Tag Archives: Obsessive Compulsive Disorder

Trichotillomania (Hair-Pulling Disorder)

Definition:
Trichotillomania (Hair Pulling) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.

It is classified as an impulse control disorder by DSM-IV, is the compulsive urge to pull out one’s own hair leading to noticeable hair loss, distress, and social or functional impairment. It is often chronic and difficult to treat.

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Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. It may be triggered by depression or stress. Due to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% (overall) and may be as high as 1.5% (in males) to 3.4% (in females).

For some people, trichotillomania may be mild and generally manageable. For others, the urge to pull hair is overwhelming and can be accompanied by considerable distress. Some treatment options have helped many people reduce their hair pulling or stop entirely.

The name, coined by French dermatologist François Henri Hallopeau, derives from the Greek: trich- (hair), till(en) (to pull), and mania (“an abnormal love for a specific object, place, or action”).

Classification:
Trichotillomania is defined as a self-induced and recurrent loss of hair. It is classified in DSM-IV as an impulse control disorder with pyromania, pathological gambling and kleptomania, and includes the criterion of an increasing sense of tension before pulling the hair and gratification or relief when pulling the hair. However, some people with trichotillomania do not endorse the inclusion of “rising tension and subsequent pleasure, gratification, or relief” as part of the criteria;   because many individuals with trichotillomania may not realize they are pulling their hair, patients presenting for diagnosis may deny the criteria for tension prior to hair pulling or a sense of gratification after hair is pulled.

Trichotillomania has been hypothesized to lie on the obsessive–compulsive spectrum, which is proposed to encompass obsessive–compulsive disorder, nail biting (onychophagia) and skin picking (dermatillomania), tic disorders and eating disorders. These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile. In the sense that it is associated with irresistible urges to perform unwanted repetitive behavior, trichotillomania is akin to some of these conditions, and rates of trichotillomania among relatives of OCD patients is higher than expected by chance. However, differences between the disorder and OCD have been noted including differing peak ages at onset, rates of comorbidity, gender differences, and neural dysfunction and cognitive profile. When it occurs in early childhood, it can be regarded as a distinct clinical entity.

Because trichotillomania can present in multiple age groups, it is helpful in terms of prognosis and treatment to approach three distinct subgroups by age: preschool age children, preadolescents to young adults, and adults.

Trichotillomania is often not a focused act, but rather hair pulling occurs in a “trance-like” state; hence, trichotillomania is subdivided into “automatic” versus “focused” hair pulling. Children are more often in the automatic, or subconscious, subtype and may not consciously remember pulling their hair. Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels “just right”, or pulling in response to a specific sensation. Knowledge of the subtype is helpful in determining treatment strategies

Symptoms:
Trichotillomania is usually confined to one or two sites, but can involve multiple sites. The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, legs, and pubic hairs. The classic presentation is the “Friar Tuck” form of vertex and crown alopecia. Children are less likely to pull from areas other than the scalp.

Individuals with trichotillomania exhibit hair of differing lengths; some are broken hairs with blunt ends, some new growth with tapered ends, some broken mid-shaft, or some uneven stubble. Scaling on the scalp is not present, overall hair density is normal, and a hair pull test is negative (the hair does not pull out easily). Hair is often pulled out leaving an unusual shape; individuals with trichotillomania may be secretive or shameful of the hair pulling behavior.

An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs, wear false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as “pulling”) whatsoever. This “pulling” often resumes upon leaving this environment. Some individuals with TTM may feel they are the only person with this problem due to low rates of reporting.

Other medical complications include infection, permanent loss of hair, repetitive stress injury, carpal tunnel syndrome, and gastrointestinal obstruction as a result of trichophagia. In trichophagia, people with trichotillomania also ingest the hair that they pull; in extreme (and rare) cases this can lead to a hair ball (trichobezoar). Rapunzel syndrome, an extreme form of trichobezoar in which the “tail” of the hair ball extends into the intestines, can be fatal if misdiagnosed.

Environment is a large factor which affects hair pulling. Sedentary activities such as being in a relaxed environment are conducive to hair pulling. A common example of a sedentary activity promoting hair pulling is lying in a bed while trying to rest or fall asleep. An extreme example of automatic TTM is found when some patients have been observed to pull their hair out while asleep. This is called sleep-isolated trichotillomania.

