OBSESSIVE COMPULSIVE DISORDER AND ITS CARE AN REVIEW

 

 

TREATMENT:
First step is to talk about your symptoms with your doctor. Next OCD is going to treat with cognitive behavioral therapy, medication. Sometimes both will be done.
Cognitive behavioural therapy: Generally, it tells you about the obsessions and compulsions in the different ways of thinking, behaving and reacting. And the exposure and response prevention are a specific form of CBT. In this the patient is allowed to exposing the fears or obsessions and teaches you about the anxiety they cause and healthy ways and habit reversal training can help to overcome the compulsions.
Medication: Doctors can prescribe the different drugs to treatment of OCD like (SSRIs) or (SRI) called clomipramine. These are commonly used for depression, and symptoms of OCD. These SSRIs can take 10-12weeks to start working.  Suppose if depression extra longer time may take. (https://www.nimh.nih.gov/index.shtml) Medications like SRIs

 

PHARMACOLOGICAL MANAGEMENT

Clomipramine


The adrs are dry mouth, dizziness, fatigue, constipation, somnolence, and nausea. 

Because of risk of seizures the dose should not exceed 250mg. And cautions should be used (www.pubmed.com, Ciba-Geigy,1998)

Dose:  25mg/day (at bed time) and Increased in first 2weeks to 100mg and the maximum dose can have increased up to 250mg. (www.pubmed.com, Ciba-Geigy,1998)

 

Fluoxetine


The side effects are nausea, headache, anxiety, sedation, insomnia, tremor, sexual dysfunction. (Dista Products 40)

Dose: effective dose-20-80 mg/day

Initial dose: 20mg/day(mng)

Average: 40-60mg/day

Maximum: 80mg/kg. (Gary S. Sachs)

Doses greater then 20mg can be given twice daily (mng and noon). (Dista Products 40)

 

Fluvoxamine:


The adrs are insomnia, nausea, somnolence, abnormal ejaculation, dry mouth (Solvay Pharmaceuticals )

Dose: Initial - 50mg/day (bed time) this can be increased to 50mg for every 4-7 days.

Average: 200mg/day

Maximum: 300mg/day.

The manufacture recommended 100mg is given BD. At bed time.

The Children 8-17yrs dose is 25mg at bed time. And increased to 25mg for every 4-7days and maximum - 200mg/kg BD (Solvay Pharmaceuticals )

 

Paroxetine:


The adrs are insomnia, nausea, somnolence, sexual dysfunction, dry mouth

Dose: Initial: -20mg/day increased 10mg from after a week.

Average: 40-50 mg/day

Maximum:60mg/day (Beecham Pharmaceuticals )

 

Sertraline


The adrs are insomnia, nausea, dry mouth, dizziness, sexual dysfunction.

Dose: initial - 50mg/day it can have increased to 200mg/day OD (mng or eve). (Pfizer,2000)

 

Citalopram


The adrs are nausea, vomiting, and decreased sleep. Increased dreaming, organic dysfunction. (Koponen H,1997)

Dose:  20mg/day or 40mg/day or60mg/day. Most of the patients may took 40 or 60mg/day. (Montgomery S,2000 )

Initial: 20mg/day and increased 20mg in intervals after 1 week. And omeprazole can decrease the clearance of citalopram. (Forest laboratories )

Pregnancy and lactation: -
Generally, CBT is given alone to a pregnant patient except in risk of treating of OCD (Gary S .Sachs,1997) These symptoms may exacerbate in 1st trimester   and these symptoms may improve in 2nd and 3rd trimester.  (Diaz SF,1997 )
Drug used fluoxetine cannot increase the risk. (Gold stein,1995, Pastuszak,1993 ).it is the safest choice.

All SRIS are excreted into the breast milking lactation also fluoxetine is the safest drug. Several infants have been safety breast feed during maternal fluoxetine use. (Burch KJ,1992, Taddio A,1966)
There are 3main therapies
a) Medication therapy
b) Family therapy
c) Group therapy [www.helpguide.org]
Self-help for OCD:  
Don’t avoid your tears
Refocus your attention.

When you are having OCD thoughts then you can try to shift your attention to something else.

