Obsessive Compulsive Disorders This is a neurotic illness ch.ch. by: - Periodic or persistent subjective experience of a certain thought or action the patient realize that it is silly & illogic (absurd ideas) - Continuous, attempts to resist it, (uncontrolled) so it is like compulsion so there is associated anxiety & depression. - This disease occurs commonly in compulsive personalities. - Their prevalence 1-3% but many people do not request ttt. Etiology: - Heredity - Personality (Compulsive personality = premorbid trait) associated with poor prognosis. - Physiological: Dysregulation of serotonin neurotransmission - Organic brain disease: e.g. postencephalitic Clinical Picture: A) Obsessions 1- Ideas, Images: which are very silly & absurd comes to the patient's mind e.g: - Ideas: which associates the name "god" with absurd words - Images: sexual intercourse with his mother. 2- Impulses are often of a suicidal or aggressive nature e.g. - to push his friend - to throw himself under a bus - laugh in the mosque of church. 3- Phobias. The phobias are related to impulses, the patient avoid things or situations which are the sources of his impulses e.g.: - Phobias of kissing children if the impulses is to have sexual, relation with children. - Phobia of going to mosques or even to pray if the impulses is to sing while praying. 4- Ruminations: - The patient ask himself questions & does not reach to a conclusion e.g. where is god, why is my nose over my mouth. B) Compulsions The pt must follow a certain routines in his life as in: dressing, in washing, in writing e.g. - he is compelled to wash his hands repeatedly after contact with certain things, checking or arranging. These obsessional motor acts alleviate his anxiety. Treatment: Psychotherapy is necessary. Behavior therapy. Also repeated exposure to the contaminated objects followed by prevention of the response of the patient Some patients are helped if they can observe a therapist behavior in presence of contamination. Drugs: - Clopiramine 50-150 mg/d (Anafranil) which is a tricyclic antidepressant - One of the SSRI group (selective serotnin reuptake inhibitors) e.g. prozac, cipram tab 20 mg tab (1-2 tab/D) or Lustral, faverin 50 mg tab (1-2 tab/d) - also BB may be helpful