Signs and symptoms of trichotillomania often include:

*Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well
*A strong urge to pull hair, followed by feelings of relief after the hair is pulled
*Patchy bald areas on the scalp or other areas of your body
*Sparse or missing eyelashes or eyebrows
*Chewing or eating pulled-out hair
*Playing with pulled-out hair
*Rubbing pulled-out hair across your lips or face

Causes:-
The cause of trichotillomania isn’t known. Most experts believe it’s a type of obsessive-compulsive disorder, but there may be a hereditary element. Some blame environmental pollution, streptococcal infections, or even deficiencies of brain or body chemicals and nutrients.

The answer probably lies somewhere between pleasant habit and a reaction to stress, at least in terms of the initial trigger. People often start by pulling out damaged hairs to relieve an itch or a follicle, but as the habit progresses they may lose any reason for it.

Risk Factors:
These factors tend to be associated with trichotillomania:

*Family history. Susceptibility to trichotillomania may be inherited.

*Age. Trichotillomania usually develops during adolescence — most often between the ages of 11 and 13 — and is often a lifelong problem. Children younger than age 5 also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.

*Sex. Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.

*Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, loneliness, fatigue or frustration.

*Positive reinforcement. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

*Other disorders. People who have trichotillomania may also have other disorders, including depression, anxiety, obsessive-compulsive disorder or eating disorders. Nail biting and skin picking have also been associated with trichotillomania.

Diagnosis:
Patients may be ashamed or actively attempt to disguise their symptoms. This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure. If the patient admits to hair pulling, diagnosis is not difficult; if patients deny hair pulling, a differential diagnosis must be pursued. The differential diagnosis will include evaluation for alopecia areata, tinea capitis, traction alopecia, and loose anagen syndrome. In trichotillomania, a hair pull test is negative.

A biopsy can be performed and may be helpful; it reveals traumatized hair follicles with perifollicular hemorrhage, fragmented hair in the dermis, empty follicles, and deformed hair shafts (trichomalacia). Multiple catagen hairs are typically seen. An alternative technique to biopsy, particularly for children, is to shave a part of the involved area and observe for regrowth of normal hairs.

Treatment:
Treatment is based on a person’s age. Most pre-school age children outgrow it if the condition is managed conservatively. In young adults, establishing the diagnosis and raising awareness of the condition is an important reassurance for the family and patient. Non-pharmacological interventions, including behavior modification programs, may be considered; referrals to psychologists or psychiatrists are considered when other interventions fail. When trichotillomania begins in adulthood, it is often associated with other psychiatric disorders, and referral to a psychologist or psychiatrist for evaluation or treatment is considered best. The hair pulling may resolve when other conditions are treated.

Psychosocial:
Habit Reversal Training (HRT) has the highest rate of success in treating trichotillomania. HRT has been shown to be a successful adjunct to medication as a way to treat TTM. With HRT, doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioral versus pharmacologic treatment, cognitive behavioral therapy (including HRT) have shown significant improvement over medication alone. It has also proven effective in treating children. Biofeedback, cognitive-behavioral methods, and hypnosis may improve symptoms.

Medication:
Medications can be used. Treatment with clomipramine (Anafranil), a tricyclic antidepressant, was shown in a small double-blind study to significantly improve symptoms, but results of other studies on clomipramine for treating trichotillomania have been inconsistent. Fluoxetine (Prozac) and other selective serotonin reuptake inhibitors (SSRIs) have limited usefulness in treating TTM, and can often have significant side effects. Behavioral therapy has proven more effective when compared to fluoxetine or control groups. Dual treatment (behavioral therapy and medication) may provide an advantage in some cases, but robust evidence from high-quality studies is lacking.[1] Acetylcysteine treatment stemmed from an understanding of glutamate’s roll in regulation of impulse control

Prognosis:
When it occurs in early childhood (before five years of age), the condition is typically self-limiting and intervention is not required. In adults, the onset of trichotillomania may be secondary to underlying psychiatric disturbances and symptoms are generally more long-term.

Secondary infections may occur due to picking and scratching, but other complications are rare. Individuals with trichotillomania often find that support groups are helpful in living with and overcoming the disorder.

Epidemiology:
Although no broad-based population epidemiologic studies had been conducted as of 2009, the lifetime prevalence of trichotillomania is estimated to be between 0.6% (overall) and as high as 1.5% (in males) to 3.4% (in females). With a 1% prevalence rate, 2.5 million people in the U.S. may have TTM at some time during their lifetimes.

TTM is diagnosed in all age groups; onset is more common during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12–13. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female. Among adults, females typically outnumber males by 3 to 1.

