Obssessive Compulsive Disorders Prof. Nahla Nagy Prof. Psychiatry Ain Shams Faculty of Medicine
Obsessive - compulsive disorder (OCD) affects 1%–3% of the world’s population .
There is increased familial risk of OCD,
-with greater rate of mental illness in the first-degree relatives of OCD probands
-early onset (before age 14)
-elevated rate of anxiety disorders
-concordance rates of monozygotic versus dizygotic twins were 80% versus 20% and 87% versus 47%
-Schedule for Affective Disorders and Schizophrenia—Lifetime Version, Modified for the Study of Anxiety Disorders, Updated for DSM-IV (SADS-LA-IV)
-Yale-Brown Obsessive Compulsive Scale
-Yale-Brown Obsessive Compulsive Scale Symptom Checklist for tics, Tourette’s syndrome, eating disorders, body dysmorphic disorder, and impulse control disorders according to DSM-IV criteria.
Most individuals (55%) in the obsessive- compulsive group had obsessions only .
OCD and Cultural aspects
Specific obssessive ideas and compulsive behaviors related to
-OC symptoms may appear in the prodromal stage of the first episode of schizophrenia,
-OC-schizophrenic patients are more impaired, both clinically and neuropsychologically.
Functional neuroimaging points to increased metabolic activity of prefrontal cortex in OCD.
Neuropsychological tests reveal that impaired performance connected with frontal lobe function is present in OCD, on the Wisconsin Card Sorting Test (WCST) especially when complicated with psychosis loaded by negative symptoms.
Frontal lobe pathology is a part of both schizophrenia and OCD, but the underlying neural circuits may involve different structures and different neurotransmitters. A circuit responsible for cognitive dysmetria is thought to effect schizophrenia, while in OCD, it is believed that basal ganglia play a prominent role. A dopaminergic deficit in frontal cortex may underlie hypofrontality in schizophrenia, while serotonergic disturbance is believed the most significant cause of OCD, which has immediate therapeutic implications.
Recent studies showed some " protective " effect of OC symptoms on frontal impairment in schizophrenia.
In molecular genetic studies, common predisposing genes were postulated for both schizophrenia and OCD,suggesting the possibility of comorbidity or prognostic course.
Major depressive disorder is the most common comorbid condition among patients with obsessive- compulsive disorder up to 55 %.
Anxiety disorders 23%(specific phobia,panic)
Substance abuse disorder 13 %
SSRIs in mega doses compared with depression, including clomipramine, fluvoxamine 300mg, fluoxetine 40mg, sertraline 200mg, and paroxetine 40mg, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive- compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents.
-gradual dosage titration is needed to avoid insomnia and restlessness or potential exacerbation of anxiety early in treatment
Adding another agent that alters other neurotransmitter systems or different serotonin receptors. It is known that dopamine and serotonin have complex structural interactions in the brain,and combinations of a dopamine antagonist and an SRI have been reported to be effective in the treatment of obsessive- compulsive disorder.
- Atypical antipsychotics with serotonergic action.
Behavioral therapy:exposure with response prevention