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... "
Lady Macbeth: "What, will these hands neer be clean? ... "
- Macbeth (Act V. ...
As the above illustrates, obsessive-compulsive disorder (OCD) is not a new phenomenon. ...
OCD is an anxiety disorder in which the mind is flooded with recurrent and persistent thoughts, images and impulses. ... a patient may repeatedly have the obsessive thought that objects are covered with "cancer germs" and so compulsively wash their hands. ... These endless requests can be viewed as compulsive rituals. ... Furthermore marital distress may exasperate the condition, as the patient substitutes their compulsive symptoms for overt marital conflict (Hafner, 1982).
On encountering Lady Macbeths condition the doctor responded, "More needs she the divine than the physician" summarising the medicines attitude to OCD until the 20th century. ... Although the compulsive ritual provides immediate relief from the anxiety it is a short-term solution, sometimes only lasting a few minutes. ...
Obsessive-compulsive disorder
What to do if you recognize baffling behavior
CME learning objectives
• To recognize the clinical features of obsessive-compulsive disorder
• To learn the general principles that guide an integrated treatment approach for obsessive-compulsive disorder
• To understand the various treatment options that are available for managing obsessive-compulsive disorder
Preview: Obsessive-compulsive disorder is now recognized as one of the most common causes of disability worldwide. Recent advances in treatment have greatly improved the prognosis for patients with this disorder, but diagnosis can be elusive. ... Shakespeares Lady Macbeth persistently washes her hands to remove imaginary bloodstains after her participation in the murder of King Duncan (1). Until recently, such obsessive-compulsive behaviors were considered rare and untreatable. In fact, this disorder is relatively common, and many patients respond to treatment. Pharmacologic advances made in the last decade have led to both a better understanding of and an improved prognosis for patients with this disorder.
Definition
Obsessive-compulsive disorder is defined as a condition in which a person has repeated and uncontrollable thoughts (obsessions) that are accompanied by persistent urges to perform repetitive rituals (compulsions). ...
Although the majority of patients with obsessive-compulsive disorder have both obsessions and compulsions, some have only one or the other (3). ... Obsessive-compulsive disorder can impair all areas of functioning, and despite its devastating effects on patients and families, it may be unrecognized by primary care physicians because of the patients secrecy about this embarrassing disorder (2,4).
Causes
Scientists have long speculated on the psychological and biologic basis for obsessive-compulsive disorder. Classic psychoanalysis, as pioneered by Freud, interprets obsessive-compulsive disorder as caused by unconscious conflicts that are defensive and punitive and that lead to regression to the anal phase of development (4,5). In modern psychoanalysis, obsessive-compulsive disorder is described as a portrayal of ambivalence, with confusion of thoughts and actions that is paradoxically manifested by rigidity and an overwhelming need for control (4). By comparison, behaviorist teachings view obsessive-compulsive disorder as a maladaptive pattern to reduce threats, fears, and anxiety. Dynamic psychiatry interprets obsessive-compulsive symptoms as a reflection of feelings and thoughts that provoke aggressive or sexual actions that might produce shame, weakness, or loss of pride (2,6).
The probable biologic explanations of obsessive-compulsive disorder include heredity, brain lesions, abnormal brain glucose metabolism, and serotonergic dysfunction. ... Positron emission tomography, single-photon emission computed tomography, and functional magnetic resonance imaging have, in fact, shown increased glucose metabolism in the orbital frontal cortex, caudate nuclei, and anterior cingulate regions of the brain in obsessive-compulsive patients. Studies showing that serotonin plays a role in the pathophysiology of obsessive-compulsive disorder have led to new and highly effective treatments (7,8).
Although a definitive cause of obsessive-compulsive disorder has not yet been found, it is considered the product of interactions between biologic predisposition and various developmental and psychosocial influences (3-5).
Obsessive-compulsive disorder can occur with other psychiatric conditions, including major depression, social phobia, alcohol abuse, pain disorders, and eating disorders, among others (1,4,13,14).
Diagnostic features
The American Psychiatric Associations (3) criteria for diagnosis of obsessive-compulsive disorder specify that the obsession or compulsion causes marked distress, is time-consuming, and significantly interferes with the persons occupational, social, and interpersonal relationships. ...
Symptoms associated with obsessive-compulsive disorder
Obsessions Compulsions
Concern with cleanliness (dirt, germs, contamination) Excessive and ritualized bathing, washing, cleaning
Concern with exactness (symmetry, order) Ritualized arranging and rearranging
Concern with household tools (dishes, spoons, soap, etc) Checking and rechecking and keeping inventory with detailed description of tools, objects, and appliances
Concern about body secretions (saliva, urine, stool) Rituals to remove contact with body secretions, avoid touching, etc
Religious obsessions Excessive religious rituals (praying or repeating the rosary all day long)
Sexual obsessions (forbidden urges or aggressive sexual actions) Ritualized and rigid sexual relationships
Obsessions with health (something terrible will happen and lead to death) Repeating rituals (checking and rechecking vital signs, rigid dietary intake, constantly checking for new information about health, death, and dying)
Obsessive fears (harming self or others) Repeated checking of doors, stoves, fire alarms, locks, and emergency brakes; when driving, retracing route for fear of having run over someone
Intrusive thoughts about numbers, sounds, words, or music Counting, speaking, writing, playing musical instruments through the performance of miscellaneous rituals
Hoarding obsessions (almost any object; newspapers, keys, cups, hats, etc) Collecting rituals involving all kinds of items or inanimate objects
Differential diagnosis
Other conditions can bring about classic obsessive-compulsive symptoms and need to be considered during diagnostic workup.
Approximate Word count = 3829
Approximate Pages = 15.3
(250 words per page double spaced)
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