“Automatic” pulling occurs in approximately three-quarters of adult patients with trichotillomania

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.bbc.co.uk/health/physical_health/conditions/hairpull.shtml
http://en.wikipedia.org/wiki/Trichotillomania
http://www.mayoclinic.com/health/trichotillomania/DS00895

http://www.wattzinternational.com/testimony_j.htm

http://www.noellesalon.com/hair-salon-boston.php?tag=trichotillomania&page=2

Electro-Convulsive Therapy

Definition:
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.

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Electroconvulsive therapy (ECT), formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown. Today, ECT is most often recommended for use as a treatment for severe depression which has not responded to other treatment, and is also used in the treatment of mania and catatonia. It was first introduced in the 1938 and gained widespread use as a form of treatment in the 1940s and 1950s.

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Informed consent is a standard of modern electroconvulsive therapy. According to the Surgeon General, involuntary treatment is uncommon in the United States and is typically only used in cases of great extremity, and only when all other treatment options have been exhausted and the use of ECT is believed to be a potentially life saving treatment. However, caution must be exercised in interpreting this assertion as, in an American context, there does not appear to have been any attempt to survey at national level the usage of ECT as either an elective or involuntary procedure in almost twenty years. In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent

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Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. In the United Kingdom and Ireland, drug therapy is continued during ECT.

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The treatment involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current across the brain, with the patient sedated or under anaesthetic. The aim is to produce a seizure lasting up to a minute, after which the brain activity should return to normal. Patients may have one or more treatment a week, and perhaps more than a dozen treatments in total.

Although ECT has been used since the 1930s, there is still no generally accepted theory to explain how it works. One of the most popular ideas is that it causes an alteration in how the brain responds to chemical signals or neurotransmitters.

Why & when it is done?
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania.

ECT is used to treat:
*Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.

*Treatment-resistant depression, long-term depression that doesn’t improve with medications or other treatments.

*Schizophrenia, particularly when accompanied by psychosis, a desire to commit suicide or hurt someone else, or refusal to eat.

*Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse and psychosis.

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*Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness.

Electroconvulsive therapy is sometimes used as a last-resort treatment for:

#Treatment-resistant obsessive compulsive disorder, severe obsessive compulsive disorder that doesn’t improve with medications or other treatments

#Parkinson’s disease, epilepsy, and certain other conditions that cause movement problems or seizures

*Tourette syndrome that doesn’t improve with medications or other treatments

ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:

#During pregnancy, when medications can’t be taken because they might harm the developing fetus

#In older adults who can’t tolerate drug side effects

#In people who prefer ECT treatments over taking medications

#When ECT has been successful in the past

Risk factor:
Patients are given short-acting anaesthetics, muscle relaxants and breathe pure oxygen during the short procedure in order to minimise the risks. However, although ECT is much safer than it was, there are still side effects to the treatment. The most common are headache, stiffness, confusion and temporary memory loss on awaking from the treatment – some of these can be reduced by placing electrodes only on one side of the head. Memory loss can be permanent in a few cases, and the spasms associated with the seizure can cause fractured vertebrae and tooth damage. However, the recommended use of muscle relaxant nowadays makes the latter a very rare occurrence. Patients can also experience numbness in the fingers and toes.

The death rate from ECT used to be quoted as one for every 1,000 patients, but with smaller amounts of electric current used in modern treatments, accompanied by more safety techniques, this has been reduced to as little as four or five in 100,000 patients.

Recomendations:
A common argument against ECT is that it destroys brain cells, with experiments conducted on animals in the 1940s often cited as evidence. However, modern studies have yet to reproduce these findings in the human brain.

Some activists, however, still campaign against the widespread use of ECT in psychiatry, quoting those cases which have resulted in long-term damage or even death, whether because of the built-in chance of problems, or through errors by doctors.

Experts say that given the correct staff training, and when used for the right clinical conditions, ECT can ‘dramatically’ benefit the patient. An audit of ECT in Scotland between February 1996 and August 1999 said concerns about unacceptable side effects, effectiveness of the treatment and disproportionate use on elderly people were ‘largely without foundation’.

It said that in nearly three quarters of cases people with depressive illness showed ‘a definite improvement’ after ECT. Women were more likely to receive the treatment than men, but the auditors said this was because they were twice as likely to suffer from depression. Only 12 per cent of patients who got ECT were aged over 75. However, the Royal College of Psychiatrists has admitted that in the past the treatment has been administered by untrained, unsupervised junior doctors. However, modern guidelines have changed this and ECTAS (ECT Accreditation Services) exist to check that such treatment is being given safely and efficiently.

