History

The patients present with a history of unwanted obsessions and compulsions. They are hard to overcome and often cause the patient a lot of distress.

Other psychiatric disorders such as mood swings, anxiety, phobia, and feeling of guilt, eating disorders, occupational disorders and social disorders may also be present. There may be a history of substance abuse.

Physical exam

The findings in obsessive-compulsive disorder may be non-specific and vary from patient to patient. In general, the patient should be examined to look for the presence of eczema due to excessive hand washing, hair loss due to hair pulling and excoriations due to pin pricking.

• Episodic Course

  Episodic course in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci. 1998; 248 (5): 240-4[ PubMed ] 26. Perugi G, Akiskal HS, Ramacciotti S, Nassini S, Toni C, Milanfranchi A, et al. [doi.org]

  The following clinical characteristics are proposed to be indicative of PANDAS: (1) onset of OCD or tic disorder before puberty, (2) sudden onset with episodic course characterized by abrupt relapse and remission of symptoms, (3) abnormal neurologic symptoms [pedsinreview.aappublications.org]

  About 8% of first degree relatives have OCD, while first symptoms occur by their 20s in 75% of the patients; this may happen suddenly or slowly, generally showing an episodic course [ 28 ]. [annals-general-psychiatry.com]

• Fatigue

  Other commonly reported adverse effects included dyspepsia, diarrhea, constipation, anxiety, fatigue, sedation, somnolence, asthenia, and forgetfulness. [web.archive.org]

• Nausea

  RESULTS: Regimen non-adherence, principally related to complaints about the taste and/or nausea, resulted in only 14 individuals who were evaluable by predetermined criteria. [ncbi.nlm.nih.gov]

  Adverseeffects — most commonly nausea, headache, and insomnia — were significantly worse with an SSRI than with placebo. [web.archive.org]

  Nausea and tiredness were more common with fluvoxamine ( p = 0.02 and p = 0.01, respectively). Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. [doi.org]

• Constipation

  Although the FDA has approved the tricyclic antidepressant clomipramine (Anafranil) for treatment of OCD, this medication may cause anticholinergic side effects such as dry mouth, blurred vision, constipation, delayed urination, and a rapid heartbeat. [health.harvard.edu]

  Other commonly reported adverse effects included dyspepsia, diarrhea, constipation, anxiety, fatigue, sedation, somnolence, asthenia, and forgetfulness. [web.archive.org]

  People taking clomipramine, which is in a different class of medication from the SSRIs, sometimes experience dry mouth, constipation, rapid heartbeat, and dizziness on standing. [nimh.nih.gov]

• Vomiting

  Rapid heartbeat, breathing problems, vomiting, nausea, shakiness, seizure, extreme drowsiness, and low blood pressure can all occur if you’ve overdosed on an anti-anxiety medication. [psychguides.com]

  The most common ones include diarrhoea, feeling sick, being sick (vomiting) and headaches. Some people develop a feeling of restlessness or anxiety (see below). Sexual problems sometimes occur. [patient.info]

  However, there may be side effects associated with the treatments, including nausea, vomiting, headaches, and dizziness. In addition, there is a risk of infection with any invasive procedure, such as these. [nimh.nih.gov]

• Sweating

  Ind Psychiatry J 2011;20:115-9 Anger attacks are characterized by sudden spells of anger, associated with a surge of autonomic arousal, which includes such symptoms as tachycardia, sweating, flushing, and a feeling of being out of control. [dx.doi.org]

  Adverse effects include dizziness, tremors, dry mouth, and sweating. Although not recommended for first-line treatment, clomipramine may be a useful alternative for treatment-refractory patients. [pedsinreview.aappublications.org]

  Early signs of serotonin syndrome include anxiety, tremor, tachycardia, and sweating. 26 The patient should continue taking the SSRI for eight to 12 weeks, with at least four to six weeks at the maximal tolerable dosage. 21 It usually takes at least four [aafp.org]

