Instruct: Given a question, retrieve relevant documents that answer the question.
Query: What's a ritual in OCD?
Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical order, and which cause distress or social dysfunction. The compulsive rituals are personal rules followed to relieve the anxiety. OCD affects roughly 1-2% of adults (somewhat more women than men), and under 3% of children and adolescents.
Antidepressants which have been shown to be effective in treating OCD include fluvoxamine (trade name Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and clomipramine (Anafranil). Although SSRIs are known to be effective for OCD in general, there have been fewer studies on their effectiveness for intrusive thoughts. A retrospective chart review of patients with sexual symptoms treated with SSRIs showed the greatest improvement was in those with intrusive sexual obsessions typical of OCD. A study of ten patients with religious or blasphemous obsessions found that most patients responded to treatment with fluoxetine or clomipramine. Women with postpartum depression often have anxiety as well, and may need lower starting doses of SSRIs; they may not respond fully to the medication, and may benefit from adding cognitive behavioral or response prevention therapy.
Mandel has spoken publicly about having obsessive compulsive disorder, which can take many forms, including mysophobia. Mandel's anxiety affects him to the point that he does not shake hands with anyone, including enthusiastic contestants on "Deal or No Deal", unless he is wearing latex gloves. Instead of shaking contestants' hands when they offer them, Mandel often opts to exchange fist bumps, put his hands on contestants' shoulders, or give an occasional hug. He once kissed a female contestant on the show for good luck despite his disorder. He now takes medicine to control his condition and even pokes fun at himself for it. He revealed on "The Howard Stern Show" on March 24, 2006, that his shaved head is not related to natural hair loss, but to OCD. He stated that the lack of hair makes him feel cleaner. In the back yard of Mandel's house is a second, smaller house which he had built especially to live in solitude when a family member is sick. During his appearance on "Mad TV", Mandel and cast member Bobby Lee made fun of the former's condition. Mandel also confronted his germophobia in Season 4, Episode 1 of the Comedy Central series "This Is Not Happening". The show aired on February 3, 2018.
Habit reversal training (HRT), massed negative practice, biofeedback, relaxation, hypnosis and other behavioral approaches are proposed as alternative treatments of tics, but few have been well assessed. Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not proven therapies for Tourette's.
Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not empirically supported therapies for Tourette's. Deep brain stimulation has been used to treat adults with severe Tourette's that does not respond to conventional treatment, but it is regarded as an invasive, experimental procedure that is unlikely to become widespread.
People with schizophrenia often have additional mental health problems such as anxiety, depressive, or substance-use disorders. Schizophrenia occurs along with obsessive-compulsive disorder (OCD) considerably more often than could be explained by chance. An estimated 21% to 47% of patients with schizophrenia have a substance misuse disorder at some time in their life, and the chances of developing a substance misuse disorder is significantly higher among patients suffering from a psychotic illness. All of these factors result in an increased range of clinical presentations and suggest a significant etiological heterogeneity.
A tic is a sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing.
Neuroimaging also uncovered different sub-regions in the anterior cingulate cortex itself based on their function. These studies showed that the caudal part of the anterior cingulate cortex plays a more important function in cognitive activities that involve attention, salience, interference and response competition. These results combined with electrophysiological investigation of the function of neurons in the anterior cingulate cortex have provided insights that can be used in the improvement of cingulotomy performed on patients treated for OCD. The basis behind this idea is the fact that a variation of certain tasks, Emotional Stroop tasks (ES), which have been particularly identified as exerting effects in OCD patients activate neurons in the more rostral part of the anterior cingulate cortex. Thus, theoretically if bilateral cingulotomy is performed in such patient in the rostral anterior cingulate cortex, better results should be obtained.
Oscar (Nathaniel Brown) lives in Tokyo with his younger sister Linda (Paz de la Huerta) and supports himself by dealing drugs, against the advice of his friend Alex (Cyril Roy), who attempts to turn Oscar's interest toward "The Tibetan Book of the Dead", a Buddhist book about the afterlife. The first segment begins with Linda leaving for work (at a local strip club) and then follows Oscar's nightly routine through strict point-of-view shots, including momentary blackouts that represent blinking, private internal thoughts, and extended sequences of a DMT-induced hallucination.
Each Druidic grove conducts its rituals and ceremonies in a unique way. Druidic rituals are designed to align their participants with the spirit imbuing nature. According to the anthropologist Thorsten Gieser, Druidic rituals are best seen not as a set of formalised actions but as "a stance, an attitude, a particular mode of experience and perception which gives rise to a feeling of being-in-the-world, of being part of Nature."