Guidelines on ECT from NICE (2003) recommend that it’s used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment. options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:

•Severe depressive illness
•Catatonia
•Prolonged or severe manic episode

NICE also says that ‘valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. The decision to use ECT should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. This discussion should be enabled by the provision of full and appropriate information about the general risks associated with ECT and about the risks and potential benefits specific to that individual. Consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. There should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged.’

 

Click to learn more  in detail  about  Electro-Convulsive Therapy

You may click to see:-

Keep fighting even when depression treatments don’t work
Video:Electroconvulsive therapy

DSM-IV Codes
Harold A. Sackeim
Insulin shock therapy
History of electroconvulsive therapy in the United Kingdom
Psychiatric survivors movement
Consumer/Survivor/Ex-Patient Movement
List of people who have undergone electroconvulsive therapy

 

Resources:
http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129
http://www.bbc.co.uk/health/physical_health/conditions/electro_convulsive_therapy.shtml
http://en.wikipedia.org/wiki/Electroconvulsive_therapy

http://www.minddisorders.com/Del-Fi/Electroconvulsive-therapy.html

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Tics

Definition:
Tics are purposeless, rapid and repeated contractions of a group of muscles that result in movement (a motor tic) or the production of a sound (a vocal tic). Sometimes, a tic involves more complex behaviour.

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Motor tics often involve the muscles of the face, head and neck, with movements such as blinking, lip smacking, facial twitching, grimacing and shrugging of the shoulders. Common vocal tics include coughing, grunting or clearing the throat.

The intensity of a tic can vary. Occasionally, tics are forceful, which can be frightening and uncomfortable.

Tics aren’t voluntary movements – in other words, they can’t be consciously controlled – although some people say they feel a strong urge to move, linked to stress. Some people are able to suppress their tics briefly, but this is said to be like holding back a sneeze and tension rises until the tic finally escapes.

Tics are usually divided into several categories, as described below.:-

Transient tic disorders:-
As many as one in ten children will develop a transient or simple tic at some point during their school years. Such tics usually occur in just one muscle group and don’t last more than a few months, although a child may have a series of different transient tics over a period of years.

Transient motor tics may include blinking, squinting, snapping the fingers, jerking the head or wrinkling the nose. Occasionally, transient vocal tics such as gurgling or humming occur. The tic may even involve more bizarre behaviour, such as touching objects or licking.

Transient tics may become more prominent when a child is tired or excited, but they don’t lead to harm and don’t need treatment. They decrease or disappear when the child sleeps.

Chronic tic disorders:-
Not only do chronic tics persist, sometimes for years, but they change little in their character. While they don’t usually need treatment, they can be disruptive, especially if a child realises others think them strange. Occasionally, a person has several tics and is said to have chronic multiple tics.

Tourette syndrome:
Chronic tics are also a feature of Tourette syndrome. This neurological disorder causes multiple motor and vocal tics, which can be quite dramatic and frequently change in nature. Tourette syndrome usually begins in early childhood, varies in intensity and lasts more than a year.

Tourette can be particularly debilitating because the vocal tics can include the uncontrollable use of obscene language (known as coprolalia) and repetition of phrases the person hears others use (called echolalia).

Those with Tourette syndrome often have a variety of psychological problems too, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and self-harm behaviour, although the link isn’t clear.

Like other tics, the exact cause of Tourette syndrome isn’t known, although genetics appear to play a part. It’s likely that a particular gene makes a person more vulnerable than others to environmental factors that also contribute to the condition.

Simple tics:-
Simple motor tics are typically sudden, brief, meaningless movements that usually involve only one group of muscles, such as eye blinking, head jerking or

shoulder shrugging.   Motor tics can be of an endless variety and may include such movements as hand clapping, neck stretching, mouth movements, head, arm or leg jerks, and facial grimacing.

A simple phonic tic can be almost any sound or noise, with common vocal tics being throat clearing, sniffing, or grunting.

Complex tics:-
Complex motor tics are typically more purposeful-appearing and of a longer nature. They may involve a cluster of movements and appear coordinated.Examples of complex motor tics are pulling at clothes, touching people, touching objects, echopraxia and copropraxia.