  Cognitive and behavioural treatments of fear of blushing, sweating or trembling. Behav Res Ther 31: 155-70. Scholing A, Emmelkamp PM. (1993). [richtlijnendatabase.nl]

• Compulsive Disorder

  When worry becomes obsession Repetitive thoughts and behaviours characterize obsessive-compulsive disorder (OCD). more The role of brain chemicals OCD is a complex disorder with a few suspected causes. more OCD: Making the diagnosis How is OCD diagnosed [pharmasave.com]

  Obsessive compulsive disorder is a chronic condition. [symptoma.com]

  "Obsessive—compulsive disorder in childhood". Journal of Anxiety Disorders. 3 (4): 295–302. doi:10.1016/0887-6185(89)90020-0. ^ Chen YW, Dilsaver SC (1995). "Comorbidity for obsessive-compulsive disorder in bipolar and unipolar disorders". [en.wikipedia.org]

  Several of the newest and most effective therapies for children with OCD were developed at our Tic Disorder & Obsessive Compulsive Disorder Program. [yalemedicine.org]

• Obsessive Thoughts

  Tip 3: Challenge obsessive thoughts Everyone has troubling thoughts or worries from time to time. [helpguide.org]

  […] that the intrusive obsessive thoughts and urges are the result of OCD. [web.archive.org]

  Obsessive-compulsive disorder is a type of mental illness. People with OCD can have either obsessive thoughts and urges or compulsive, repetitive behaviors. Some have both obsessions and compulsions. [webmd.com]

  People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. [mentalhealthamerica.net]

  Symptoms of OCD If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours. [nhs.uk]

• Compulsive Behavior

  If it is not treated successfully, the compulsive behaviors may cause extreme stress for children and their parents. [ncbi.nlm.nih.gov]

  However, in individuals with OCD, compulsive behaviors may change form. Thus, a child with OCD may have a handwashing compulsive behavior, but this may change later to a need for order. [web.archive.org]

  But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. [helpguide.org]

• Stereotyped Behavior

  In addition, autistic stereotypic behaviors tend to be unique to the child; in persons with OCD, stereotypic behaviors are almost always those discussed earlier (see History). [web.archive.org]

  Ritualistic and stereotyped behavior can be found in almost all autistic patients. [doi.org]

• Antisocial Personality Disorder

  T, The antisocial personalities, Hillside, New Jersey: Lawrence Erlbaum, 1995. Marks, I, Fears, phobias and rituals: Panic, anxiety and their disorders, Oxford University Press, 1987. [cogprints.org]

  Furthermore, subjects with OCD and comorbid BD have higher rates of panic/agoraphobia, substance use disorders, and higher rates of narcissistic and antisocial personality disorders ( Hantouche et al., 2003 ; Millet et al., 2004 ; Maina et al., 2007 ) [doi.org]

• Perseveration

  Modern views of OCD as a neuropsychiatric disorder originated from early lesion studies, with more recent models incorporating detailed neuropsychological findings, such as perseveration in set-shifting tasks, and findings of altered brain structure and [ncbi.nlm.nih.gov]

  "Am I willing to persevere with the level of distress I am currently experiencing or have all of my resources been depleted?" [web.archive.org]

  Healthy controls will tend to quickly focus on a 'good' deck, whereas patients with orbitofrontal dysfunction will tend to persevere on 'bad' decks. [doi.org]

  Behaviors that present as (or seem to be) obsessive or compulsive can also be found in a number of other conditions as well, including obsessive–compulsive personality disorder (OCPD), autism spectrum disorder, disorders where perseveration is a possible [en.wikipedia.org]

• Agitation

  Because of this possible link, see your doctor promptly if you become restless, anxious or agitated, or if you have any suicidal thoughts. [patient.info]

