Obsessive Compulsive Disorder (OCD) is a mental health condition where a person experiences unwanted and intrusive obsessive thoughts and engages in compulsive behaviors to try and reduce the distress of the obsessions. Common obsessions include fears of contamination or harming others. Compulsions are repetitive behaviors like excessive cleaning, checking, or ordering. OCD is the 4th most common psychiatric disorder. While its exact causes are unknown, biological and genetic factors are believed to play a role. Treatment involves cognitive behavioral therapy and medication like selective serotonin reuptake inhibitors.

1. Obsessive Compulsive Disorder
Dr. Suresh Chenchu
Assistant Professor
Department of Pharmacy Practice
RIPER- Anantapur

2. Obsessive compulsive disorder
• Obsessive-Compulsive Disorder (OCD) is a common, chronic, and
long-lasting disorder in which a person has uncontrollable,
reoccurring thoughts (obsessions) and/or behaviors (compulsions)
that he or she feels the urge to repeat over and over.
• The person having a obsession or compulsion.
• Obsession: Recurrent intensive thought or idea or sensation or
imagination.
• Compulsion: Motor behavior or activity which will be against to
obsession.

3. Obsessions are repeated thoughts, urges, or mental images that cause anxiety.
Common symptoms include:
• Fear of germs or contamination
• Unwanted thoughts involving sex, religion, or harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in
response to an obsessive thought.
Common compulsions include:
• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked
or that the oven is off
• Compulsive counting

4. Epidemiology
• OCD is the 4th most common psychiatric disorder
1 – phobia
2 – substance abuse disorder
3 – major depressive disorder
4 – OCD
• Lifetime prevalence of OCD is 2-3%
• In adulthood females have more prevalence in childhood males.
• 20 years is mean age of persons with OCD.
• The OCD it alone cannot will come
• comorbidities of other psychiatric disorders
personality disorder,
MDD,
Tornett’s disorder, etc

5. Etiology
There is no exact cause of OCD. Some theories are present
1. Biological theory
2. genetic theory
3. Behavioral therapy
4. Psychodynamic theory
5. Psychoanalytical theory

6. 1.Biological theory
OCD may be a result of changes in your body's own natural chemistry or brain functions.
Deregulation between both serotonergic and noradrenergic system.
Rx: SSRI & TCA – Clopiramine
2. Genetics : Genetics: No specific markers are present
If the parents both are having OCD , 2% chance is for children.
3. Behavioral therapy:
Obsessions are conditioned provoke thoughts.
Compulsions are learning behavior.
4. Psychodynamic theory:
Psychodynamic factors are involved in progression of OCD
1. Secondary gain
2. Family accommodation

7. Pathophysiology
• The pathogenesis of OCD is a complex interplay between Neurobiology, genetic
and environmental influences.
• Historically dysfunction in the serotonin system was postulated to be the main
factor in OCD pathogenesis
• The role Glutamine, dopamine and possibly other neurochemicals also play a role
in pathogenesis.

8. Clinical presentation
• Obsession:
Repetitive thoughts (feeling contaminated by germs, fear to harming others)
Repetitive images (Unpleasant sexual images)
Thoughts about shouting obscenities or acting inappropriately in public
Repetitive urges (putting things in specific order, impulse to shout out obscenities in a church)
Compulsions
Repetitive activities (eg, hand washing, checking, arranging, need to ask, need to confess)
Repetitive mental acts (eg, counting excessively, repeating words silently, praying)
• Washing and cleaning
• Checking
• Counting
• Orderliness
• Following a strict routine
• Demanding reassurance

9. Examples of compulsion signs and symptoms include:
• Hand-washing until your skin becomes raw
• Checking doors repeatedly to make sure they're locked
• Checking the stove repeatedly to make sure it's off
• Counting in certain patterns
• Silently repeating a prayer, word or phrase
• Arranging your canned goods to face the same way

10. Diagnosis
• Obsessions are recurrent intrusive thoughts or images that cause marked distress.
• Person make an attempt to either suppress or ignore his thoughts – Thought is product
of his own mind.
• They can involve contamination; repeated doubts; or taboo thoughts of a sexual,
religious, or aggressive nature.
• Compulsions are repetitive behaviors or mental rituals performed to counteract the
anxiety caused by obsessions.
• They can include hand washing, checking, ordering, praying, counting, and seeking
reassurance.

11. Treatment
• Pharmacologic Therapy
• SSRI :
SSRI’s are considered to be the drugs of choice for patients with OCD
Clomipramine,
MOA : inhibit the reuptake of serotonin in synaptic cleft so serotonin concentration will be
increased.
TCA : strong 5-HT reuptake inhibition, has an active metabolite, desmethylclomipramine,
which inhibits NE Reuptake
Amitriptyline
Amoxapine
Doxepin

12. Alternative Drug Treatments
• augmentation approaches
Augmentation with the drugs that modulate the excitatory
neurotransmitter glutamate
Riluzole
Memantine
Topiramate