The Obsessive Compulsive Disorder

Obsessive Compulsive Disorder is a common, chronic, and lifelong disorder in which a person develops irrepressible, recurring feelings and behaviors and feels compelled to repeat them over and over. The most difficult psychiatric disorder to comprehend is Obsessive Compulsive Disorder. People suffering from the syndrome are aware that repeating their behaviors is useless, but they are unable to quit. Checking the gates, windows, lights, or even the periodic invasive ideas of hurting other people or oneself are prevalent types of the disorder. The distressed individuals frequently experience relentless nervousness if they are not able to accomplish their habits; nonetheless, some therapies work by helping the sick to understand that when the behavior ceases, no upheaval may transpire. The level of OCD always vary from mild to severe, and if left untreated, the disorder can limit the person’s ability to function at duty or even to have that comfortable existence around other people or at home.

In the United States, the Obsessive Compulsive Disorder affects about 2.2 million adults and is usually in the company of other anxiety disorders such as the eating disorders and depression. OCD hits both men and women in approximately equal proportions and emerges in infancy, teenage years, or in early middle age. Research has it that the Obsessive Compulsive Disorder can be hereditary, and a third of the affected individuals develop the symptoms in childhood even though they usually start during the teenage years or early adulthood (Psychology Today, p.4). For children, suffering from OCD during the first phase of growth can result in severe tribulations. For that reason, it is imperative that such young individuals, as soon as possible, get the evaluation and treatment so that they don’t miss on the essential life opportunities due to the disorder. Most importantly, the OCD patients don’t get any pleasure from engaging in the behaviors or rituals; however, they do get some relief from the nervousness that the obsessions create.

Medications for the OCD

The pharmacotherapy of the obsessive compulsive disorder in the modern era started in the late 1960s with the surveillance that no other tricyclic antidepressants like imipramine was active in OCD’s treatment apart from clomipramine. The most thoroughly premeditated drug for OCD and the first to get the approval of the FDA for indication was clomipramine. Likewise to the other tricyclic antidepressants, the common side effects of the drug include urinary withholding, constipation, and dry mouth (Goodman, p. 1). Moreover, nausea and tremor are also in association with the drug just like other serotonin reuptake inhibitors, and also belated or futile orgasms. In most instances, the patients also experience fatigue and weight gain due to the clomipramine use; also the drug hurts the heart conduction and seizures.

The antidepressants that are interactive with serotonin, which is a brain chemical, are the only medications that have shown consistency when it comes to the effective management of the OCD. Serotonin is one of the many chemical neurotransmitters or messengers of the brain that permit the communications between the different neuron nerve cells. The majority of neurons are having a separation of the synapse, which is a narrow fluid-filled gap, from each other, instead of having a direct joint. There is the release of neurotransmitter into the synapse, for the electrical indication to travel from one neuron to the other so as to freely slide transversely to the adjacent neuron (Goodman, p.1).

Once there, it comes into contact with the receptor, which is a functional part of the neuron in a kind of lock and key hypothesis where the receptor is the lock and the neurotransmitter is the key. After that, there is the triggering of the electrical signal which then passes along the recipient neuron so as to transmit to the brain the relevant information. There is an actual taking back of the released serotonin apart from its interaction with the adjoining neuron, and the reuptake pump offers the recycling of serotonin thus assisting in the later release reclaiming. Furthermore, it reduces the intensity of noise whose generation might take place if there is much serotonin lingering, after every nerve firing in the synapse.

The clomipramine (Anafranil) has a proportion of various chemical properties such as the ability to latch on to the serotonin reuptake thrust thus preventing the movement of serotonin into its residence neuron. Such medications like clomipramine which offers blockage to the serotonin are known as the serotonin reuptake inhibitors or SRIs. There are also other selective SRIs other than the clomipramine that is useful in the treatment of OCD, and they include fluvoxamine (Luvox), sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil). In a progression of various studies, research has it that the SRIs are more efficient in the OCD treatment than the other antidepressants that have no interaction with the serotonin pump. For that case, all SRIs are effective in the treatment of depression, but not all the antidepressants are effectual in the healing of OCD.

Most recently, there has been conduction of trials in the patients with the OCD with a newer invention of powerful and discerning blockers of serotonin reuptake antidepressant drugs like, amongst others, fluoxetine and sertraline. These drugs don’t lose their selectivity for jamming the reuptake of serotonin in the body, unlike clomipramine which does. Additionally, in comparison to the clomipramine, the drugs are lacking the noteworthy affinity for the brain receptors which have the consideration for being responsible for the detrimental side effects. That is to say; the selective SRIs are spotless medications in comparison to the clomipramine. All the examined potent SRIs up to date have demonstrated to be successful in the treatment of OCD. There has been the confirmation of the efficiency of fluvoxamine in children. There is well-tolerance of the selective SRIs, and their frequent side effects include insomnia, nausea, drowsiness, tremor, and sexual dysfunction.

