Obsessive-compulsive disorder overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: : Sonya Gelfand
Overview
Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions. It is listed by the World Health Organization as one of the top 10 most disabling illnesses in terms of a diminished quality of life.[1]
Historical Perspective
Classification
Obsessive compulsive disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) as an anxiety disorder. According to the American Psychiatric Association there will be change in the classification of OCD and associated conditions into DSM-5 once the the fifth edition of the DSM scheduled for release in May 2013 comes out.
Pathophysiology
Different biological and psychological explanations have been put forward to understand the pathophysiology of obsessive-compulsive disorder. It is generally agreed that neurotransmitters play an important role in the pathophysiology of obsessive–compulsive disorder.
Causes
It is generally agreed that neurotransmitters, biological, psychological, and environmental factors all play a probable role in causing obsessive–compulsive disorder.
Differentiating Obsessive Compulsive Disorder from other Diseases
The differential diagnosis of obsessive-compulsive disorder (OCD) includes tics, mood and anxiety disorders, and other compulsive behaviors, such as trichotillomania or neurodermatitis.[2]
Epidemiology and Demographics
Once believed to be rare, OCD was found to have a lifetime prevalence of 2,300 per 100,000 (2.3%) of the overall population. The twelve month prevalence of OCD is 1,200 per 100,000 (1.2%) of the overall population. Discovery of effective treatments and education of patients and health care providers have significantly increased the identification of individuals with OCD. International studies have shown a similar incidence and prevalence of OCD worldwide.
Risk Factors
Risk factors for obsessive compulsive disorder include genetic predisposition, a variety of genetic factors, environmental factors, and brain structure and function.
Screening
This screening test for obsessive-compulsive disorder is designed as a guide to find out whether one shows symptoms similar to those of obsessive-compulsive disorder (OCD). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is considered as a gold standard to screen for the symptoms and severity of obsessive compulsive disorder.
Natural History, Complication and Prognosis
The course of obsessive compulsive disorder is difficult to predict, and minimal research has been done on it. However, it is known that stress exacerbates the symptoms of OCD, and if left untreated, OCD often develops into a chronic condition that presents varying complications and results in an overall poor quality of life.
Diagnosis
History and Symptoms
Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.
Physical Examination
Although obsessive-compulsive disorder is a mental health problem, certain physical examinations are done to pin point the diagnosis for OCD.
Laboratory Findings
The laboratory tests for obsessive compulsive disorder may include a complete blood count (CBC), screening for alcohol and drugs, and a check of the thyroid function.
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), medications, or any combination of the three are first-line treatments for OCD. Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD. Though there is no known treatment for full remission of OCD yet, there are a number of successful treatment options available to promote significant improvement.
Interventions
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Kohn, R. et al. "The treatment gap in mental health care". The World Health Organization, 2004. Accessed June 28, 2007.
- ↑ Differential for OCD