Obsessive-compulsive disorder (OCD), a type of anxiety disorder, is a group of neuropsychiatric disorders characterized by obsessive-compulsive thoughts and behaviors. Although patients experience these thoughts or impulses as originating from themselves and try to resist them, they are always unable to control them.
In recent years, statistics suggest that the incidence of OCD is increasing, and because of its early onset and prolonged course, OCD often has a great impact on patients’ social functioning and quality of life, and a global disease survey conducted by the World Health Organization (WHO) found that OCD has become one of the 20 diseases that cause the heaviest burden of disease among young and middle-aged people aged 15 to 44. In addition, patients often do not seek medical attention at the beginning of the disease due to various considerations, and some patients who are afraid of getting dirty and repeatedly wash their hands may come to the clinic only after their symptoms are so severe that they cannot live normally.
I. Etiology
The etiology of OCD is complex and inconclusive. It is believed that it is mainly related to psychosocial, personality, genetic and neuroendocrine factors.
Many studies have shown that patients often suffer from adverse life events when they first develop OCD, such as interpersonal tensions, marital trials, frustration with school work, etc. Some patients with OCD have an obsessive-compulsive personality, which is characterized by excessive caution, an excessive sense of responsibility, and a desire for perfection in everything, resulting in inflexibility in dealing with adverse life events and difficulties in adaptation. The conflicts and anxieties experienced by the patient can only be expressed through obsessive-compulsive symptoms in the end.
In addition, numerous studies in recent years have found that there may be a genetic predisposition to the development of OCD and that there are neuroendocrine dysfunctions that cause imbalances in neurotransmitters such as 5-hydroxytryptamine and dopamine, which prevent them from performing their physiological functions properly.
Clinical manifestations
The symptoms of OCD can be summarized as obsessive-compulsive thinking and compulsive behavior.
Compulsive thinking can be divided into compulsive ideas, compulsive emotions and compulsive intentions. The content is diverse, such as repeatedly doubting whether the doors and windows are closed, whether you will get sick if you touch something dirty, why the sun rises in the east and sets in the west, and the urge to jump down when standing on the balcony. Compulsive behaviors are often actions that have to be taken in order to reduce the anxiety generated by obsessive-compulsive thinking, which the patient knows is irrational but has to do. Some patients with prolonged disease often repeat certain actions, and over time a certain procedure is formed, such as washing hands from the fingertips, and continuously washing to the wrist, if the order is reversed or interrupted in the middle, you have to start washing again, which often takes a lot of time and is painful.
Third, obsessive-compulsive symptoms have the following characteristics.
1, is the patient’s own thinking or impulses, rather than imposed by the outside world.
2. There must be at least one thought or action that the patient is still trying in vain to resist, even if the patient is no longer resisting the other symptoms.
3, the idea of implementing the action itself will make the patient feel unpleasant (simply to relieve tension or anxiety is not considered pleasant in the true sense of the word), but if not implemented will produce great anxiety.
4. The idea or impulse always recurs unpleasantly.
IV. Examination
Complete relevant physical, psychiatric and ancillary examinations to exclude organic diseases.
V. Diagnosis
The diagnosis should be based on the history, psychiatric examination, physical examination and necessary ancillary tests to exclude obsessive-compulsive symptoms due to organic and other psychiatric disorders. . These symptoms cause distress or interfere with activities. Obsessive-compulsive symptoms need to meet the four characteristics of the clinical presentation.
VI. Differential diagnosis
The first thing that needs to be identified is normal repetitive behaviors to avoid strawmen and broadening the diagnosis. Almost everyone has some repetitive behaviors or actions in a set order, such as pulling the door two or three times before leaving the house to make sure it is closed; brushing teeth always follows the order of first using the left hand to hold the cup with water, then using the right hand to get the toothbrush, followed by using the left hand to squeeze the toothpaste. Generally this habitual behavior is for efficiency and is not painful or disruptive to normal life. In contrast, patients who clearly have obsessive-compulsive symptoms need to be differentiated from the following diseases
1. Schizophrenia
Patients with this disease can also produce obsessive-compulsive symptoms, but they are often not distressed by the compulsion and do not actively seek treatment. The content of obsessive-compulsive thinking is often bizarre and bizarre and has psychotic symptoms such as hallucinations and delusions.
2. Depression
Patients with this disease can appear obsessive-compulsive symptoms, and patients with OCD can also produce depressive mood, the identification is mainly to identify which are the primary symptoms, appear first.
3, anxiety disorder
Both can have anxiety manifestations, the anxiety of OCD is mostly due to the recurrence of obsessive thinking or compulsive behavior can not be implemented, in contrast, the anxiety of anxiety disorders can be unprovoked and lack of a specific object.
