing hands and things to many times in a row even though they are clean.
- Repeat to make sure to close windows and locks and the closure of key gas and the separation of iron and to check on the presence of children is sometimes until the patient returns after going out to the street to check again, causing disabling dates.
- Repeat the count until a specific number for several times or repeated desire to touch something in particular.
- Act violently with people as a result of doubt in their intentions and urgency in the request security precautions such as putting locks on the door and the like.
- A lot of work tables, writing áÓĘĺ things even if they are not important.
Note: The OCD patient is fully aware that such behavior is normal for the duration of his illness, these actions take more than an hour a day or more, causing loss of time and affects the activities of daily living.
Rate of occurrence:
A proportion of patients in the world from 1.7% - 4% of the world, and usually appears at the age of 10-24 years and even in the incidence of males with females, although males appear in childhood and is usually accompanied by disease, hyperactivity and lack of Attention Attention deficit hyperactivity disorder (ADHD).
Causes to happen:
There are no known reasons to cause the injury OCD, although scientists have found a relationship between infection and the following reasons in some patients, including:
1. Genetic causes of Genetics: where he found a relationship between the incidence of OCD and the incidence of attention deficit and hyperactivity in children where the spread in some families and as a pervasive trait inherited Autosomal dominant.
2. Infection Infections: Word in some cases of infection OCD after bacterial infection known Bstervtokokay from the first group Group A streptococcal infection, where the view of some scholars that the injury Balsterbtokokay affects the nervous system in children is known as PANDAS ß pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, as well as in some cases infected with Herpes Herpes simplex.
3. Stress Stress: increasing severity of symptoms with the patient's exposure to pressure nervous.
4. Circumstances surrounding the person Interpersonal relationship: sometimes affect the person or the circumstances surrounding the exposure to a given position of being infected with OCD but has yet to prove the relation between the origin and disease.
Symptoms of the disease:
Patients by the history of the situation and that by asking the patient several questions which can diagnose the disease, has the world's Yale-Brown developed a set of questions with known ß Yale-Brown obsessive compulsive scale (Y-BOCS)
The doctor receives psychological assessment of the situation and concludes, including:
The severity of the disease and its impact on the activities of daily life for the patient and in the presence of a specific idea in control of the thought of a patient with a burning desire to repeat a particular action for example, to doubt the patient in that he left the door open goes back several times to check to close the door and locks with because he knows that he did close it, as well as unclear whether the patient is suffering from a mental disorder last companion of injury OCD Among the most famous examples for this:
- Teenage girls often Intabehn constant worry about their weight, they Vck girl suffers an increase in weight and still trying to lose weight consistently Eating disorder.
- Continue to be tampering with the patient's head and hair Akhalah and continues in this even led to the disarmament portion of the hair of the head Tricholillomania.
- The permanent concern of a certain disease which causes the patient to make a permanent and continuous checks to ensure that no cases of this disease Hypochondriasis.
- Constant sense of guilt and that he has committed sin and guilt and is often accompanied by depression OCD.
Determine when these symptoms began to emerge with the presence of other symptoms such as anxiety Anxiety disorder, the presence of symptoms Nevsgesmah Somatoform disorders, problems in nutrition Eating disorders, hyperactivity in children.
Patients know the history of the family and whether there was a family member suffering mental disorder or not.
Find out if the patient already taking drugs, or drugs that cause psychiatric disorder without consulting a doctor.
Infection by bacterial or viral infection.
By examining the patient's clear the following:
The presence of different symptoms depending on the type of obsessive thinking, which controls the patient's eczema, such as ß injury and inflammation in the hands of the large number of repeated washing, the loss of part of the hair off the hair as a result an ongoing basis, etc. ....
Tests:
When the work-ray MRI on the brain MRI, or the work of test waves provocative Positron emission topography (PET) is a (giving the brain signals audio or visual) is clear form that in case of injury OCD increase the amount of blood contained the brain in the frontal lobe is responsible for emotion.
Treatment:
Treatment includes 3 things were: pharmacotherapy Pharmacotherapy, behavioral therapy Behavioral therapy, group therapy Group therapy.
First, drug therapy Pharmacotherapy:
Through the use of antidepressants such as Mglqat receptors serotonin seritonin reuptake inhibitor (SSRI) Selective increases the risk of serotonin in the blood which is which works to improve mood, as well as the use of Tricyclic antidepressant (TCA) such as Alonafranjl Anafranil, and the patient needs to use one type of anti- depression, and in severe cases more than one type is used with some, and the effect of treatment begins to emerge, some of 6-10 weeks of regular treatment.
It is drugs, which proved effective use of newly Alnuraabernfrin Norepinephrine (NE) such as Desipramine, some patients showed rapid improvement after the use of SSRI with NE.
