Contents

Search

obsessive-compulsive disorder (OCD)

A condition that is characterized by the presence of obsessions &/or compulsions. Etiology: -> in children, group A streptococcus may play a role [5] Epidemiology: 1) affects 1-2% of the general population 2) 2.5% lifetime prevalence 3) 1st symptoms begin in childhood or adolescence 4) equally common in males & females Pathology: - comorbidities not uncommon a) depression b) eating disorders c) substance abuse d) other anxiety disorders e) Tourette's syndrome Genetics: - associated with polymorphism in SLC6A4 gene Clinical manifestations: 1) obsessions - recurrent, intrusive thoughts usually irrational worries that often necessitate behaviors to prevent untoward consequences a) fears of contamination from dirt requiring the individual to wear gloves at all times b) frightening impulses of hurting someone c) sexual imagery 2) compulsions - recurrent behaviors beyond the normal range that the individual feels compelled to undertake, usually to preserve personal safety, to avoid embarrassment, or to perform adequately a) checking multiple times to see that the gas is turned off before leaving home b) repeated hand washing resulting in hand dermatitis [2] c) mentally repeating words or counting 3) symptoms are time-consuming & disabling 4) in children, a preceeding pharyngitis may be noted [5] 5) patient must realize the obsessions &/or compulsions are unreasonable [2] Differential diagnosis: - autism - repetitive behaviors may be common to autism & OCD Management: 1) cognitive behavioral therapy (CBT) with exposure & response prevention interventions is 1st line therapy [2,10] - internet-based CBT effective [8] 2) selective serotonin reuptake inhibitors (SSRI) a) higher doses than those for major depression are often needed [10] b) agents of choice during pregnancy [3] c) may be agents of choice in elderly due to anticholinergic effects of clomipramine [6] d) SSRI modestly better than placebo for treating OCD in children & adolescents [14] 3) serotonin & norepinephrine reuptake inhibitors (SNRI) - SNRI modestly better than placebo for treating OCD in children & adolescents [14] 4) venlafaxine is only antidepressant with strong evidence supporting use [13] 5) clomipramine (Anafranil) a) not superior to SSRI b) less well tolerated than SSRI [12] c) may be useful for patients with poor response to SSRI 6) risperidone may augment effects of antidepressant [7] 7) in children with PANDAS, antibiotic therapy for group A streptococcus [5] 8) bilateral deep brain stimulation for medically refractory OCD - subthalamic nucleus [NGC] - nucleus accumbens - insufficient evidence for use of unilateral deep brain stimulation 9) transcranial magnetic stimulation FDA-approved Aug 2018 [15]

Related

clomipramine (Anafranil) compulsion obsession risperidone (Risperdal) selective serotonin reuptake inhibitor (SSRI)

Specific

kleptomania; pathologic stealing pyromania; fire setting

General

anxiety disorder cluster C personality disorder

Database Correlations

OMIM 164230 Entrez Gene 4949

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Prescriber's Letter 7(11):65 2000
  4. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. Journal Watch 22(10):75, 2002 Murphy MI & Pichichero ME Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS). Arch Pediatr Adolesc Med 156:356, 2002 PMID: 11929370
  6. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  7. Maher AR et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults. JAMA 2011 Sep 28; 306:1359 PMID: 21954480
  8. Andersson E et al. Internet-based cognitive behaviour therapy for obsessive- compulsive disorder: A randomized controlled trial. Psychol Med 2012 Feb 21 PMID: 22348650 http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8496709
  9. Franklin ME, Foa EB. Treatment of obsessive compulsive disorder. Annu Rev Clin Psychol. 2011;7:229-43 PMID: 21443448
  10. Grant JE Obsessive-Compulsive Disorder N Engl J Med 2014; 371:646-653. August 14, 2014 PMID: 25119610 http://www.nejm.org/doi/full/10.1056/NEJMcp1402176
  11. Stein DJ, Hollander E. Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):237-42. PMID: 1552059
  12. Skapinakis P et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: A systematic review and network meta-analysis. Lancet Psychiatry 2016 Jun 15 PMID: 27318812 Free Article
  13. Wong J, Motulsky A, Abrahamowicz M et al. Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication based electronic prescribing system. BMJ 2017;356:j603 PMID: 28228380 Free PMC Article http://www.bmj.com/content/356/bmj.j603
  14. Locher C, Koechlin H, Zion SR et al Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents. A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online August 30, 2017. PMID: 28854296 http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2652447 - Merry SN, Hetrick SE, Stasiak K. Effectiveness and Safety of Antidepressants for Children and Adolescents. Implications for Clinical Practice. JAMA Psychiatry. Published online August 30, 2017. PMID: 28854300 http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2652446
  15. FDA News Release. August 17, 2018 FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm617244.htm
  16. Obsessive Compulsive Disorder National Institute for Health and Clinical Excellence (NICE) http://www.nice.org.uk/page.aspx?o=cg031