Obsessive Cumpulsive Disorder - Essay Example

Obsessive Compulsive Disorder(OCD) Obsessive Compulsive Disorder or OCD is a disease or a problem of the mind related to ones way of thinking and acting on the basis of these thoughts. When daily based normal superstitions, rituals and worries cross a certain threshold of normalcy and a person starts spending hours on hand washing, lock or gas checking or constantly rearranging things thus impairing his social and physiological activities then obsessive compulsive disorder is diagnosed and the person needs medical assistance. Symptoms- Obsessive compulsive disorder or OCD as the name suggests consists of both obsessions and compulsions and an individual suffering from this disorder generally show both. In this disorder the brain seemingly gets stuck on one thought or idea and cannot remove itself from it. To remove this obsessive idea one feels the urge to perform compulsive action and this keeps on repeating itself . Obsessions – It consists of pictures, feelings or thoughts that keep on recurring and disturbs the mental make up of a person making him feel worried, distressed, guilty and uncomfortable. These obsessions are often recognised by the patients as unrealistic but it is generally out of their control. Obsessions are commonly related to thoughts of contamination from germs and dirt, of harming others and oneself, having strong moral and religous feelings, strong sexual thoughts. Such obsessions can occur in any one and at any time. Every day rituals like praying, singing at particular times are normal but when these day to day activities turn to obsessions that persist and cause mental disturbances then medical attention is certainly needed. Compulsions – compulsions are the actions which an individual suffering from OCD undertakes repeatedly to get rid of the obsession under a rigid set of certain rules. People with an obsession of contamination may wash their hands repeatedly. Other types of compulsions include constant skin picking or touching, hair pulling or even constantly rearranging items. Such compulsive urges do not give any sense of pleasure but individuals with OCD constantly feel the urge to repeat the acts to remove their obsessions. Onset – General onset of this disorder is about 19 years. However children and adolescents may also be affected by this disorder. The disorder generally sets in by age 30 and is seen to affect male population more. On an average count this disorder affects about 1% to 2% of the total population and the symptoms shown and frequency of the illness are very similar irrespective of the culture of an individual with OCD. Eating disorders like bulimia and anorexia are often seen in individuals with OCD and other problems like depression and sudden panic attacks are often associated with this disorder. Various records of research on OCD show that this illness occurs mainly due to improper communication between the frontal part of the brain(orbital cortex) and the basal ganglia.Chemical imbalance or low levels of the chemical messenger serotonin in the brain and also genetic factors like specific variation in the chromosome make up are said to be some of the factors for causing this disorder though no specific causes have been discovered as of yet. It has been seen that people with OCD family history have a good chance of developing this disorder. However many people suffering from this disease show no family record of the illness. Also general nature of the disorder is inherited and not the particular symptoms. Etiology – The causes given for this disorder are many and varied. Many causes are still at a hypothetical level and yet to be proven. Some given theories have been researched and verified as one of the many causing agents of OCD. There are some well known theories regarding the etiology of this disease. Cognitive Behavioral theory states that the compulsive behavior of an OCD patient keeps on recurring owing to the need to get rid of the anxiety or worry caused by intrusive thoughts or pictures inside the sufferers mind. However the compulsive actions bring about only a temporary relief and the anxiety provoking thought keeps on happening over and over again being reinforced in a negative manner by the temporary relief. Thus the disorder manifolds itself and spreads to other related anxiety provoking thoughts or stimuli. As for example after shaking hands with someone an OCD patient may get the thought that he might fall sick through contamination. This anxiety is removed after washing the hands and the patient gets temporary relief. Then he might get the anxiety that the hands were not thoroughly cleaned and so he starts hand washing all over again and so the cycle keeps on repeating every time the fear of contamination occurs. It might extend to the thought of contamination from door knobs, sofas, utensils, chairs that is to anything the patient thinks the person he had shaken hands with might have touched. Biological theory – there are quite a number of biological theories regarding the etiology of this disorder. The most popular one states that this disorder occurs due to an abnormality or low levels of the neurotransmitter serotonin. There are damaged or blocked receptor sites that stop the serotonin from functioning properly. When SSRIs are given as medication they stop the reuptake of serotonin by the neurons thus increasing the presence of the neurotransmitter and providing some relief to the patient. It is also theorised that an improper connection between orbiti frontal cortex, caudate nucleus and thalamus results in failure to correctly communicate the chemical message that an action has been completed leading to the feeling of doubt and resulting in worry and anxiety for the sufferer. Another theory states that this disorder results from a possible genetic variation or mutation in the transporter gene hSERT. It has also been stated