Second, behavioral therapy Behavioral therapy:
Is behavioral therapy help of psychologist known as the treatment cognitive Cognitive behavioral therapy (CBT), by exposing the patient to an influential, which motivates him to repeat the act with a try to reduce the repetition gradually example, if a patient used to wash his hands 40 times Fagzlea 20 and 10 and then 5 with the leave the place after this number and then try to relax and not return again until the patient gets rid of this behavior gradually, with the work of exercises to relax Relaxation techniques.
Third, group therapy Group therapy:
This is done through the seating group who suffer from this problem with some, which helps ease the tension and feeling of the patient that he is not alone in suffering from this problem, as the patients to give tips to each other through the experience of every one of them.
New in Version:
Of modern methods for the treatment of chronic and difficult cases that do not respond to treatment and the patient can live with is the following:
- Surgical intervention and through the development of an electric field on certain areas of the brain and that the purpose of organizing the brain power in this region and the organization of brain power in this region and to stop any shipments of excess.
- Exposing the brain to a magnetic field to work on the organization of brain electrical Trascranial magnetic stimulations, without resorting to open surgery.
- Methods that are tested with the use of Stereotactic teqnique known Stereotactic placement of bilateral lesion in the anterior cingulate cortex, has achieved this way Nhaj where an improvement in the kidney of 27% of the cases has the experience and it showed 17% partial improvement.
Self-care:
- In 70% of cases the situation will improve with drug therapy and behavioral, although it is possible to re-state the patient again, so you must follow the patient with a psychologist with the education of the patient and the family nature of the disease, treatment and side effects of treatment and the importance of follow-up.
- 5% of patients are cured with no complete recovery of symptoms again even after you stop treatment and that it was possible to show symptoms again like any other disease, but is controllable with treatment for another term.
- 15% of patients until their condition worsens with treatment and a few of them need to enter the hospital, and when you do not respond to treatment is to follow the form with the patient:
· Increasing the treatment dose or use more than one type with some such as SSRI with NE.
• Increased behavioral therapy sessions and relaxation.
· The use of some other drugs if OCD is accompanied by another mental illness such as: the use of lithium Lithium in cases of depression and Albesberon Buspirone in the incidence of other types of anxiety.
· Work sessions of ECT Electroconvulsive therapy is done drugged patient anesthesia completely and the development of polar electric current weak influences from the temporal lobe helps that the organization of electricity of the brain, and help these sessions to improve the situation in some patients who suffer from severe depression and the desire to commit suicide with an obsessive compulsive.
· Surgical intervention is the ultimate weapon and is used only in severe cases difficult and that does not work with drug therapy and other methods and use of this method is very limited and the limited number of centers in the world, which is only used this method.
The OCD is a chronic disease that requires treatment for long periods with a follow-up of good and regular meetings of behavioral therapy and group therapy, but the cure and improvement is something easy when you follow the instructions so you must resort to the doctor, the psychological suffering of this problem to help solve them
This topic has been prepared by committees of medical doctors network one of the networks of the center of the specialized medical advice, Kingdom of Bahrain, this information is only for education and not for treatment, and is treated better than the doctor. Copyright, in the case of quotation, please refer to the network. www.medicalcom.net
Introduction:
Obsessive-compulsive disorder (OCD) is a type of anxiety Anxiety disorder, is characterized by Ptsult a specific idea on the mind, such as ß not clean the hands and the attendant repeat a particular action unnecessarily, such as ß repeated hand washing for several times in a row with the patient fully aware of what he does and sometimes he feels that he You do not need to repeat such an act, but he finds himself driven to repeat it.
It consists of two main parts:
Dominant obsessions Obsessions: characterized by four things ß
- The idea of a certain control of the thinking.
- These ideas are not relevant to the problems experienced by the patient.
- Try to ignore the nafs of these ideas and forget about it and not to repeat the act which constitutes a psychological pressure it (where the patient is aware that these obsessive thoughts do not unfounded Unlike patients with schizophrenia who believed the health of his ideas).
- The patient fully aware of these ideas that stem from it is and not to any other person with income.
Compulsory act (compulsive) Compulsions:
- Repeat this action several times in spite of the desire of the patient to stop this action but that the desire to repeat the act stronger than him, such as repeated hand washing several times in spite of cleanliness or repeat count a specific number in mind and return to many times without the need for it.
- The patient tries to get rid of these thoughts constantly and the more forced himself to stop this action is being subjected to intense psychological pressure, which leads him to re-act again.
Among the most famous obsessions, which controls the rights:
- Doubt in things clean.
- A sense of insecurity.
- Uncertainty in the forgetting something, or loss of something or someone.
- The fear of committing sin.
- Commitment to love a specific system and not change whatever the circumstances.
