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

  1. Mena Moner

    Mena Moner Active member

    Oct 10, 2017
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    Practicing medicine in:

    Obsessive Compulsive Disorders
    This is a neurotic illness 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.


    - 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.

    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.


    - 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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