Obsessive Compulsive Disorder or neurosis is a relatively rare but potentially severe, debilitating disorder, characterized by severe obsession and/or compulsion that interferes with normal daily activities, work and thinking.
Definition of key concepts
A. Obsession: These are unwanted, intrusive and persisted thoughts, impulse or mental images that can cause anxiety and distress to oneself. Additionally, it is a feeling or a thought that cannot be diverted, but begins to interfere with individual’s ability to function. common obsession are aggression, and sexual thoughts, fears of contamination, pathological doubt.
B. Compulsion: Theses are behaviours that are performed repeatedly, in a ritualistic fashion with the goal of preventing or relieving a feeling of anxiety and distress caused by obsessions. For instance, if an individual becomes obsessed about fear of contamination with germs, the compulsion may be in form of continuous cleaning or repeated hand washing. When the person performs the compensatory actions, the anxiety and worry are temporarily relieved.
Causes Of Obsessive Compulsive Disorder
A. Physical ailments involving neuro-anatomic structures;
Many individual who have sleeping sickness during the encephalitis epidemic after world war I developed obsessive compulsive disorder (OCD)
Individuals who experience head injury, neurological disorders OCD
- A predisposition for OCD is transmitted genetically
- OCD occurs more often in persons who have 1st degree relatives with OCD than in general population.
- Some students have also shown an increased prevalence of anxiety and mood disorders in relative of individuals who have OCD
- Till date serotonin is the only neuro-transmitter that have been implicated in OCD;
- A convincing evidence for serotonins role in OCD comes from the fact that anti-depressants that act more specifically on serotonin relieve
- the symptoms of OCD for most patients, whereas anti-depressants that are more specific for other neurotransmitter do not relieve OCD symptoms.
D. Parent and Guardian Attitude
In OCD patients, it is quite often to find out their parents/guardian have been particularly concern over bowel training, and acquistion of skills or feats beyond the children capabilities.
E. Premorbid Personality
OCD commonly develop in people who have previously shown marked obsessional traits, e.g their high standard of conduct, marked caution and need or preciseness, orderliness and cleaniness, leading to a rigid control over their feelinhgs, and behaviour. Obsessional personality is also called “Anankastic personality“
F. Changing Environmental Circumstances
Obsessional personality is vunerable when faced with demands arising out of changing circumstances such as changes at work involving new responsibilities, changes in environment involving new relationships, cahnges in way of life as a result of getting married.
OCD may be secondary to or associated with other psychiatric conditions, such as anxiety, depressive illness and early schizophrenia. Comorbidity personality disorders occur in 80% of individuals with OCD.
Signs and Symptoms Of Obsessive Compulsive Disorder
1. The obsessive compulsive idea or impulses are recognized by the patient to be irrational and he amy be depressed.
2. Obsession must irresistibly be accompanied by actions which usually relieve tension and distress
3. OCD symptoms and character arise from the implement tation of the three defense mechanisms.
- Isolation – Separation of affect from a thought
- Undoing– An act performed with the goal of preventing consequences of a thought;
- Reaction formation – Behaviour and consciously staled attitudes that are opposite to underlying impulse.
Other Manifestions Of OCD Include;
- Aggressive Obsessions – Repeated thought of hurting others that they are unable to dismiss.
- Symmetrical Obsessions – Objects must be kept in certain order such as room arrangements
- Precisional Obsessions – Activities must be performed in a rigid fashion
- Somatic Obsessions – Concerns about health, death associated with compulsive checking and request for reassurance.
- Obsessions doubt (foli de doute) compulsion to check possessions (money, clothes) over and over again. Checking garbage over and over again to see that nothing has been thrown away.
- Religious Obsessions – Hyper-morality that is associated with non-forgiveness of self even after divine pardon is assured
- Obsession Phobias – Fear of contamination, fear of harm, fear of mistakes, leading to a life of being extremely cautious about dirty and making decisions.
4. Investigative Studies
Neuro-imaging studies using computerized tomography and magnetic resonance imaging on OCD patients reveal abnormalities in frontal cortex, limbic system and basal nuclie. CT also reveal differences in cerebral glucose metabolism between patients with OCD and those non-affected.
5. Incidence Of Obsessive Compulsive Neurosis
Gender – Rate of OCD are similar in women and men in ratio 2:1
Age – Onset is typically early twenties (adolescence) bit early for men than women.
Social-cultural – Higher rates found among the divorced or separated and unemployed.
Management Of Obsessive Compulsive Disorder And Assessment
- Physical And Psychological Assessment
Lessions secondary to compulsive acts such as dermatological lessions due to hand-washing or excessive bathing, joint damage due to cleaning rituals.
Type and severity of obsession, including mental status, ;looking out for concentration attention, memory speech.
2. Electo-Convulsive Therapy: Helping in treating obsessional symptoms that occur with depression.
3. Psychosugery: Pre-frontal leucotomy are indicated for severe long standing obsessional state causing patient to be c rippled by their symptoms.
4. Physical Care:
Attention to activities of daily living, nutrition and rest
Personal and environmental protective measure
- 5. Chemotherapy
- Anxiolytics for anxiety
- Serotonin re-uptake inhibitors, monoamine oxidase inhibitors for depressive symptoms and obsessional symptoms.
- Supportive drugs in case of side effects
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