4, drug-induced obsessive-compulsive symptoms
Some drugs, such as clozapine, can cause obsessive-compulsive symptoms during the treatment of schizophrenia, but patients do not feel distressed, and the symptoms gradually ease and disappear after stopping the drug.
5.Organic mental disorders
Organic lesions in certain parts of the brain, such as hemorrhage or infarction, can cause obsessive-compulsive symptoms, so it is quite necessary to inquire about the history of relevant cerebrovascular diseases and complete relevant auxiliary examinations such as cranial magnetic resonance during diagnosis.
VII. Treatment
Although the cause of OCD has not yet been elucidated, it is not difficult to find that its development is not only related to the psychological factors of human personality, but also to the imbalance of neurotransmitter secretion in the brain, according to existing research. Therefore, both psychotherapy and medication play a pivotal role in relieving the patient’s condition.
1.Psychotherapy
As a psychological disease, the mechanism of OCD is very complex, and the psychological mechanism of patients with similar symptoms may be very different. In psychotherapy, the therapist establishes a good doctor-patient relationship with the patient, listens to the patient, helps him/her discover and analyze the inner conflict, promotes the patient to solve the problem, increases his/her ability to adapt to the environment, and rebuilds a sound personality.
Commonly used clinical approaches include: psychodynamic therapy, cognitive-behavioral therapy, supportive psychotherapy and Morita therapy. Among them, cognitive behavioral therapy is considered to be the most effective psychotherapy for OCD, mainly including thought blocking and exposure response prevention. Thought blocking is used to block compulsive thoughts by diverting attention or exerting external control, such as setting an alarm clock bell, when the patient has recurrent compulsive thoughts, and to relieve anxiety if necessary with relaxation training. For example, if the patient is afraid of getting dirty and has to wash his hands repeatedly to make sure he does not get sick, he needs to gradually touch his sweat, the soles of his shoes, the door handles of public toilets and toilet seats without washing his hands during several sessions in exposure prevention. The anxiety that accompanies obsessive-compulsive symptoms will be relieved after several treatments until it subsides, thus achieving the role of controlling obsessive-compulsive symptoms.
2.Medication
The onset of OCD is related to the imbalance of various neurotransmitters in the brain, mainly manifested by the disorder of the 5-hydroxytryptamine system. Currently used anti-OCD drugs are antidepressants, which are characterized by the ability to regulate the function of neurotransmitters such as 5-hydroxytryptamine in the brain, so as to improve the role of obsessive-compulsive symptoms. The most used are selective 5-hydroxytryptamine reuptake inhibitors (SSTIs), including fluvoxamine, paroxetine, sertraline, fluoxetine, citalopram, etc., and tricyclic antidepressants clomipramine, and if necessary, clinical use of benzodiazepines and benzodiazepines to help relieve anxiety and improve insomnia. For refractory OCD, risperidone, quetiapine, olanzapine, aripiprazole, etc. are often used in combination to improve the efficacy. As with psychotherapy, the efficacy of medication is not immediate. Generally, SSRIs require 10 to 12 weeks to achieve full anti-compulsive effect, and if the treatment is effective, the medication still needs to be maintained for 1 to 2 years to consolidate the effect.
3.Physical therapy
Modified electroconvulsive shock and transcranial magnetic stimulation can be used selectively for patients with refractory OCD depending on the specific situation. Neurosurgery is considered to be the last option for OCD, but because of the adverse effects of spasticity and sensory loss, the indications for surgery must be strictly controlled and the patient should be considered for surgery after consultation with three chief psychiatrists.
VIII. Prevention
The onset of OCD is related to psychosocial, personality, genetic and neuroendocrine factors, the first two of which can be intervened and prevented beforehand. As parents, they should build a stable, safe and harmonious living environment for their children, should not be overly demanding, can be more flexible in their life dealings, pay attention to mutual communication, and promote the construction of a sound personality. OCD self-screening.
1.Do you have stupid, dirty or terrible unnecessary thoughts, ideas or impulses?
2. Do you have an excessive fear of dirt, germs or chemicals?
3, are you always worried about forgetting something important, such as the room door is not locked, the valve is not closed and something happens?
4.Are you worried that you will make or say aggressive behavior or aggressive words that you do not want to do?
5.Are you always worried that you will lose something important?
6.Do you have something you have to do over and over again, or have any ideas you have to think over and over again so as to get relaxed?
7.Do you over-bath or over-wash things?
8, do you have to do a thing must be repeated to check a number of times to rest assured?
9, do you avoid certain occasions or individuals for fear of aggressive language or behavior that hurts others?
10.Do you keep a lot of useless things that you think you can’t throw away?
If one or more of the above symptoms persist and are troubling your life and making you feel miserable, don’t fight alone, consult a professional doctor to help you overcome OCD together.