- Frequent thinking about issues related to sex.
Accompanied by the repetition of certain actions such as:
- Frequency of washing hands and things to many times in a row even though they are clean.
- Repeat to make sure to close windows and locks and the closure of key gas and the separation of iron and to check on the presence of children is sometimes until the patient returns after going out to the street to check again, causing disabling dates.
- Repeat the count until a specific number for several times or repeated desire to touch something in particular.
- Act violently with people as a result of doubt in their intentions and urgency in the request security precautions such as putting locks on the door and the like.
- A lot of work tables, writing áÓĘĺ things even if they are not important.
Note: The OCD patient is fully aware that such behavior is normal for the duration of his illness, these actions take more than an hour a day or more, causing loss of time and affects the activities of daily living.
Rate of occurrence:
A proportion of patients in the world from 1.7% - 4% of the world, and usually appears at the age of 10-24 years and even in the incidence of males with females, although males appear in childhood and is usually accompanied by disease, hyperactivity and lack of Attention Attention deficit hyperactivity disorder (ADHD).
Causes to happen:
There are no known reasons to cause the injury OCD, although scientists have found a relationship between infection and the following reasons in some patients, including:
1. Genetic causes of Genetics: where he found a relationship between the incidence of OCD and the incidence of attention deficit and hyperactivity in children where the spread in some families and as a pervasive trait inherited Autosomal dominant.
2. Infection Infections: Word in some cases of infection OCD after bacterial infection known Bstervtokokay from the first group Group A streptococcal infection, where the view of some scholars that the injury Balsterbtokokay affects the nervous system in children is known as PANDAS ß pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, as well as in some cases infected with Herpes Herpes simplex.
3. Stress Stress: increasing severity of symptoms with the patient's exposure to pressure nervous.
4. Circumstances surrounding the person Interpersonal relationship: sometimes affect the person or the circumstances surrounding the exposure to a given position of being infected with OCD but has yet to prove the relation between the origin and disease.
Symptoms of the disease:
Patients by the history of the situation and that by asking the patient several questions which can diagnose the disease, has the world's Yale-Brown developed a set of questions with known ß Yale-Brown obsessive compulsive scale (Y-BOCS)
The doctor receives psychological assessment of the situation and concludes, including:
The severity of the disease and its impact on the activities of daily life for the patient and in the presence of a specific idea in control of the thought of a patient with a burning desire to repeat a particular action for example, to doubt the patient in that he left the door open goes back several times to check to close the door and locks with because he knows that he did close it, as well as unclear whether the patient is suffering from a mental disorder last companion of injury OCD Among the most famous examples for this:
- Teenage girls often Intabehn constant worry about their weight, they Vck girl suffers an increase in weight and still trying to lose weight consistently Eating disorder.
- Continue to be tampering with the patient's head and hair Akhalah and continues in this even led to the disarmament portion of the hair of the head Tricholillomania.
- The permanent concern of a certain disease which causes the patient to make a permanent and continuous checks to ensure that no cases of this disease Hypochondriasis.
- Constant sense of guilt and that he has committed sin and guilt and is often accompanied by depression OCD.
Determine when these symptoms began to emerge with the presence of other symptoms such as anxiety Anxiety disorder, the presence of symptoms Nevsgesmah Somatoform disorders, problems in nutrition Eating disorders, hyperactivity in children.
Patients know the history of the family and whether there was a family member suffering mental disorder or not.
Find out if the patient already taking drugs, or drugs that cause psychiatric disorder without consulting a doctor.
Infection by bacterial or viral infection.
By examining the patient's clear the following:
The presence of different symptoms depending on the type of obsessive thinking, which controls the patient's eczema, such as ß injury and inflammation in the hands of the large number of repeated washing, the loss of part of the hair off the hair as a result an ongoing basis, etc. ....
Tests:
When the work-ray MRI on the brain MRI, or the work of test waves provocative Positron emission topography (PET) is a (giving the brain signals audio or visual) is clear form that in case of injury OCD increase the amount of blood contained the brain in the frontal lobe is responsible for emotion.
Treatment:
Treatment includes 3 things were: pharmacotherapy Pharmacotherapy, behavioral therapy Behavioral therapy, group therapy Group therapy.
First, drug therapy Pharmacotherapy:
Through the use of antidepressants such as Mglqat receptors serotonin seritonin reuptake inhibitor (SSRI) Selective increases the risk of serotonin in the blood which is which works to improve mood, as well as the use of Tricyclic antidepressant (TCA) such as Alonafranjl Anafranil, and the patient needs to use one type of anti- depression, and in severe cases more than one type is used with some, and the effect of treatment begins to emerge, some of 6-10 weeks of regular treatment.