The practices of modern Druids typically take place outside, in the daylight, in what is described as "the eye of the sun", meaning around midday. In some cases, they instead perform their rites indoors, or during the night. Druidic rituals usually reflect on the time of year and the changing of the seasons.
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 (repeating or imitating another person's actions) and copropraxia (involuntarily performing obscene or forbidden gestures).
In Catholic practice the person performing the exorcism, known as an exorcist, is an ordained priest. The exorcist recites prayers according to the rubrics of the rite, and may make use of religious materials such as icons and sacramentals. The exorcist invokes God—specifically the Name of Jesus—as well as members of the Church Triumphant and the Archangel Michael to intervene with the exorcism. According to Catholic understanding, several weekly exorcisms over many years are sometimes required to expel a deeply entrenched demon.
The treatment of Tourette's focuses on identifying and helping the individual manage the most troubling or impairing symptoms. Most cases of Tourette's are mild, and do not require pharmacological treatment; instead, psychobehavioral therapy, education, and reassurance may be sufficient. Treatments, where warranted, can be divided into those that target tics and comorbid conditions, which, when present, are often a larger source of impairment than the tics themselves. Not all people with tics have comorbid conditions, but when those conditions are present, they often take treatment priority.
According to the Vatican guidelines issued in 1999, “the person who claims to be possessed must be evaluated by doctors to rule out a mental or physical illness.” Most reported cases do not require an exorcism because twentieth-century Catholic officials regard genuine demonic possession as an extremely rare phenomenon that is easily confounded with natural mental disturbances. Despite that fact, every diocese is required to have at least one priest that is an exorcist, or is trained to perform exorcisms (17). As the demand for exorcisms has increased over the past few decades, the number of trained exorcists has also risen. In prior times, exorcists were kept fairly anonymous, and the performance of exorcisms remained a secret. Some exorcists attribute the rise in demand of exorcisms to the rise in drug abuse and violence, which leads to the suggestion that such things might work hand in hand. Many times a person just needs spiritual or medical help, especially if drugs or other addictions are present. The specially trained priest and medical professionals will be able to work together to address the patient, and be able to determine what type of illness the patient is suffering from. After the need of the person has been determined then the appropriate help will be met. In the circumstance of spiritual help, prayers may be offered, or the laying on of hands or a counseling session may be prescribed. The exorcist might not perform an exorcism if he does not know the person.
Tourette syndrome (also Tourette's syndrome or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of motor and phonic tics. Treatment of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication. Explanation and reassurance alone are often sufficient treatment; education is an important part of any treatment plan.
There is no cure for Tourette's and no medication which works universally for all individuals without significant adverse effects; knowledge and understanding are the best treatments available for tics. Management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological treatment is reserved for more severe symptoms, other types of treatments may help avoid or improve symptoms of depression or social isolation, and improve supportive family functioning. Educating the patient, family, and surrounding community (school, church, friends, etc.) is a key part of treatment.
In Catholic Christianity, exorcisms are performed in the name of Jesus Christ. A distinction is made between a formal exorcism, which can only be conducted by a priest during a baptism or with the permission of a bishop, and "prayers of deliverance" which can be said by anyone.
The Catholic rite for a formal exorcism, called a "Major Exorcism", is given in Section 11 of the Rituale Romanum. The Ritual lists guidelines for conducting an exorcism, and for determining when a formal exorcism is required. Priests are instructed to carefully determine that the nature of the affliction is not actually a psychological or physical illness before proceeding.
Command hallucinations are hallucinations in the form of commands; they can be auditory or inside of the person's mind or consciousness. The contents of the hallucinations can range from the innocuous to commands to cause harm to the self or others. Command hallucinations are often associated with schizophrenia. People experiencing command hallucinations may or may not comply with the hallucinated commands, depending on the circumstances. Compliance is more common for non-violent commands.
Exorcism in Christianity is the practice of casting out demons from a person they are believed to have possessed. The person performing the exorcism, known as an exorcist, is often a member of the Christian Church, or an individual thought to be graced with special powers or skills. The exorcist may use prayers and religious material, such as set formulas, gestures, symbols, icons, amulets, etc. The exorcist often invokes God, Jesus and/or several different angels and archangels to intervene with the exorcism. A survey of Christian exorcists found that most exorcists believe that any mature Christian can perform an exorcism, not just members of clergy. Christian exorcists most commonly believe the authority given to them by the Father, Son, and Holy Spirit (the Trinity) is the source of their ability to cast out demons.