  Possible side effects of SSRIs can include headaches, feeling agitated or shaky, and feeling sick. However, these will often pass within a few weeks. [nhsinform.scot]

  […] obsessive-compulsive disorder ( F42- ) F60.5 ) obsessive-compulsive symptoms occurring in depression ( ICD-10-CM Diagnosis Code F32 Major depressive disorder, single episode 2016 2017 2018 2019 Non-Billable/Non-Specific Code Includes single episode of agitated [icd10data.com]

  Suddenly stopping all involvement in a person’s OCD could trigger overwhelming distress for the person with OCD and lead to increased symptoms, high agitation, anxiety and depression. [sane.org]

• Automatic Behavior

  Projections from the dlPFC to neurons in the striatal matrix are proposed to influence the indirect pathway, thus participating in the interruption of automatic behaviors and the adaptive switch from one behavioral program to another ( Baxter, 1987, 1992 [doi.org]

• Sexual Dysfunction

  Some people also experience sexual dysfunction with SSRIs. Adjusting the dosage or switching to another SSRI may help with these side effects. [web.archive.org]

  The most common side effects of SSRIs are gastrointestinal distress, restlessness, insomnia, and sexual dysfunction (such as reduced libido, erectile dysfunction, and inability to reach orgasm). [health.harvard.edu]

  Second-generation and newly approved antipsychotics, serum prolactin levels and sexual dysfunctions: a critical literature review. Expert Opin Drug Saf. 2014;13:605–24. PubMed CrossRef Google Scholar 118. [doi.org]

• Magnetic resonance imaging and Pet scan show increased blood flow to primitive brain with right side predominance.
• Yale-Brown Obsessive Compulsive Scale is used to mark the severity of the disease. 5 obsession and 5 compulsions are taken into the account. Then from a scale of 0 to 4, each obsession or compulsion is graded. The total score is 40. The score out 40 then indicates the severity of obsessive compulsive disorder in any particular patient.
• A complete psychiatric exam to look for the presence of delusions, hallucinations or any judgmental or suicidal thoughts should be performed.
• Any associated tic disorder should be looked for.

Behavioral psychotherapy training with a professional psychotherapist should be considered in all the patients of obsessive-compulsive disorder. In exposure and response prevention, a person is exposed to increasing amount of stimulus and in turn person needs to suppress his impulse. This is stressful but quiet effective. A patient can use a self-help book. Other techniques such as thought stopping, habit reversal and saturation are also useful. In thought stopping, the patient is required to distract himself with obsessive or compulsive thoughts appear. In habit reversal, the patient replaces his compulsions with some other non-compulsive responses. In saturation, the patient has to think his obsession long enough so that he may lose interest in it. A definitive medication and eating plan can lead to improvement in outcome. Relaxation techniques can also help the patient.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) are used as the first line drug therapy [5] [6]. The dose is given for 6 to 10 weeks and then the responses are noted. Usually, it takes up to 12 weeks for a noticeable response to appear. Drugs take more time to respond in this disorder as compared to other psychiatric disorders where the response is very rapid. Sometimes antipsychotics are also combined [7].

With obsessive-compulsive disorder that is resistant to treatment, the use of aggressive psychotherapy and aggressive pharmacological therapy may be considered.

In a small number of cases, we can use surgical interventions. These include small brain lesion, deep brain stimulation or stereotactic placement [8] [9] [10].

• Obsessive compulsive disorder is a chronic condition.
• With proper medication there is reduction in symptoms in 70 % of the cases.
• 15% of the cases worsen and have reduction of brain function despite proper treatment.
• 5% have no symptoms except for acute periods of exacerbation.
• A small number of candidates improve dramatically with use of surgery.

The factors contributing to the development of obsessive-compulsive disorder include the following.

• Brain trauma
• Genetic influences [1] [2] [3]
• Stimulant abuse
• Streptococcal type A infection
• Herpes simplex infection
• Carbon monoxide poisoning

Stress can aggravate the factors but doesn’t intrinsically cause obsessive-compulsive disorder. Problems in parenting and bringing up of the child have no role in the development of obsessive compulsive disorder.