Complex phonic tics may fall into various series (categories), including echolalia (repeating words just spoken by someone else), palilalia (repeating one’s own previously spoken words), lexilalia (repeating words after reading them) and coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases). Coprolalia is a highly publicized symptom of Tourette syndrome; however, only about 10% of TS patients exhibit coprolalia.Complex tics are rarely seen in the absence of simple tics. Tics “may be challenging to differentiate from compulsions”, as in the case of klazomania (compulsive shouting).

•Simple motor tics involve a single muscle group.
•Complex motor tics usually involve more than one muscle group.
•Complex vocal tics involve more meaningful speech (such as words) than simple vocal tics.
•Complex motor tics aren’t as rapid as simple motor tics and can even look like the person is performing the tic on purpose.

Shoulder shrugging is one of the most common simple motor tics; others include:
•nose wrinkling
•head twitching
•eye blinking
•lip biting
•facial grimacing
•repetitive or obsessive touching
•kicking
•jumping

Common vocal tics include:
•coughing
•throat clearing
•grunting
•sniffing
•barkingTransient vs. Chronic Tics

Transient vs. Chronic Tics:-
It’s perfectly normal to worry that a tic may never go away. Fortunately, that’s not usually the case. Most tics are temporary and are known as transient tics. They tend to not last more than 3 months at a time.In rarer instances people have tics that persist for an extended period of time. This is known as chronic tic disorder. These tics last for more than a year. Chronic tics can be either motor or vocal, but not both together.

Dignosis:
Tics can sometimes be diagnosed at a regular checkup after the doctor asks a bunch of questions. No specific test can diagnose tics, but sometimes doctors will run tests to rule out other conditions that might have symptoms similar to tics.

Tic disorders occur along a spectrum, ranging from mild to more severe, and are classified according to duration and severity (transient tics, chronic tics, or Tourette syndrome). Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe.    The treatment for the spectrum of tic disorders is similar to the treatment of Tourette syndrome.

Differential diagnosis:
Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome as the result of other diseases or conditions—also known as secondary causes. Although tic disorders are commonly considered to be childhood syndromes, tics occasionally develop during adulthood; adult-onset tics often have a secondary cause. Tics that begin after the age of 18 are generally not considered symptoms of Tourette’s syndrome.

Tics must be distinguished from fasciculations. Small twitches of the upper or lower eyelid, for example, are not tics, because they do not involve a whole muscle. They are twitches of a few muscle fibre bundles, which one can feel but barely see

The Embarrassment Factor
Many times, people don’t see themselves having a tic — they’re not walking around with a huge mirror at all times! So it’s only natural that they may think that their tic is the worst tic ever. Of course it isn’t, but it’s still a concern for many people with tics. And these exaggerated thoughts can cause unnecessary feelings of embarrassment or angst, and actually make the tic worse.

The tic might seem to begin either for no appreciable reason, or perhaps be incited by something like an eye irritation which begins a cycle of blinking that doesn’t stop when the irritation is gone. The simple tic usually goes away in six months or so, seemingly sooner if the child is not being reminded of it all the time by his family.

Sometimes the symptoms become more chronic. If the symptoms are limited to muscular movements, the condition is called multiple chronic motor tic disorder. If the child has both vocal and motor symptoms which last more than a year, the term Gilles de la Tourette syndrome or more commonly Tourette syndrome.

Symptoms (motor and vocal tics) in Tourette syndrome can be pretty bizarre.
Most extreme and distressing are involuntary cursing (coprolalia) and obscene gestures (copropraxia). Suffice it to say that any involuntary repetitive activities or vocalizations in children between 2 and 14 or so deserve consideration for Tourette syndrome.

A significant percentage of children with Tourette syndrome show signs of attention deficit disorder as well. Because treatment of ADD with stimulants such as methylphenidate (Ritalin¨) may possibly initiate or worsen tics, and perhaps may bring on full-blown Tourette syndrome, any new or worsening tics in a child on ADD medication must be immediately reported to the childs physician.

Long term studies of the natural history of Tourette syndrome show the average age of onset as about five to six years old. Tic severity peaks around 10 years of age, with a range between 8 and 12 years. About one fifth of patients with Tourette syndrome will have such severe problems that school is interfered with or impossible. Almost all patients get better with time, and by age 18, half of affected children are tic-free, and nine of ten have only mild or no tics.

