Obsessive–Compulsive Disorder

2014 ◽  
Vol 27 (2) ◽  
pp. 116-130 ◽  
Author(s):  
Gyula Bokor ◽  
Peter D. Anderson
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Package Insert ◽  
Repetitive Behaviors ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Mental Acts ◽  
The Brain

Obsessive–compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico–striato–thalamo–cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

Repeating, counting, and touching to prevent harm

2021 ◽  
pp. 137-142
Author(s):  
Ivana Viani
Keyword(s):  
Gold Standard ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Repetitive Behaviors ◽  
Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Impairment In Functioning ◽  
Clinically Significant ◽  
Mental Acts

Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning. Obsessions are recurrent and persistent intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress. Examples of obsessions include worrying about germs, the feeling things need to be “just right,” worrying about bad things happening, and disturbing thoughts or images about hurting others. Compulsions are repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. Examples of compulsions include washing, checking, tapping, ordering, and repeating. Young children may not be able to articulate the aims of these repetitive behaviors or mental acts. Selective serotonin reuptake inhibitors (SSRIs) are the first-line class of medications used to treat OCD in children and adolescents. Exposure and response prevention (ERP) therapy is the gold standard psychotherapy treatment for OCD.

scholarly journals Agomelatine Augmentation of Escitalopram Therapy in Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Domenico De Berardis ◽  
Nicola Serroni ◽  
Stefano Marini ◽  
Giovanni Martinotti ◽  
Francesca Ferri ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Chronic Condition ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Young Female ◽  
Treatment Resistant ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Augmentation Strategies

Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy.

scholarly journals Central norepinephrine transmission is required for stress-induced repetitive behavior in two rodent models of obsessive-compulsive disorder

2019 ◽  
Author(s):  
Daniel Lustberg ◽  
Alexa Iannitelli ◽  
Rachel P. Tillage ◽  
Molly Pruitt ◽  
L. Cameron Liles ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Symptomatic Relief ◽  
Repetitive Behavior ◽  
Repetitive Behaviors ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
General Anxiety ◽  
Compulsive Disorder ◽  
Adrenergic Drugs ◽  
Compulsive Behaviors

AbstractRationaleObsessive-compulsive disorder (OCD) is characterized by repetitive behaviors exacerbated by stress. Many OCD patients do not respond to available pharmacotherapies, but neurosurgical ablation of the anterior cingulate cortex (ACC) can provide symptomatic relief. Although the ACC receives noradrenergic innervation and expresses adrenergic receptors (ARs), the involvement of norepinephrine (NE) in OCD has not been investigated.ObjectiveTo determine the effects of genetic or pharmacological disruption of NE neurotransmission on marble burying (MB) and nestlet shredding (NS) in two animal models of OCD.MethodsWe assessed NE-deficient (Dbh -/-) mice and NE-competent (Dbh +/-) controls in MB and NS tasks. We also measured the effects of anti-adrenergic drugs on NS and MB in control mice and the effects of pharmacological restoration of central NE in Dbh -/- mice. Finally, we compared c-fos induction in the locus coeruleus (LC) and ACC of Dbh -/- and control mice following both tasks.ResultsDbh -/- mice virtually lacked MB and NS behaviors seen in control mice but did not differ in the elevated zero maze (EZM) model of general anxiety-like behavior. Pharmacological restoration of central NE synthesis in Dbh -/- mice completely rescued NS behavior, while NS and MB were suppressed in control mice by anti-adrenergic drugs. Expression of c-fos in the ACC was attenuated in Dbh -/- mice after MB and NS.ConclusionThese findings support a role for NE transmission to the ACC in the expression of stress-induced compulsive behaviors and suggest further evaluation of anti-adrenergic drugs for OCD is warranted.

Face and Object Perception in Body Dysmorphic Disorder versus Obsessive-Compulsive Disorder: The Mooney Faces Task

2017 ◽  
Vol 23 (6) ◽  
pp. 471-480 ◽  
Author(s):  
Wei Lin Toh ◽  
David J. Castle ◽  
Susan L. Rossell
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Body Dysmorphic Disorder ◽  
Clinical Symptoms ◽  
Object Perception ◽  
Repetitive Behaviors ◽  
The Other ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Perceptual Anomalies ◽  
Mental Acts

AbstractObjectives: Body dysmorphic disorder (BDD) is characterized by repetitive behaviors and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. There are some similarities, but also important differences, between BDD and obsessive-compulsive disorder (OCD), not just in terms of core clinical symptoms, but possibly in the domain of perception. This study compared the nature and extent of perceptual anomalies in BDD versus OCD and health controls (HC), using a modified Mooney task. Methods: We included 21 BDD, 19 OCD, and 21 HC participants, who were age-, sex-, and IQ-matched. A set of 40 Mooney faces and 40 Mooney objects arranged in three configurations (i.e., upright, inverted, or scrambled) were presented under brief (i.e., 500 ms) free-viewing conditions. Participants were asked to decide whether each image represented a human face, an object, or neither in a forced-choice paradigm. Results: The BDD group showed significantly reduced face and object inversion effects relative to the other two groups. This was accounted for by BDD participants being significantly more accurate in identifying inverted Mooney faces and objects than the other participants. Conclusions: These data were interpreted as reflecting an overreliance on independent components at the expense of holistic (configural) processing in BDD. (JINS, 2017, 23, 471–480)

scholarly journals Detailed measurements and simulations of electric field distribution of two TMS coils cleared for obsessive compulsive disorder in the brain and in specific regions associated with OCD

