OBSESSIVE COMPULSIVE DISORDER

DEFINITION

                CLINICAL FEATURES OF OBSESSIVE COMPULSIVE DISORDER

The patient is a young adult whose behavior is riddled with obsessions and compulsions. The obsessions are centered on cleanliness, orderliness, dirt, religion, god anger and revenge.

 The compulsions resulting from these are mainly excess hand washing and recurrent checking of things along excess praying and rituals with regard to religion.

Anxiety and depression are a part of OCD and the patient is many a time distressed with the symptoms of these disorders.

 Suicidal thoughts and ideas are common and an attempt is made when the patient is totally fed up of his symptoms.

The main difference between obsessions and perversion is that an obsession causes significant anxiety to the patient while a perversion causes pleasure.

Patients suffering from schizophrenia may also many a time have obsessive symptoms and may be misdiagnosed as OCD.

TREATMENT

PHARMACOTHERAPY

 Tricyclic antidepressants- Clomipramine in the dose of 25-50 mg TDS is still considered the standard treatment for OCD having an edge over other treatments. Likewise Imipramine 25-50 mg TDS also has been used.

 Selective Serotonin Reuptake Inhibitors (SSRI)- Sertraline is the most preferred SSRI for benefit in OCD in a dose of 50-100 mg TDS. Fluvaxomine improves many symptoms of OCD in a dose of 50-100 mg TDS. Fluxetine has also been tried with success in OCD at doses of 20-40 mg BD.

 Anxiolytics- Buspirone 5-10 mg TDS has been highly recommended. Diazepam at 5-10 mg BD or Clonezapam at 0.5-2 mg TDS has also been used with varying success.

PSYCHOTHERAPY AND BEHAVIOR THERAPY

 Every neurosis needs psychotherapy in spite of the best rug being around. Supportive psychotherapy with an aim to strengthen the weak ego of the patient is the main stay of treatment. Re-educative and Reconstructive psychotherapy may also be used.

Behavior therapy is used when there is an insignificant response to drugs.

 Desensitization- repeated exposure to the stimulus that causes compulsive behavior can be done in gradually increasing intensity. Relaxation therapy is needed prior to this that the patient feces the stimulus in a better manner.

Thought Stop- the patient is instructed to bring out the stopping by even mentioning stop or words like ‘cut it out’ and these ideas are bring about relaxation.

Flooding- her you expose the patients to a bolus of obnoxious stimuli from where he cannot escape and it’s forced to accept the facts.

 Exposure and response prevention may be tried after adequate relaxation.

 A version therapy and punishment may be tried although at times may not be acceptable to the relatives.

Rewards for facing the stimulus and not giving in may be tried.

NEUROSURGERY

          This may considered for intractable cases. The choice of operation depends on symptoms and the expertise of the neurosurgeon concerned. Thus anterior cingulotomy, limbic leucotomy, tractotomy and anterior capsulotomy are the techniques that have been used. The results are favorable in around 50% cases.

          In OCD, treatment is very difficult and it needs perseverance on the part of the patient, relatives and above all the psychiatrist for improvement to be expected.