Nobody wants to make tics worse, but is there any way to make them better? While you can’t cure tics, you can take some easy steps to lessen their impact:

•Don’t focus on it. If you know you have a tic, forget about it. Concentrating on it just makes it worse.
•Avoid stress-filled situations as much as you can — stress only makes tics worse. So get your work done early and avoid the stress that comes with procrastination and last-minute studying.
•A tic? What tic? If a friend of yours has a tic, don’t call attention to it. Chances are your friend knows the tic is there. Pointing it out only makes the person think about it more.
•Get enough sleep. Being tired can makes tics worse. So make sure to get a full night’s rest!
•Let it out! Holding back a tic can just turn it into a ticking bomb, waiting to explode. Have you ever felt a cough coming on and tried to avoid it? Didn’t work out so well, did it? Chances are it was much worse. Tics are very similar.
In certain cases, tics are bad enough to interfere with someone’s daily life and medication may be prescribed.

Don’t let a little tic dictate who you are or how you act. Learning to live with and not pay attention to the tic will make you stronger down the road.

Treatment and recovery :-
Psychological support and counselling can be helpful for those with disruptive tics and cognitive behavioural therapy may help some people control their condition.

Medication is the most effective treatment in reducing the tic itself. However, the powerful drugs used (such as haloperidol, pimozide, fluphenazine and clonidine) tend to have unpleasant side-effects. So, while 70 per cent of those with Tourette have tried drugs, for example, many people prefer to manage without medication if possible.

*Don’t panic if your child develops a tic – most are mild and transient
*Most tics don’t interfere with life or school and don’t require treatment
*People taking stimulant drugs (for ADHD, for example) may develop tics but these should cease when the drug is stopped
*Stress can aggravate symptoms or simply make life harder – relaxation and biofeedback techniques may help.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/conditions/tics1.shtml
http://kidshealth.org/teen/diseases_conditions/brain_nervous/tics.html
http://www.drhull.com/EncyMaster/T/tics.html
Tics

http://en.wikipedia.org/wiki/Tic

 

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Obsessive Compulsive Disorder(OCD)

Illustration of Gowers' tract

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Definition:

Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder most commonly characterized by obsessive, distressing,repetitive thoughts and related compulsions. Compulsions are tasks or “rituals” which attempt to neutralize the obsessions.

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OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life. The phrase “obsessive-compulsive” has become part of the English lexicon, and is often used in an informal or caricatured manne to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.

Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive-compulsive personality disorder (OCPD) or some other condition. Obsessive-compulsive disorder is very frustrating to the affected person and any friends and family.

Obsessive-compulsive disorder is an anxiety disorder characterized by an inability to resist or stop continuous, abnormal thoughts or fears combined with ritualistic, repetitive and involuntary defense behavior.It is an anxiety disorder in which people have thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). A person may have both obsessions and compulsions.

Causes:

Psychological

Scientists studying obsessive-compulsive disorder are split into two factions disagreeing over the illness’s cause. One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin.

Biological

There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality with the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain’s response to OCD, and not its cause. Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs) — a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells. For more about this class of drugs, see the section about potential treatments for OCD.

The Stanford University School of Medicine OCD webpage states, “Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to Group A streptococcal infection promises to bring increased understanding of the disorder’s pathogenesis.”

Obsessive-compulsive disorder (OCD) is more common than was once thought. Most people who develop it show symptoms by age 30. There are several theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.

About 20% of people with OCD have tics, which suggests the condition may be related to Tourette syndrome. However, this link is not clear.

Symptoms and prevalence:

*Obsessions or compulsions are not due to medical illness or drug use
*Obsessions or compulsions cause major distress or interfere with everyday life
*An example of obsessive-compulsive disorder is excessive, repeated handwashing to ward off infection.

The person usually recognizes that the behavior is excessive or unreasonable.
OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically-recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed. The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that they have the condition.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one’s parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain amount of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as tics or Parkinson’s disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.

There are many other possible symptoms, and it is not necessary to display those described in the lists below to be considered as suffering from OCD. Formal diagnosis should be performed by a psychologist, a psychiatrist or psychoanalyst. OCD sufferers are aware that their thoughts and behavior are not rational, but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time. For people with OCD, the thoughts are intrusive and persistent, and cause them great anxiety and distress.

Contamination:
A major subtype of the fear category is the fear of contamination:(see mysophobia); some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine, semen or feces. Some OCD sufferers even fear that the soap they are using is contaminated. These anxiety-driven fears may cause a person to experience significant distress, which may make it difficult for a person with OCD to tolerate a workplace, venture into public locations, or conduct normal social relationships.

