25 yr old gentleman has repeated thoughts that he has not locked his car door properly, frequently checks it while driving, he repeatedly checks locks in his house. Diagnosis
OCD
OPCD
Phobia
Personality disorder
Obsessive Compulsive Disorder : Obsession: recurrent and persistent thoughts that are involuntary unwanted, distressing and the individual tries to neutralize them by a thought or action (compulsion). Ex: Contamination(most common), Need for symmetry, Pathological doubt, Sexual compulsion: Act aimed to reduce the anxiety arising out of obsession but fails to do so. Ex: checking(most common), washing, counting, Hoarding, counting. obsession (a door is unlocked )leads to compulsion (checking ), which tries to relieve distress but fails and the obsession-compulsion cycle repeats leading to distress, time consumption. thoughts are one's own thoughts, it may be an idea/urge/image -behavior or mental behavior. M:F- 1:1 age of onset 20-25 years 2-3% prevalence in general population Comorbidity: major depressive disorder, delusional beliefs, overvalued ideas, personality disorder Etiology Psychoanalytical concept*-regression from the oedipal phase to the anal psychosexual phase. Anatomical- altered function in the connections between orbitofrontal coex, caudate, thalamus. Biochemical-*dysregulation of serotonin. Treatment : Pharmacotherapy-Selective serotonin Reuptake InhibitorsSSRI *(fluoxetine, fluvoxamine, paroxetine, seraline) Tricyclic antidepressants TCA(clomipramine) Behavior therapy*: Desensitization, thought stopping, flooding, implosion therapy, aversive conditioning Psychotherapy Surgical cingulotomy*, capsulotomy(e.g., subcaudate tractotomy,). Nonablative surgical techniques like Deep Brain Stimulation *of basal ganglia nuclei Reference: P.605 Kaplan & Sadock's Synopsis of psychiatry clinical Psychiatry, 10th Edition16.4
All India exam