A tic can be defined as a repeated, individually recognizable, intermittent movement or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement. These abnormal movements occur with intervening periods of normal movement. These movements are predictable, often triggered by stress, excitement, suggestion, or brief voluntary suppressibility. Many children say that the onset of tics can stem from the strong urge to move. Tics can be either muscular (alter normal motor function) or vocal (alter normal speech) in nature and most commonly involve the face, mouth, eyes, head, neck or shoulder muscles. Tics can also be classified as simple motor tics (a single brief stereotyped movement or movement fragment), complex motor tics (a more complex or sequential movement involving multiple muscle
groups), or phonic tics (including simple, brief phonations or vocalizations).
Motor tics are movement-based tics affecting discrete muscle groups.
Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. OCD usually causes pain and swelling of the affected joint which catches and locks during movement. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement.
OCD is caused by blood deprivation in the subchondral bone. This loss of blood flow causes the subchondral bone to die in a process called avascular necrosis. The bone is then reabsorbed by the body, leaving the articular cartilage it supported prone to damage. The result is fragmentation (dissection) of both cartilage and bone, and the free movement of these bone and cartilage fragments within the joint space, causing pain and further damage. OCD can be difficult to diagnose because these symptoms are found with other diseases. However, the disease can be confirmed by X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) scans.
Non-surgical treatment is rarely an option as the ability for articular cartilage to heal is limited. As a result, even moderate cases require some form of surgery. When possible, non-operative forms of management such as protected reduced or non-weight bearing and immobilization are used. Surgical treatment includes arthroscopic drilling of intact lesions, securing of cartilage flap lesions with pins or screws, drilling and replacement of cartilage plugs, stem cell transplantation, and joint replacement. After surgery rehabilitation is usually a two-stage process of immobilization and physical therapy. Most rehabilitation programs combine efforts to protect the joint with muscle strengthening and range of motion. During the immobilization period, isometric exercises, such as straight leg raises, are commonly used to restore muscle loss without disturbing the cartilage of the affected joint. Once the immobilization period has ended, physical therapy involves continuous passive motion (CPM) and/or low impact activities, such as walking or swimming.
OCD occurs in 15 to 30 people per 100,000 in the general population each year. Although rare, it is an important cause of joint pain in physically active adolescents. Because their bones are still growing, adolescents are more likely than adults to recover from OCD; recovery in adolescents can be attributed to the bone's ability to repair damaged or dead bone tissue and cartilage in a process called bone remodeling. While OCD may affect any joint, the knee tends to be the most commonly affected, and constitutes 75% of all cases. Franz König coined the term osteochondritis dissecans in 1887, describing it as an inflammation of the bone–cartilage interface. Many other conditions were once confused with OCD when attempting to describe how the disease affected the joint, including osteochondral fracture, osteonecrosis, accessory ossification center, osteochondrosis, and hereditary epiphyseal dysplasia. Some authors have used the terms "osteochondrosis dissecans" and "osteochondral fragments" as synonyms for OCD.
In osteochondritis dissecans, fragments of cartilage or bone become loose within a joint, leading to pain and inflammation. These fragments are sometimes referred to as joint mice. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. OCD most commonly affects the knee, although it can affect other joints such as the ankle or the elbow.
Kleptomania is frequently thought of as being a part of obsessive-compulsive disorder (OCD), since the irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary, and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.
Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examining the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%) while others demonstrate low rates (0%-6.5%). Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found (2.2%-5.9%).
Obsessive-compulsive disorder (OCD) involves both obsessions and compulsions that disrupt daily routines and activities. The obsessions include recurrent unwanted thoughts that cause compulsions, including repetitive behaviors. Individuals that suffer from OCD may realize that their obsessions are not normal and try to stop their actions, but this only increases the person's anxiety towards the situation, and has an adverse effect. OCD often revolves around themes in one's life; for example, fear of coming in contact with germs (obsession). To deal with the fear of germs one may compulsively wash their hands until they are chapped. OCD is a constituent of many other disorders including autism, Tourette's syndrome, and frontal lobe lesions.
Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents. Similar to the treatment of adults with OCD, CBT stands as an effective and validated first line of treatment of OCD in children. Family involvement, in the form of behavioral observations and reports, is a key component to the success of such treatments. Parental interventions also provide positive reinforcement for a child who exhibits appropriate behaviors as alternatives to compulsive responses. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious", establishing it as one of the leading psychosocial treatments for youth with OCD. After one or two years of therapy, in which a child learns the nature of his or her obsession and acquires strategies for coping, that child may acquire a larger circle of friends, exhibit less shyness, and become less self-critical.