Performing tasks:
Symptoms related to performing tasks may include repeated hand washing or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions — more generally, this can involve an obsession with numbers or types of numbers (e.g., odd numbers). These obsessive behaviours can cause individuals to feel psychological distress, because they are very concerned about having “made mistakes” in the number of steps that they have taken, or the number of stairs on a staircase. For some people with OCD, these obsessive counting and re-counting tasks, along with the attendant anxiety and fear, can take hours of each day, which can make it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.

Intrusive thoughts and fears:
Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.[8] Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts. Most people experience these thoughts; when they are associated with OCD or depression, they may become paralyzing, anxiety-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.[8] When intrusive thoughts co-occur with OCD, patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.

Violent or aggressive thoughts:
Intrusive thoughts may involve violent obsessions about hurting others or one’s self. They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile. A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent. A person with OCD may meet up with their best friend, to whom they bear no ill will, and an image of them stabbing their friend may suddenly appear in their imagination.

While some individuals with OCD who have these unwanted images pop into their minds are able to dismiss the images as random “static” generated by the mind, others are tormented by the thoughts, and they may worry that they are actual desires that they may act on, or that they are “going crazy.” In some cases, the person struggling with these horrible images may try to deal with them by developing compulsions. For example, a person who is tormented by unwanted thoughts of them stabbing their mother with a kitchen knife may ensure that all kitchen knives are kept locked away, to prevent the perceived danger that they may “act upon” the horrible thoughts.

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won’t act upon the thoughts. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn’t feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don’t see; or feels uncontrollable irresistible anger.

Inappropriate sexual thoughts:
Sexual obsessions involve intrusive thoughts or images of “kissing, hugging a lot, touching, fondling, oral sex, anal sex, intercourse, and rape” with “strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures”, involving “heterosexual or homosexual content” with persons of any age. Like other intrusive, unpleasant thoughts or images, most people have some inappropriate sexual thoughts at times[citation needed], but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing.

One of the more common sexual intrusive thoughts occurs when an obsessive person doubts his or her sexual identity, a symptom of OCD called homosexuality anxiety or HOCD.[14] As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity. A person experiencing sexual intrusive thoughts may feel shame, “embarrassment, guilt, distress, torment, fear that you may act on the thought or perceived impulse and, doubt about whether you have already acted in such a way.” Depression may be a result of the self-loathing that can occur, depending on how much the OCD interferes with daily functioning or causes distress. The possibility that most patients suffering from intrusive thoughts to sexually assault people will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts.

Related conditions
OCD is often confused with the separate condition obsessive-compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer’s self-concept. Because disorders that are ego dystonic go against an individual’s perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic — marked by the individual’s acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions. This is a significant difference between these disorders.

Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not.

OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD’s effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.

Related/Spectrum disorders
People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, Asperger syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive-compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD suffer also from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an “out of control” type of feeling.

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal antibodies become involved in an autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be “caught” via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it.

Diagnostic criteria:
To be diagnosed with OCD, a person must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) states six characteristics of obsessions and compulsions:

Obsessions:

1.Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress.

2.The thoughts, impulses, or images are not simply excessive worries about real-life problems.

3.The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.

4.The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions:

1.Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.

2.The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not actually connected to the issue, or they are excessive.

In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning. OCD often causes feelings similar to those of depression.

Diagnosis: Exams and Tests :

Your own description of the behavior can help diagnose the disorder. A physical exam can rule out physical causes, and a psychiatric evaluation can rule out other mental disorders.

Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale, can help diagnose OCD and track the progress of treatment.

Treatment :

According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), and medications 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.

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as “exposure and response prevention“) or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly “contaminated” (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a “contaminated” location, such as a school.) That is the “exposure”. The “ritual prevention” is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more “contaminated” or not checking the lock at all — again, without performing the ritual behavior of washing or checking.

Exposure ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone.

However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.

Recently it has been reported simultaneous administration of D-Cycloserin (an antibiotic) substantialy improves effectiveness of Exposure and Response prevention. See :->http://www.ncbi.nlm.nih.gov/pubmed/18245177


Medication
Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious.

Benzodiazepines are also used in treatment. It’s not uncommon to administer this class of drugs during the “latency period” for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and can be addictive.[32]

Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Much current research is devoted to the therapeutic potential of the agents that effect the release of the neurotransmitter glutamate or the binding to its receptors. These include riluzole, memantine, gabapentin (Neurontin) and lamotrigine (Lamictal).

Low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD. The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics — CYP2D6 — so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.

