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 realistically connected with what they are designed to neutralize/prevent or are clearly excessive.
B. At some point, the person recognizes that the obsessions or compulsions are excessive or unreasonable. Note: This is not required for children.
C. The obsessions or compulsions cause marked distress; are time-consuming (taking >1 hour a day); or significantly interfere with a normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D.If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder).
E. The disturbance is not due to thedirect physiologic effects of a drug of abuse, a medication, or a general medical condition.
Specify the following:
With poor insight: if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable group A beta-hemolytic streptococcal infection. Early antibiotic therapy may help treat these cases.
OCD has been linked to a disruption in the brain’s serotonin,glutamate, and dopamine systems. Overactivity in neural pathways involving orbital frontal cortex and the caudate nucleushas been implicated in OCD.
Physical examination may reveal rough, cracked skin as evidence of excessive hand washing. The Yale-Brown Obsessive-Compulsive Scale (also known as Y-BOCS) is regarded as the gold standard measure of obsessive-compulsive symptom severity. Although somewhat lengthy, it can be helpful in the clinical setting.
Cognitive-behavioral therapy (CBT) involving exposure and response prevention is considered the treatment of choice in milder cases. CBT provides durability of symptom relief and avoidance of potential pharmacotherapy-associated side effects. As with other anxiety disorders, CBT is at least as good, if not better, than medications. The combination of medications and CBT has shown the best response.
Selective serotonin reuptake inhibitors (SSRI) are useful for higher severity of symptoms and complications with comorbidities or when cognitive or emotional ability are insufficient to cooperate in CBT. If quality CBT is not available, treatment with medications alone while psychotherapy referral is pursued is a reasonable choice.
SSRI (paroxetine, fluoxetine, fluvoxamine, sertraline, citalopram and escitalopram) treatment is generally thought to show a favorable risk-to-benefit ratio in OCD. Side effects such as activation, akathisia, disinhibition, impulsivity, and hyperactivity may be seen. Monitoring of height may be advisable due to possible growth suppression associated with the SSRIs.
If an SSRI trial is unsuccessful, clomipramine can be tried next. Combination therapy using an SSRI with an antipsychotic medication (risperidone or another atypical antipsychotic) is also considered especially with specific comorbidities, for example, in tic disorders. Antipsychotics are also useful when the intrusive thoughts associated with OCD become nearly delusional in nature. Psychostimulants are used with comorbid ADHD, even though there is a risk that stimulants may increase obsessional symptoms and tics.
Most responders exhibit partial response only, and as many as one third of young people with OCD are refractory to treatment. Poor prognostic factors include comorbid psychiatric illness and a poor initial treatment response.
Deep brain stimulation of the basal ganglia, through surgically implanted electrodes and surgical interventions (anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy), are reserved for very severe cases or highly refractory cases.