The SRIs usually take the time to function, and there is a requirement for eight to twelve weeks’ daily treatment before the OCD symptoms start to recede. The continuation with the medication is advisable for at least six to twelve months; once there is an improvement because the majority of patients decline after complete medical termination and only a few can be successful. The addition of behavior therapy may also assist in the reduction of the rate of reversion of the disorder that might happen after the medical discontinuation (Goodman, p.2).

Psychotherapy

For many decades, there was the classification of the obsessive compulsive disorder purely as a psychological disorder, but the use of insight-oriented psychotherapy only has never been successful in the treatment of the disease. Nonetheless, the behavior therapy has been successful mainly the ones with specific small steps taken towards particular obsessions and compulsions involved in the sick. The Exposure and Response Prevention, also known as the (EX/RP) is one of the most recognized effective behavioral treatments for OCD. The EX/RP entails two mechanisms, the first one involves the obsessions’ provocation and letting the patient undergo the succeeding anxiety, and then the next step is abstaining the sick from engaging in the rites.

The aim of the procedure is to slowly put out the ill person’s fascination-related nervousness by letting them learn by action. When there is repeated predictions test by the patient of the feared outcome, for instance, getting sick and dying from exposure to the anxiety trigging behaviors such as dirt in the hands and then defying the urge of the ritual performance like hand washing three times. It results in the weakening of the pairing association between the obsessions and the compulsions (Medina, p.5). Remarkably, through the rituals prevention, the patient gets to learn that in spite of the anxiety and compelling urge, there is no likelihood of the feared outcome occurring as long as there is no performance of the compulsions. As a result, the majority of patients also undergo a sense of control and empowerment over their nervousness instead of getting ruined by the obsessions and compulsions (Harvard Health Publications, p.5).

Treatment-resistant OCD

Even though the SRIs medication and cognitive behavioral therapy (CBT) are successful in the cure of OCD for the majority of patients, there are those who experience negligible relief from the symptoms of the disorder with the standard managements. The OCD is debilitating and has destructive repercussions for both the suffering and the family members when it becomes severe. Regardless of the preface of the CBT and the SRIs, the treatment-resistant OCD remains a comparatively common and incapacitating predicament. The treatment-resistant OCD are the persons who are unsuccessful in more than two sufficient SRIs’ tests. There is also the treatment-refractory which is a higher level of treatment failure. There are some therapeutic strategies whose attempts in the treatment-resistant populace have conceptually failed in the categories of augmentation strategies, invasive procedures, and alternative monotherapies (Pittenger, Kelmendi, Bloch, Krystal, and Coric, p.9).

Conclusion

Medications have proved to be relatively successful in the management of obsessive-compulsive disorder in the last twenty-five years. The first one was the tricyclic antidepressant clomipramine, and then later followed by the several new SSRI category anti-depressants that selectively act on the serotonin re-uptake neurotransmitter. Most recently, the neuroimaging research has started disclosing the pathophysiology of the disorder. The abnormal functioning area of the brain is directly after the sectors that are about the tick disorders such as the Attention Deficit Disorder and the Tourette’s syndrome. The majority of people with ADD also has ticks and so does for many people having OCD (Pittenger, et al. p.11).

The early diagnosis and treatment usually minimize the severity of the symptoms and the intensity of disability. The effectual first-line management with SRI prescriptions and CBT are enthusiastically accessible and offer fragmentary assistance of the symptoms. The neurosurgical involvements remain the management alternative in the relentless refractory cases. There is an urgent need for theoretically new pharmacological stratagems to offer improvement in the treatment results for the patients only demonstrating a partly reaction to psychotherapy or proving to be incredibly treatment refractory.





Works Cited

Goodman, Wayne K. "Medications for Obsessive-compulsive Disorder | Part 2." Psych Central, Mar. 2017, psychcentral.com/lib/medications-for-obsessive-compulsive-disorder/2/.

Harvard Health Publications. "Treating Obsessive-compulsive Disorder." Harvard Health, Mar. 2009, www.health.harvard.edu/mind-and-mood/treating-obsessive-compulsive-disorder.

Medina, Johnna. "Obsessive-Compulsive Disorder (OCD) Treatment." Psych Central, Mar. 2017, psychcentral.com/disorders/obsessive-compulsive-disorder-treatment/.

Pittenger, Christopher, et al. "Clinical Treatment of Obsessive Compulsive Disorder." PubMed Central (PMC), Nov. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC2993523/.

Psychology Today. "Obsessive-Compulsive Disorder | Psychology Today." Psychology Today: Health, Help, Happiness + Find a Therapist, 2017, www.psychologytoday.com/conditions/obsessive-compulsive-disorder.