Alternative Drug Treatments

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse desensitisation of the neurotransmitter’s receptors. St John’s Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John’s Wort and the placebo. Studies have also been done that show nutrition deficiencies may also contribute to OCD and other mental disorders. Certain vitamin and mineral supplements may aid in such disorders and providethe nutrients necessary for proper mental functioning.

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the use of them is not sanctioned for treatment and considered an “off-label” use, factors being physical dependence and long term drug tolerance. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as tramadol (Ultram) and hydrocodone (Vicodin, Lortab), though the off-label use of such painkillers is not widely accepted, research on this has been limited. Tramadol is an atypical opioid that may be a viable option as it has a low potential for abuse and addiction, mild side effects, and shows signs of rapid efficacy in OCD. Tramadol not only provides the anti-OCD effects of an opiate, but also inhibits the re-uptake of serotonin (in addition to norepinephrine). This may provide additional benefits, but should not be taken in combination with antidepressant medication unless under careful medical supervision due to potential serotonin syndrome.

Recent studies at the University of Arizona using the tryptamine alkaloid psilocybin have shown promising results. There are reports that other hallucinogens such as LSD and peyote have produced similar benefits. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less importantly, 5-HT2C receptors. This causes, among many other effects, an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD.

Emerging evidence suggests that regular nicotine treatment may be helpful in improving symptoms of OCD, although the pharmacodynamical mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis. Anecdotal reports suggest OCD can worsen when cigarettes are smoked as a way of obtaining nicotine.

Psycho surgery

For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure. Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive-behavioral therapy with exposure and ritual/response prevention. Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.

Psychotherapy is used to:

*Provide effective ways of reducing stress
*Reduce anxiety
*Resolve inner conflicts

Behavioral therapies may include:

Exposure/response prevention: You are exposed many times to a situation that triggers anxiety symptoms, and learn to resist the urge to perform the compulsion.
Thought-stopping: You learn to stop unwanted thoughts and focus attention on relieving anxiety.

Transcranial magnetic stimulation

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. The magnetic pulses are focused on the brain’s supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA’s activity, so that it properly filters out thoughts and behaviors associated with OCD

Neuropsychiatry

OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. OCD involves several different receptors, mostly H2, M4, NK1, NMDA, and non-NMDA glutamate receptors. The receptors 5-HT1D, 5-HT2C, and the M opioid receptor exert a secondary effect. The H2, M4, NK1, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.

The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H2); the Muscarinic acetylcholine receptor(M4); the Tachykinin receptor (NK1); and non-NMDA glutamate receptors. Correlations where activity is negatively correlated to severity include the NMDA receptor (NMDA); the Mu opioid receptor (? opioid); and two types of 5-HT receptors (5-HT1D and 5-HT2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects.

Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Also, the anti-Alzheimer’s drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. One case study published in The American Journal of Psychiatry suggests that “memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation.”The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms. Many trials are currently underway to investigate the efficacy of a variety of agents that affect these ‘core’ neurotransmitters, particularly glutamatergic agents

Prognosis:

OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment.

Possible Complications:

Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not usually progress into another disease.

When to Contact a Medical Professional

Call for an appointment with your health care provider if your symptoms interfere with daily life, work, or relationships.

Prevention :

There is no known prevention for this disorder.

You may click to see->How mad are you?

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000929.htm
http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder

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Brain Region Linked to OCD

Scientists have located an area in the brain that fails to “kick-in” for people with obsessive compulsive disorder and those at risk of developing the condition.

The discovery could allow experts to diagnose the disorder much earlier and better track how treatments are working.

“The main finding is that in people with obsessive compulsive disorder and their unaffected relatives, part of their orbitofrontal cortex didn’t kick in on line as it should have,” said Samuel Chamberlain, a neuroscientist at the University of Cambridge, who led the study.

Obsessive Compulsive Disorder (O.C.D.) is quite a common disabling anxiety disorder. Three percent of the population will suffer from it at some time in their lives. It is more common than schizophrenia or manic depression but it is well concealed and rarely diagnosed.


People with OCD may feel compelled to perform a certain action to cope with their obsession.

OCD is a psychiatric anxiety disorder that tends to run in families and is marked by recurrent and persistent thoughts and impulses, such as uncontrollable and repeated hand washing.They may be obsessed with the idea that germs are everywhere, for example. Even if they know they are being irrational, they feel compelled to repeat some action over and over again, like constant cleaning or hand washing. Others feel they must check things repeatedly, perhaps before leaving the house.

Sources: The Times Of india