Obsessive Compulsive Disorder OCD is characterized by recurrent

Obsessive Compulsive Disorder.

. OCD is characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress, and by repetitive mental or behavioral acts (compulsions) that the individual feels driven to perform.

Obsessions Ideas, images or impulses Repetitive Distressing Resisted Recognized as own

Compulsions Acts or rituals that are repeated Physical or Mental Not inherently enjoyable or useful May be viewed as preventing some objectively unlikely event Often recognized by the individual as pointless or ineffectual

How to diagnose Obsessional symptoms or compulsive act or both must be present on most days for at least 2 successive weeks. They should be a source of distress or interference with activities The obsessional symptoms should have the following characteristics: (a) recognized as the individual's own thoughts or impulses: (b) Resistance to at least one thought (c) thought of carrying out the act must not in itself be pleasurable (d) thoughts, images, or impulses must be unpleasantly repetitive.

Prevalence . Male to female ratio 0. 9 : 1. 3 Prevalence: 2 -3% of the general population Mean age: 20 years (earlier onset in males) 40% cases associated with tics disorder.

. OBSESSIONS PERCENTAGE Contamination 45 Pathological Doubt 42 Need for symmetry 31 Aggressive 28 Sexual 26 Mixed 60

. COMPULSIONS PERCENTAGES Checking 63 Washing 50 Counting 31 Symmetry 28 Hoarding 18 Multiple compulsions 48

Co-morbidities (albina et al amj-psy 2006) Obsessions……………. . 55% Compulsions……………. 11% Both obss/compuls……………. . 34% Depression & anxiety…………. 62% Substance abuse……………… 13 -20% Suicidal attempts……………. . 25%

Genetics • Monozygotic Twins: 50 -80 % • Dizogytic Twins: 25 % • 3 to 5 times increased risk in first degree relative • Mutation in the human serotonin transporter gene (h. SERT)

Neurochemical Dysregulation in the serotonergic system Imbalance in serotonin/dopamine ratio Deficiency of nor-epinephrine.

Brain Imaging (Radua -bjp 2009) Increased metabolism and blood flow in the orbitofrontal cortex, basal ganglia (caudate), cingulum and thalamus on PET Bilaterally smaller caudates in OCD patients on CT and MRI Increased grey matter volume in bilateral lenticular nuclei and decreased grey matter in frontal and cingulate region on

Medical/Neurological Conditions � Tourette Syndrome � Parkinson’s Disease � Huntington’s Disease/syndenham chorea � Stroke that involves the basal ganglia/autoantibodies against basal ganglia. � Post encephalitis/ encephalitis lethargica. � Post streptococcal � PANDAS

Differential diagnosis of OCD Major depressive disorder Panic disorder Body dysmorphic disorder Generalized anxiety disorder Social phobia and simple phobia ADHD Tourette syndrome Other tic disorders Trichotillomania Substance abuse Eating disorders

Other specialized treatments ECT: Resistant cases. co-morbid severe depression. patients having high suicide risk. Transcranial magnetic stimulation: TMS applied to the dorsolateral prefrontal cortex, the orbitofrontal cortex and supplementary motor areas resulted in transient reduction in obsessive–compulsive symptoms. Neurosurgery cingulotomy, subcaudate tractotomy, capsulotomy, and limbic leucotomy Deep Brain Stimulation Vagus Nerve Stimulation

Course and Prognosis � .

Course/prognosis Mostly sudden onset 50% cases related with a stressful event 5 -10 years before coming to psychiatrist Fluctuating course with remissions and relapses

prognosis 20 -30% of cases show significant improvement 50% show moderate improvement and were on treatment. 40 -50% cases show no improvement or deterioration and left the medications. 40% have co-morbid diagnosis with OCD Micali et al BJP 2010

Good Prognostic Factors Good pre-morbid adjustment Precipitating event Episodic symptoms Good social support.

Poor Prognostic Factors �Compulsions �Longer duration �Early onset �Bizarre compulsions �Co morbid depression �Personality Disorder(cluster-c, borderline, histrionic, schizotypal. �Delusional beliefs