The lifetime prevalence of obsessive-compulsive disorder is generally in the range of 1.7 to 4% of the population [4]. It is more common in orthodox Jew and Catholics due to firm beliefs. The peak age of obsessive-compulsive disorder is 10 to 24 years.

It is seen equally in males and females but presents at different ages. Males develop obsessive compulsive disorder during childhood. It usually associated with a tic disorder. Females get obsessive-compulsive disorder in their twenties. During pregnancy and premenstrual period, symptoms of obsessive-compulsive disorder usually worsen.

Obsessions can be defined as unwanted ideas, thoughts, images or impulses. Common obsessions are related to fear of contamination, doubting his/her memory, the need to do the right thing, the fear of committing a sin, the need for symmetry in everyday life, unwanted thoughts and aggressive thinking about sex.

Compulsions are repetitive and seemingly purposeful actions. Common compulsions are vigorous cleaning of the hands, checking locks and children, repeating actions until person feels satisfied, arranging objects, tapping objects (such as any desk or chair), unnecessarily accumulating food and seeking reassurance.
These obsessions and compulsions are recognized by the patient as unreasonable and are sufficiently severe to cause marked distress.

Some evidence suggests that there are abnormalities in serotonin (5-HT) neurotransmission in the brain and this leads to impaired intracortical inhibition of specific orbitofrontal-subcortical circuits. This causes strong emotions and the autonomic responses to them. In some cases of obsessive-compulsive disorder, a mutation has been found in the human serotonin transporter gene (hSERT).

In childhood, obsessive-compulsive disorder can be related to PANDAS and PANS. Extensive studies are being conducted in order to find the role of glutamate dysregulation in obsessive-compulsive disorders.

There is not a proven way of preventing the development of obsessive-compulsive disorder. With early diagnosis and management, the effects of the disease can be limited.

Obsessive-compulsive disorder is a psychiatric disorder characterized by recurrent and persistent obsessions and compulsions.

Obsession is any unwanted idea, thought or image; whereas compulsion refers to repetitive and seemingly purposeful actions. It usually occurs insidiously during childhood, adolescence or early adulthood. Males are affected in the early childhood and females are affected in adulthood.

Due to disturbance in serotonin neurotransmitter there is impaired intracortical inhibition of specific orbitofrontal-subcortical regions of the brain. There is usually marked distress in these patients due to unwanted thoughts and repetitive actions.

The patients of obsessive-compulsive disorder usually present in the childhood or early adulthood. The patient experiences unwanted thoughts, images or impulses and/or the desire to do repetitive and seemingly purposeful movements.

The treatment consists of a specific type of behavioral psychotherapy. Sometimes, drugs that reduce depression may be given. In rare cases, surgery may be needed.

1. Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL. Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Archives of general psychiatry. Jul 2006;63(7):769-776.
2. van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive-compulsive disorder: a review. Twin research and human genetics : the official journal of the International Society for Twin Studies. Oct 2005;8(5):450-458.
3. Dickel DE, Veenstra-VanderWeele J, Cox NJ, et al. Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Archives of general psychiatry. Jul 2006;63(7):778-785.
4. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Archives of general psychiatry. Dec 1988;45(12):1094-1099.
5. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology. Apr 1998;136(3):205-216.
6. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Archives of general psychiatry. Jan 1995;52(1):53-60.
7. Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Molecular psychiatry. Jul 2006;11(7):622-632.
8. Dettling M, Anghelescu IG. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. The New England journal of medicine. Feb 26 2009;360(9):931; author reply 932.
9. Greenberg BD, Malone DA, Friehs GM, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. Nov 2006;31(11):2384-2393.
10. Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotactic and functional neurosurgery. 2006;84(4):184-189.