mostly neglected psychiatric disorder , but 2-5% prevalent in general population

1. whatis O C D?
Excessive
unwanted
thoughts that
leads to
repetitive
behaviors

2. ? obsession
Obsessions are un wanted intrusive
thoughts or images/ impulses, that
enter in an individuals mind ,again
& again n a stereotyped manner,
which is very distressing & tried to
resist with out success

3. ?? compulsions
Compulsions are acts or
stereotyped behavior of an
individual engaged to get rid off
the obsessions with no success.

4. Who gets O C D ?
Prevalence- Epidemiology ;-
2-5 % of general population
Age- usually starts @ 19-20 yrs,
M:F = Equally affected.

5. ?presentations
Obsession can occur independent
of compulsions or vice versa
They can occur together in same
individual
One my have one or more
obsessions/ one or more
compulsions

6. Presentation of obsessions
 As rumination = continuous thinking about
the same thoughts sad->depression-
>anxiety= brooding over…
 AS Fear of Germs/ contaminations- 30%
 As Doughts -> whether the door is locked
or not? (pathological doughts)
 Need to arrange objects in specific manner

7. Presentation of obsessions
 Repeated counting of coins/rupees/ tiles/
numbers etc, cursing etc
 Unwanted sexual thoughts
 Religious mania-constant praying-
beseeching, entreating etc…
 Aggressive thoughts towards others/self
 Indifferent / impulsiveness

8. Presentation of obsessions
 MOOD ?- Anxiety- depression-social
isolation- suicidal thoughts- apprehension -
guilty feelings- panic.
 Hyper vigilance
 Ritualistic/ religious behavior
 Unwanted hoardings
 Guilty-cursing-muttering…

9. Compulsions ??
Repetitive acts/ behavior that a
person with O C D with the urge
to do in a response to obsessive
thoughts with no success

10. Presentation of compulsions
 Fear of---
 Contamination  eloberate cleaning / washing/
bathing …. 30%
 Germs/ disease  “Doctors shopping”…
 Doubts repeated checking, counting money
over & over
 Arranging furniture's / books/ utensils
repeatedly in a specific/ perfect manner-
fastidiousness


11. Presentation of compulsions
 Compulsive hoardings of office items/
furniture/ clothe/ books/ news papers/etc…>
office or house becomes as go down… 5%
 Patient is aware of irrational nature of
thoughts or actions but she/he can not get
away from them .
 So that it takes a large amount of time each
day resulting various hurdles in daily
personal/social/professional levels

12. What causes O C D ?
 Genetic base- 63%
 Bio chemical- due to low Serotonin, Dopamine &
Glutamate.
 Anatomical- neuro-imaging sows abnormalities
in several areas of brain in the form of hyper
activity especially at Fronto-orbital cortex,
cingulate gyres , basal ganglia & Thalamus

13. evaluation of History may reveals
 Child abuse
 Cruelty to
 Job environments
 Death/ accidents
 After divorce

14. PANDAS- (after infections)
Following streptococcal infections
during pediatric age results in
PANDAS (Pediatric Auto immune
Neuropsychiatric Disorder Associated
with Streptococcal infections)

15. co morbidity
 Depressive disorder- 67%
 Sleep disorder-40%
 Un reasonable fear- 30%
 Social phobia-20%
 Schizophrenia
 Other Anxiety disorders- as phobias/ panic
 Delusional disorders
 Personality disorders
 Alcohol/ other drug abuse etc.

16. Impact ?
 Personal
 Professional
 Social

17. Prognosis?
 Cure rate-20-30%
 Bad prognosis- 30 %
 Suicide -40 %

18. starting
50% starts suddenly
50% after stressful situations

19. How O C D is to be treated ?
 Personal & social education / empowerment
 CBT
 Exposure with response prevention
 Thought stopping
 De sensitization
 Supportive psychotherapy
 Insight oriented therapy
 ECT
 Acceptance & commitment therapy
 Psycho surgery

20. After effects ?
 Job issues
 Educational issues
 Accidents
 Disease
 Divorce
 Suicide
 homicide

21. Check possible other causes like
 Pituitary- Thyroid –Adrenal disorders
 CNS issues
 CVS
 Cancer etc like vital somatic disorders

22. Homoeopathic Medicines
 Nux Vomica
 Pulsatilla
 Staphysagria
 Auram metallicum
 Strmonium
 Ignatia platina
 Zincum metalicum
 Tarentula etc….