Challenge obsessive thoughts:
• Take a pencil and write your thoughts on the keypad, phone, or something else by writing it hundreds of times it will help you.
• Create an   OCD worry period: In this you can put some time like during this time you don’t think anyone or don’t anxious or don’t worry about anything and slowly continue to about the day.
• Create a tape of your OCD obsessions: you can record your obsessions or worries in the recorder and by listening that it comes to your mind. you can listen at least every 45min each day. By continuously doing this you will become less anxious and can repeat this to avoid.
• Take care of yourself
• Practice relaxation techniques. By doing mediation, yoga, deep breath or other techniques can help you to lower the stress and manage the tensions also. For best results it can do regularly.
• Get enough sleep: Insomnia occurs not only because of anxious and worry and also for lack of sleep. When you will take rest, it can must easier to keep your mind relax.
• Avoid alcohol and nicotine.
• Reach out for support
• Stay connected to family: By talking about your thoughts to your friends can feel less worries and urges and become less threatening.
• Join in OCD support groups: In this group there are so many members who are with the same symptoms they can discuss each other and come out by facing the problems. (www.helpguide.org)

CONCLUSION
Although there is no cure for OCD, and its exact origins are not specifically known by science or medicines at this time, there is help for those who suffer from compulsions obsessions, and severe or intense anxiety created by unwanted thoughts and inaccurate beliefs .The first step toward feeling better is to seek out the help of a therapist through a medical clinic, mental health facility or with the help of family members or friends.OCD anxiety and activities can be reduced through different types of management.

