Obsessive compulsive disorder (OCD) is a mental illness characterized by repetitive unwanted thoughts (obsessions) and behaviors (compulsions) that are difficult to control. It is caused by genetic and neurological factors and affects 1.2-3% of the population. OCD is classified into types based on the content of obsessions and nature of compulsions, such as contamination fears/washing rituals. Treatment involves cognitive behavioral therapy and medication like SSRIs, with some FDA approved for children. More research is still needed to improve treatment outcomes for what can be a chronic and disabling condition.

1. OBSESSIVE
COMPULSIVE
DISORDERS
Presented by Krishna M

2. INTRODUCTION
• Obsessive compulsive disorder (OCD) was once considered a very rare and
untreatable condition (Kringlen, 1965). However, in the past fifty years changes in
how the condition is defined and understood has led to the identification of a broad
swath of symptoms and associated features that suggest the disorder is fairly
common, afflicting upto approximately 1.2%–3% of the population
• Further,research has shown that those with OCD have high rates of disability and
occupational and social role dysfunction (Markarian et al., 2010). When the
prevalence and functional impairment are considered together with the anxiety and
distress that individuals with this condition experience, one recognizes that OCD
represents a significant public health concern.

3. DEFINITION
• OBSESSIVE COMPULSIVE DISORDER IS A MENTAL ILLNESS THAT CAUSES REPEATED
UNWANTED THOUGHTS OR SENSATION OR THE URGE TO DO SOMETHING OVER
AND OVER AGAIN. SOME PEOPLE CAN HAVE BOTH OBSESSIONS AND
COMPULSIVES.

4. ETIOLOGY
• OCD IS DUE TO GENETRIC AND HEREDITARY FACTORS
• CHEMICAL , STRUCTURAL AND FUNCTIONAL ABNORMALTIES IN THE BRAIN ARE
THE CAUSE.
• COMPLUSIVE ARE LEARNED BEHAVIOURS , WHICH BECOME REPETIVE AND
HABITUAL WHEN THEY ARE ASSOCIATED WITH RELIEF FROM ANXIETY

5. TYPES OF PATHOPHYSIOLOGY
• OCD IS CHARACTERIZED BY REPETIVE INTRUSIVE THOUGTHS AND COMPULSIVE
TIME-CONSUMING BEHAVIORS
• CLASSIFIED INTO 5 TYPES
• AGGRESSIVE / SOMATIC OBSESSIONS WITH CHECKING COMPLUSIVE
• CONTAMINATION CONCERNS WITH WASHING COMPLUSIVE
• SYMMETRY OBSESSIVE WITH COUNTING/ORDERING COMPULSIVE
• HOARDING OBSESSION WITH COLLECTING COMPLUSIVE
• SEXUAL/RELIGIOUS CONCERNS

6. SIGNS AND SYMPTOMS
• FEAR OF BEING CONTAMINED BY GERMS OR DIRT OR CONTAMINATION OTHERS.
• FEAR OF LOSING CONTROL AND HARMING YOURSELF OR OTHERS
• INTRUSIVE SEXUALLY EXPLICIT OR VIOLENT THOUGTHS AND IMAGE.
• EXCESSIVE FOCUS ON RELIGIOUS OR MORAL IDEAS
• FEAR OF LOSING OR NOT HAVING THINGS YOU MIGTH NEED.
• ORDER AND SYMMENTARY : THE IDEA THAT EVERTHING MUST LINE UP “JUST
RIGTH”
• SUPERSTITIONS; EXCESSIVE ATTENTION TO SOMETHING CONSIDERED LUCKY OR
UNLUCKY

7. • EXCESSIVE DOUBLE – CHECKING OF THINGS, SUCH AS LOCKS , APPLIANCES AND
SWITCHES.
• REPEATRDLY CHECKING IN ON LOVED ONES TO MAKE SURE THEY ARE SAFE.
• COUNTING, TAPPING , REPEATING CERTAIN WORDS OR DOING OTHER SENSELESS
THINGS TO REDUCE ANXIETY
• SPENDING A LOT OF TIME WASHING OR CLEANING
• ORDERING OR ARRANGINGTHINGS “JUST SO”
• PRAYING EXCESSIVELY OR ENGAGING INRITUALS TRIGGERED BY REIGIOUS FEAR.

8. DIAGNOSIS
• (a) contamination obsessions and compulsions,
• (b) repugnant obsessions with mental and checking compulsions,
• (c) obsessions about responsibility for causing disasters and checking or
reassurance-seeking compulsions, and
• (d) symmetry obsessions and compulsions

9. TREATMENT

10. FRIST LINE THERAPY
• In adults,
• clomipramine,
• fluoxetine,
• fluvoxamine,
• paroxetine and
• Sertraline
• are approved by the FDA for treatment of OCD. Citalopram and escitalopram are
not approved by the FDA for treatment of OCD, but are considered to be as
efficacious as the other FDA-approved SSRIs.

11. FRIST LINE THERAPY
• PEDIATRICES
• Medication Starting dose (mg/day) Dosage
• range (mg/day)
• Citalopram 5–10 10–60†
• Escitalopram 5–10 10–40
• Fluoxetine* 5–10 10–80
• Fluvoxamine* 12.5–50 50–300
• Paroxetine* 5–10 10–60
• Sertraline* 12.5–25 50–250
• Clomipramine* 12.5–25 50–200
• * FDA approved medications for treatment of
• children and adolescents with OCD.

12. TREATMENT AND AUGMENTATION
• The fact that many patients with OCRD experience minimal or no improvement with
SSRI therapy, the rate of treatment resistance in thesepopulations should be
considered to be relatively high, with many patients requiring multiple trials of
pharmacotherapy in attempts to gain sufficient improvement in symptoms.Some
caveats must be observed before labeling a patient as treatment resistant or
refractory. First, the clinician must verify that the diagnosis is valid.Second, an
adequate trial of a first-line treatment is essential. This means at least 12 weeks at
amoderate to high dose of the SSRI.

13. SUMMARY
• The amount of research that has been performed regarding pharmacotherapy for
OCRD has lagged behind that of many other psychiatric disorders.
• This will likely change now that these illnesses have been highlighted in a separate
chapter in the
• DSM-5. As more data is gathered, further improvements and refinements in
medication treatment for OCRD should be forthcoming, leading to better patient
outcome