It is drugs, which proved effective use of newly Alnuraabernfrin Norepinephrine (NE) such as Desipramine, some patients showed rapid improvement after the use of SSRI with NE.
Second, behavioral therapy Behavioral therapy:
Is behavioral therapy help of psychologist known as the treatment cognitive Cognitive behavioral therapy (CBT), by exposing the patient to an influential, which motivates him to repeat the act with a try to reduce the repetition gradually example, if a patient used to wash his hands 40 times Fagzlea 20 and 10 and then 5 with the leave the place after this number and then try to relax and not return again until the patient gets rid of this behavior gradually, with the work of exercises to relax Relaxation techniques.
Third, group therapy Group therapy:
This is done through the seating group who suffer from this problem with some, which helps ease the tension and feeling of the patient that he is not alone in suffering from this problem, as the patients to give tips to each other through the experience of every one of them.
New in Version:
Of modern methods for the treatment of chronic and difficult cases that do not respond to treatment and the patient can live with is the following:
- Surgical intervention and through the development of an electric field on certain areas of the brain and that the purpose of organizing the brain power in this region and the organization of brain power in this region and to stop any shipments of excess.
- Exposing the brain to a magnetic field to work on the organization of brain electrical Trascranial magnetic stimulations, without resorting to open surgery.
- Methods that are tested with the use of Stereotactic teqnique known Stereotactic placement of bilateral lesion in the anterior cingulate cortex, has achieved this way Nhaj where an improvement in the kidney of 27% of the cases has the experience and it showed 17% partial improvement.
Self-care:
- In 70% of cases the situation will improve with drug therapy and behavioral, although it is possible to re-state the patient again, so you must follow the patient with a psychologist with the education of the patient and the family nature of the disease, treatment and side effects of treatment and the importance of follow-up.
- 5% of patients are cured with no complete recovery of symptoms again even after you stop treatment and that it was possible to show symptoms again like any other disease, but is controllable with treatment for another term.
- 15% of patients until their condition worsens with treatment and a few of them need to enter the hospital, and when you do not respond to treatment is to follow the form with the patient:
· Increasing the treatment dose or use more than one type with some such as SSRI with NE.
• Increased behavioral therapy sessions and relaxation.
· The use of some other drugs if OCD is accompanied by another mental illness such as: the use of lithium Lithium in cases of depression and Albesberon Buspirone in the incidence of other types of anxiety.
· Work sessions of ECT Electroconvulsive therapy is done drugged patient anesthesia completely and the development of polar electric current weak influences from the temporal lobe helps that the organization of electricity of the brain, and help these sessions to improve the situation in some patients who suffer from severe depression and the desire to commit suicide with an obsessive compulsive.
· Surgical intervention is the ultimate weapon and is used only in severe cases difficult and that does not work with drug therapy and other methods and use of this method is very limited and the limited number of centers in the world, which is only used this method.
The OCD is a chronic disease that requires treatment for long periods with a follow-up of good and regular meetings of behavioral therapy and group therapy, but the cure and improvement is something easy when you follow the instructions so you must resort to the doctor, the psychological suffering of this problem to help solve them
References :
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association Press; 1994.
- Breiter
HC, Rauch SL, Kwong KK, et al: Functional magnetic resonance imaging of
symptom provocation in obsessive-compulsive disorder. Arch Gen
Psychiatry 1996 Jul; 53(7): 595-606.
- Goodman
WK, McDougle CJ, Price LH: The role of serotonin and dopamine in the
pathophysiology of obsessive compulsive disorder. Int Clin
Psychopharmacol 1992 Jun; 7 Suppl 1: 35-8[Medline].
- Goodman WK: Obsessive-compulsive disorder: diagnosis and treatment. J Clin Psychiatry 1999; 60 Suppl 18: 27-32.
- Goodman
WK, Price LH, Delgado PL, et al: Specificity of serotonin reuptake
inhibitors in the treatment of obsessive-compulsive disorder. Comparison
of fluvoxamine and desipramine. Arch Gen Psychiatry 1990 Jun; 47(6):
577-85.
- Greenberg BD,
Ziemann U, Harmon A, et al: Decreased neuronal inhibition in cerebral
cortex in obsessive- compulsive disorder on transcranial magnetic
stimulation. Lancet 1998 Sep 12; 352(9131): 881-2.
- Greist JH, Jefferson JW: Pharmacotherapy for obsessive-compulsive disorder. Br J Psychiatry Suppl 1998; (35): 64-70.
- Hollander E, Cohen LJ: The assessment and treatment of refractory anxiety. J Clin Psychiatry 1994 Feb; 55 Suppl: 27-3.
- Samuels J, Nestadt G: Epidemiology and genetics of OCD. International Review of Psychiatry 1997; 9(1): 61-72.
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