that there is a possible difference in brain activities and brain structures in a normal individual and an OCD sufferer. Often psychodynamically it is theorised that OCD may occur after an accident or shock because the trauma might cause imbalance in the serotonin levels in the brain leading to this disorder though researchers are still working on this theory and yet to come to a conclusion. Sometimes OCD is seen in patients with other psychological problems like depression etc. Treatments – People with milder symptoms of OCD and those who have no other problems react more favourably to the various treatments available. Most patients with OCD suffer persistently for a long time and indefinite time period with favourable times alternating with difficult periods. Various types of effective treatment available are exposure therapies,cognitive therapies, ritual prevention therapies and SSRIs (Selective seratonin reuptake inhibitors). Exposure therapies include situations where a person suffering from OCD is put in to a position which further aggrevates the condition and increases the compulsive urge of the patient. Then the patient is given help so that he or she learns to resist the compulsive urge. In Ritual prevention the patient is made to undergo resistance towards the compulsive urge for a consistently longer periods under proper medical guidance. Cognitive therapy includes the patient or the sufferer to come out of his worries or anxieties which form the obsessions. It helps the person to start thinking more positively which would remove his anxiety feeling that creates the obsession. SSRIs are the generally used medication to treat OCD patients. SSRIs like Fluvoxamine(luvox),Fluxetin(prozac),Citalopram(celexa) etc. They work by increasing the level of serotonin in the synapses ( the connection point between two brain cells or neurons). These drugs prevent the reuptake of serotonin by the neurons while the impulse is passing thus blocking the formation of new serotonin and so the message keeps on coming through.This in turn activates cells which had stopped working due to OCD and so reversing the condition and giving relief to the patient.Often Chlomipramine (an older medication) is also used to treat OCD and in some cases found to be more effective than the SSRIs though with more negative side effects than the SSRIs. Various research works have been done on this subject and many papers published dealing with the variety of treatments available for this illness. 4 such works have been discussed below. In his paper Hollander Eric et al experiments with Risperidone augmentation in treatment resistant OCD cases in a double blind placebo controlled study. It was done to understand the results of Risperidone augmentation of SRI in OCD patients who are treatment resistant. 16 patients wre treated to augmentation with 8 weeks of either Risperidone or placebo after involving SRI treatments for at least 12 weeks. Results show that risperidone was better tolerated and less number of dropouts as compared to placebo. Thus it can be said that Risperidone could be a more effective and better tolerated solution on treatment resistant OCD individuals (2003 Dec). Pigott T A and Seay S M in their paper does a review on effect of the SSRIs in OCD. Their work includes study of the anti depressant clomipramine which is the most effective medication on OCD patients when compared to other tricylic anti depressants. Their study shows that agents like fluvoxamine,sertraline have at various times shown effective results along with good tolerance levels. Clomipramine gives the most desired result but it has certain anticholinergic side effects. Other agents show far lesser side effects and further tests have revealed paroxetine to be as effective as Clomipramine without the side effects. Thus the tests prove that other SSRIs like Paroxetine and fluoxetine have similar desired result as that of Clomipramine but minus the adverse side effects which would affect the patients undergoing longtime medications.(1999 Feb) In his paper March J S does a review and gives recommendations for cognitive behavioral psychotherapy to children and adolescents with OCD. In his review March studied the results of thirty two cases to understand the benefits of cognitive behavioral psychotherapy in children and adolescent OCD patients. Positive results were noticed in all but one case for C-B psychotherapy. Graded exposure and response training, anxiety management training and OCD specific family interventions played a secondary role. Thus results prove that C-B psychotherapy alone or even along with medications show favourable effects in children and adolescents.(1995 Jan) Jenike M A made a comprehensive data study of medications on OCD patients under controlled clinical trials which show that pharmacologic treatments benefit the majority of OCD patients. Patients with resistant symptoms and how to deal with them have also been discussed.The adverse and therapeutic effects of medications have been studied and discussed (1995 Jan) References Hollander Eric , Rossi Baldini Nicolo et al (2003 dec). Risperidone augmentation in treatment resistant OCD: A double blind, placebo - controlled study. Retrieved on 2008 December. http://lib.bioinfo.pl/find?field=Papers&query=treatment+on+ocd   Jenike M A (1995 jan). Pharmacologic treatment of Obsessive compulsive disorder. Retrieved on 2008 December. http://lib.bioinfo.pl/find?field=Papers&query=treatment+on+ocd March J S(1995 jan). Cognitive-behavioral psychotherapy for children and adolescents with OCD : A review and recommendations for treatment. Retrieved on 2008 December http://lib.bioinfo.pl/find?field=Papers&query=treatment+on+ocd Pigott T A , Seay S M (1999 feb). A Review of the efficacy of selective serotonin reuptake inhibitors in OCD. Retrieved on 2008 December. http://lib.bioinfo.pl/find?field=Papers&query=treatment+on+ocd Read More