REFERENCE:
1. Abramowitz js, Taylor S, Mckay D (2009) “obsessive-compulsive disorder”. Lancet. 374(9688): 491-9.
2. Ab Boileau B (2011). “A review of obsessive compulsive disorder in children and adolescents”. Dialogues clin. neurosci; 13(4):401-11.
3. Amoretto, Germana; pasquini, Mass:mo; et al. (2008);  What every psychiatrist should know about PANDAS. A review “, clinical practise and epidemiology in Mental health, Department of psychiatric sciences and psychological medicine, sapienza. university of Rome; 4:13
4. Aardema.F, o’ connor (2007).” The menace with in: obessions and the self” International journal of cognitive therapy.
5. American psychiatric Association: - Diagnostic and statistical manual of mental disorders, 4th edition –Text revision. Washing ton, DC, USA. www.psychiatry.org/psychiatrists/practice/dsm
6. Angst I, Gamma A, Endrass I, Hantouche E, Good win R, Ajdacic V, EichD, Rossler W(2005); obsessive compulsive syndromes and disorders. Significance of comorbidity with bipolar and anxiety syndromes; Eur Arch psychiatary clin Neurosci; 255(1);65-71
7. Bland RC, Canino GJ, et al.
(1994); The cross-national epidemiology of obsessive compulsive disorder. The cross national Collaborative Group. J Clin Psychiatry; 55 Suppl:5-10.
8. Barr LC, Goodman WK, Price LH, et al. (1992); The serotonin hypothesis of obsessive-compulsive disorder: implications of pharmacologic challenge studies. J Clin Psychiatry ;53(suppl 4); 17-28.
9. Baxter LR.(1995); Neuroimaging Studies of human anxiety disorders: Cutting paths of knowledge through the field of neurotic phenomena. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology: Fourth Generation of progress. New York, Raven ; 1287-1300.
10. Beecham Pharmaceuticals. Paxil Package insert. Philadelphia, 1998
11. Burch KJ, Wells, BG
(1992);  Fluoxetine/norfluoxetine concentration in human milk. Paediatrics ; 89; 676-677.
12. beyondocd.org   , information – for- parents/ helium. ping. a child –who-has-ocd.
13.  Ciba-Geigy. Anafranil package insert. Summit NJ, 1998.
14. Clomipramine collaborative study group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch Gen psychiatry. 1991; 48:730-738  access at www.pubmed.com
15. Diaz SF, Grush LR, Sichel DA, Cohen LS. Obsessive   compulsive disorder in pregnancy and the puerperium. In: Pato MT, Steketee G, eds. OCD Across the life cycle. Section 123 of review of Psychiatry vol-16. Washington, DC, American Psychiatric press,1997;97-112.
16. Dista Products. Prozac Package insert. Indianapolis, 2000
17. Diagnostic and statistical manual of mental disorders: DSM-5 (5. ed). Washington: American psychiatric publishing.2013. Pp.237-242 www.psychiatry.org
18.  Forest laboratories, Inc. Celexa package insert. St. Louis, MO, 2000.
19. Greist JH, Jefferson JW, Kobhan KA, et al. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. Arch Gen psychiatry 1995; 52:53-60 .
20. Gary S. Sachs, M.D
(1997); Expert Consensus Panel for obsessive compulsive disorder. obsessive compulsive disorder executive summary: Recommendations for first line treatments by clinical situations. J Clin Psychiatry ; 58 (suppl 4); 11-12.
21.  Gold stein DJ
(1995); Effects of third trimester fluoxetine exposure on the new born. J Clin Psychopharmacol ; 15;417-420.
22. Hollander E, DeCaria CM, Nitescu A, et al.(1992); Serotonergic function in obsessive-compulsive disorder: Behavioural and neuroendocrine responses to oral m-chlorophenyl piperazine and fenfluramine in patients and healthy volunteers. Arch Gen psychiatry ;53(suppl-4);17-28.
23. https://www.nimh.nih.gov/index.shtml 
24. https://www.medicalnewstoday.com/articles/178508.php
25.  https://kidshealth.org/
26. https://childmind.org/article/kids-and-ocd-the-parents-role-in-treatment/
27.  https://psychcentral.com
28. http://med.stanford.edu/rodriguezlab/research/ocd-research.html
29.  https://www.Ocduk.Org/types - ocd  .
30.  https://www.keyword-suggest-tool.com/search/treatment+of+ocd/ 
31.  Jenike MA
(2004); clinical practice. obsessive compulsive disorder. N Engl, Med., 350; 259-265.
32. Kessler RC, Chiu WT, Demler O, et al
(2005); prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry; 62(6); 617-27
33. Koponen H, Lepola U, Leinonen E, et al
(1997); Citalopram in the treatment of obsessive compulsive disorder: An open pilot study. Acta PsychiatrScand ; 96(5); 343-346.
34. Lysaker Ph, Bryson GJ, Marks KA, Greig TC, Bell MD(2000);  Association of obsessions and compulsions in schizophrenia with neuro cognition and negative symptoms. J neuropsychiatry clin neurosci. 2000, 14(4):
449-453
35. Maria LauraBianchi PaoloCavedini StefanoErzegovesi LauraBellodi, (1997); Relationship betweenobsessive-compulsive personality disorder and obsessive-compulsive disorderComprehensive PsychiatryVolume 38(1); 38-42
36. McDougle CJ, Goodman WK, Price LH.
(1994); Dopamine antagonists in tic related and Psychotic spectrum obsessive compulsive disorder. J clin pstchiatry ;55(suppl 3): 24-31.
37. Montgomery S, Kasper S, Bang-Hedegaard K, Lundbeck H. The SSRI citalopram is effective in the obsessive-compulsive disorder: Results from a double-blind, fixed dose, placebo-controlled trail. Presented at the Annual meeting of the American psychiatric Association, Chicago, IL, May 13-18, 2000.
38. Pato MT, Pato CN. (
1997); obsessive-compulsive disorder in adult’s life. IN: Pato MT, Steketee G, eds. OCD Across the Life cycle. Section III Review of psychiatry, vol 16. Washington, DC, American Psychiatric Press, :30-55.
a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry (1992); 49:739-744.
39. Pfizer. Zoloft package insert. New York, 2000
40. Pastuszak A, Schick- Poschetto B, Zuber C, et al.
(1993); Pregnanacy outcome following first trimester exposure to fluoxetine (Prozac); JAMA ; 269;2246-2248.
41. Ruscio AM, Stein DJ, Chiu WT, Kessler RC(
2010); The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry; 15(1):53-63
42. Robertson MM, Yakeley J. Gilles de la
1996 Tourette syndrome and obsessive-compulsive disorder. In: Fogel BS, Schiffer RB, eds. Neuropsychiatry, Baltimore, Williams & Wilkins ,:827-870
43. Stein DJ. Lochner L: obsessive- compulsive spectrum disorders: amulti. dimensions approach psychiatrelin north. Am 2006, (29.343:351)
44. Solvay Pharmaceuticals. Luvox package insert. Marietta, GA, 1998.
45. Taddio A. Excretion of fluoxetine and its metabolite, norfluoxetine, in human breast milk. J Clin Pharmacol 1996; 36:42-27.
46. The National Institute of Mental Health (NIMH). “(jan 2010).” What is ocd”? U.S National institute of health (NIH). www.nih.gov
47. www.helpguide.org
48.  www.elementsbehavioralhealth.com/mental-health/
49. www.mayoclinic.org/ diseases –conditions /obsessive-compulsive-disorder /symptoms- causes/ dxc-20245951/ 
50. www.webmd.Com / mental health/ obsessive compulsive disorder.
51. www.psychguides.com/guides/obsessive-compulsive disorder-symptoms-causes-and effects.

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