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OCD

Discussion in 'Psychiatry' started by Mena Moner, Oct 19, 2017.

  1. Mena Moner

    Mena Moner Active member

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    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
     

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