Obsessive Compulsive Disorder (OCD) (cont.)
What causes OCD?
While there is no known specific cause for OCD, family history and chemical
imbalances in the brain are thought to contribute to the development of the
illness. Generally, while people who have relatives with OCD are at a higher
risk of developing the disorder, most people with the illness have no such
family history. A specific chromosome/gene variation has
been found to possibly double the likelihood of a person developing OCD. It is thought that an imbalance of the chemical serotonin in the
brain may also contribute to the development of OCD.
How is OCD diagnosed?
In addition to looking for symptoms of obsessions and compulsions by
conducting a mental-status examination, mental-health professionals will explore
the possibility that the individual is suffering from another emotional illness
instead of or in addition to OCD. The practitioner will also likely ensure that
a physical examination and any other appropriate tests have been done recently
to explore whether there is any medical problem that could be contributing to
the signs of OCD.
What are the treatments for OCD?
Most individuals with OCD experience some symptoms of the disorder
indefinitely, with times of improvement alternating with times of difficulty.
However, the prognosis is most favorable for OCD sufferers who have milder
symptoms that last for less time and who have no other problems before
developing this illness.
Treatments include cognitive behavioral psychotherapy, behavioral therapies,
and medications. Behavioral therapies for OCD include ritual prevention and
exposure therapy. Ritual prevention involves a mental-health
professional helping the OCD sufferer to endure longer and longer periods of
resisting the urge to engage in compulsive behaviors. Exposure therapy is the
process by which the individual with OCD is put in touch with situations that
tend to increase the OCD sufferer's urge to engage in compulsions, then helping
him or her resist that urge. Cognitive/behavioral therapists help patients
change the negative styles of thinking and behaving that are often associated
with the anxiety involved with obsessive compulsive disorder.
Selective serotonin reuptake inhibitors (SSRIs) are the medications that are
most commonly used to treat OCD. These medications increase the amount of the
neurochemical serotonin in the brain. (Remember that brain serotonin levels are
thought to be low in OCD.) As their name implies, the SSRIs work by selectively
inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the
synapse, the place where brain cells (neurons) are connected to each other.
Serotonin is one of the chemicals in the brain that carries messages across
these connections (synapses) from one neuron to another.
The SSRIs work by
keeping serotonin present in high concentrations in the synapses. These drugs do
this by preventing the reuptake of serotonin back into the nerve cell that is
transmitting an impulse. The reuptake of serotonin is responsible for turning
off the production of new serotonin. Therefore, the serotonin message keeps on
coming through. It is thought that this, in turn, helps arouse (activate) cells
that have been deactivated by OCD, thereby relieving the symptoms of the
condition.
SSRIs have fewer side effects than clomipramine, an older medication
that is actually thought to be somewhat more effective in treating OCD. SSRIs do
not cause orthostatic hypotension (a sudden drop in blood pressure when sitting
up or standing) and heart-rhythm disturbances, like clomipramine can. Therefore,
SSRIs are often the first-line treatment for this illness. Examples of SSRIs
include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram
(Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).
SSRIs are generally
well tolerated, and side effects are usually mild. The most common side effects
are nausea, diarrhea, agitation, insomnia, and headache. However, these side
effects generally go away within the first month of SSRI use. Some patients
experience sexual side effects, such as decreased sexual desire (decreased
libido), delayed orgasm, or an inability to have an orgasm. Some patients
experience tremors with SSRIs. The so-called serotonergic (meaning caused by
serotonin) syndrome is a serious neurologic condition associated with the use of
SSRIs. It is characterized by high fevers, seizures, and heart-rhythm
disturbances. This condition is very rare and has been reported only in very ill
psychiatric patients taking multiple psychiatric medications.
Studies on the
effectiveness of treatment of OCD in adults have variable results. Some indicate
that medications, response prevention, and CBT are equally, although only mildly
to moderately, effective in treating this problem. Cognitive
behavioral group therapy (CBGT) has also been found to be an effective treatment
for OCD.
Research on treating OCD in children and adolescents suggests that while
medications are clearly effective in treating this disorder, the improvement
that is experienced as a result is quite mild. However, clomipramine tends to be
more effective than the SSRIs, and the individual SSRIs tend to be equally
effective. As in adults, people under the age of 18 years
tend to improve more significantly when treated with a combination of medication
and CBT.
Next: What happens if OCD is not treated? »
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