2022 ◽  
Author(s):  
Marietta Tzirini ◽  
Yiftach Roth ◽  
Tal Harmelech ◽  
Samuel Zibman ◽  
Gaby S Pell ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Electric Field ◽  
Obsessive Compulsive Disorder ◽  
Field Distribution ◽  
Inferior Frontal Gyrus ◽  
Anterior Cingulate ◽  
Head Model ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
The Brain

The FDA cleared deep transcranial magnetic stimulation (Deep TMS) with the H7 coil for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. Two years later the FDA cleared TMS with the D-B80 coil on the basis of substantial equivalence. In order to investigate the induced electric field characteristics of the two coils, these were placed at the treatment position for OCD over the prefrontal cortex of a head phantom, and the field distribution was measured. Additionally, numerical simulations were performed in eight Population Head Model repository models with two sets of conductivity values and three Virtual Population anatomical head models and their homogeneous versions. The H7 was found to induce significantly higher maximal electric fields (p<0.0001, t=11.08) and to stimulate two to five times larger volumes in the brain (p<0.0001, t=6.71). The rate of decay of electric field with distance is significantly slower for the H7 coil (p < 0.0001, Wilcoxon matched-pairs test). The field at the scalp is 306% of the field at a 3 cm depth with the D-B80, and 155% with the H7 coil. The H7 induces significantly higher intensities in broader volumes within the brain and in specific brain regions known to be implicated in OCD (dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC) and pre-supplementary motor area (pre-SMA)) compared to the D-B80. Significant field ≥ 80 V/m is induced by the H7 (D-B80) in 15% (1%) of the dACC, 78% (29%) of the pre-SMA, 50% (20%) of the dlPFC, 30% (12%) of the OFC and 15% (1%) of the IFG. Considering the substantial differences between the two coils, the clinical efficacy in OCD should be tested and verified separately for each coil.

scholarly journals Repeated Cortico-Striatal Stimulation Generates Persistent OCD-Like Behavior

Science ◽  
2013 ◽  
Vol 340 (6137) ◽  
pp. 1234-1239 ◽  
Author(s):  
Susanne E. Ahmari ◽  
Timothy Spellman ◽  
Neria L. Douglass ◽  
Mazen A. Kheirbek ◽  
H. Blair Simpson ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Orbitofrontal Cortex ◽  
Progressive Increase ◽  
Repetitive Behaviors ◽  
Mouse Behavior ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Chronic Fluoxetine

Although cortico-striato-thalamo-cortical (CSTC) circuit dysregulation is correlated with obsessive compulsive disorder (OCD), causation cannot be tested in humans. We used optogenetics in mice to simulate CSTC hyperactivation observed in OCD patients. Whereas acute orbitofrontal cortex (OFC)–ventromedial striatum (VMS) stimulation did not produce repetitive behaviors, repeated hyperactivation over multiple days generated a progressive increase in grooming, a mouse behavior related to OCD. Increased grooming persisted for 2 weeks after stimulation cessation. The grooming increase was temporally coupled with a progressive increase in light-evoked firing of postsynaptic VMS cells. Both increased grooming and evoked firing were reversed by chronic fluoxetine, a first-line OCD treatment. Brief but repeated episodes of abnormal circuit activity may thus set the stage for the development of persistent psychopathology.

scholarly journals Voxel-wise meta-analysis of grey matter changes in obsessive–compulsive disorder

2009 ◽  
Vol 195 (5) ◽  
pp. 393-402 ◽  
Author(s):  
Joaquim Radua ◽  
David Mataix-Cols
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Grey Matter ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Anterior Cingulate ◽  
Control Group ◽  
Grey Matter Volume ◽  
Obsessive Compulsive ◽  
Caudate Nuclei ◽  
Compulsive Disorder

BackgroundSpecific cortico-striato-thalamic circuits are hypothesised to mediate the symptoms of obsessive–compulsive disorder (OCD), but structural neuroimaging studies have been inconsistent.AimsTo conduct a meta-analysis of published and unpublished voxel-based morphometry studies in OCD.MethodTwelve data-sets comprising 401 people with OCD and 376 healthy controls met inclusion criteria. A new improved voxel-based meta-analytic method, signed differential mapping (SDM), was developed to examine regions of increased and decreased grey matter volume in the OCD group v. control group.ResultsNo between-group differences were found in global grey matter volumes. People with OCD had increased regional grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, as well as decreased volumes in bilateral dorsal medial frontal/anterior cingulate gyri. A descriptive analysis of quartiles, a sensitivity analysis as well as analyses of subgroups further confirmed these findings. Meta-regression analyses showed that studies that included individuals with more severe OCD were significantly more likely to report increased grey matter volumes in the basal ganglia. No effect of current antidepressant treatment was observed.ConclusionsThe results support a dorsal prefrontal–striatal model of the disorder and raise the question of whether functional alterations in other brain regions commonly associated with OCD, such as the orbitofrontal cortex, may reflect secondary compensatory strategies. Whether the reported differences between participants with OCD and controls precede the onset of the symptoms and whether they are specific to OCD remains to be established.

Sign in / Sign up

Export Citation Format

Share Document