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Obsessive-compulsive
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The information contained herein are for illustrative purposes only: they do not regard either to prescriptions or medical advice - Read the warnings
The information contained herein are for illustrative purposes only and informative: they do not regard either to requirements or to psychological advice - Read the warnings
The obsessive-compulsive disorder or DOC (in English obsessive-compulsive disorder or OCD), also called obsessive-compulsive disorder, or SOC (in English or obsessive-compulsive syndrome OCS) in some texts known as obsessive-compulsive disorder, obsessive-compulsive or just as obsessive and obsessive and before the release of DSM-III-R as a (psycho) neurosis, obsessive-compulsive (psycho) neurosis, obsessive-compulsive or simply as a (psycho) neurosis and obsessive (psycho) neurosis forced, is a psychiatric disorder that manifests itself in a variety of forms, but is mainly characterized dall'anancasmo, consisting of symptoms associated with obsessive thoughts, compulsions (actions or special rituals to be performed) which attempt to neutralize obsession.
The obsessive-compulsive disorder, although four of the classified version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), including anxiety disorders (code 300.30), is widely regarded instead as an autonomous entity nosographic with a defined core psychopathology, with a particular course and symptoms and biological correlates of which are gradually taking shape.
According to the DSM-IV, it is characterized by obsessive symptoms and / or compulsions that are the source of marked distress for the patient, lead to waste of time (more than an hour a day) and interfere with normal daily activities. In order to be diagnosed
an obsessive-compulsive disorder must be present or only obsessions or compulsions and obsessions [1].
Index
[hide] * 1
Definition of "obsession"
* 2 Definition of "compulsion"
* 3 Symptoms and manifestations
or 3.1 Rituals anancastici
* 4 Possible causes: heredity and environment
or 4.1 Base or genetic
4.2 Assumptions and autoimmune connection with Tourette's syndrome or 4.3
behavioral development
Course * 5 * 6 * 7 Comorbidities
Treatment
* 8 \u200b\u200bNotes * 9 References * 10 External links
* 11 Other progetti
* 12 Collegamenti esterni
Definizione di "ossessione" [modifica]
* Pensieri, dubbi, immagini o impulsi ricorrenti e persistenti che affliggono l'individuo e che da questo vengono percepite come invasive e inappropriate (o comunque fastidiose) e che provocano una marcata sofferenza. La differenza con i disordini della personalità risiede proprio in questo fatto: mentre nel DOC le ossessioni sono avvertite come intrusive, nel disturbo ossessivo-compulsivo di personalità (o OCPD) hanno carattere egosintonico.
* L'individuo si rende conto che i pensieri, le immagini o gli impulsi sono frutto della propria mente. Se le ossessioni venissero ritenute reali, allora si cadrebbe nel campo della schizofrenia (cfr. "disturbo schizotipico di personalità" che, a volte, è connesso col DOC).
* L'individuo tenta (inutilmente) di ignorare o sopprimere tali pensieri, immagini o impulsi, o di neutralizzarli (altrettanto inutilmente) con altri pensieri e comportamenti ("compulsioni", in alcuni testi chiamati anche "psichismo da difesa"[2] e più anticamente "coazioni").
Definizione di "compulsione" [modifica]
* Comportamenti o azioni mentali ripetitivi che l'individuo si sente obbligato a eseguire, come una sorta di rituale stereotipato (che può servire a "riparare" un "danno" oppure a diminuire l'ansia causata da un pensiero), per difendersi da una certa ossessione.
* I comportamenti o le azioni mentali sono mirate a combattere le ossessioni; spesso questi comportamenti o queste azioni mentali sono chiaramente eccessivi e/o non sembrano, da parte di un osservatore esterno, essere realmente connessi con l'ossessione che cercano di neutralizzare.
* Le compulsioni possono riguardare diverse tematiche come la contaminazione, il perfezionismo, l'ordine, il controllo.
Sintomi e manifestazioni [modifica]
Le ricerche hanno dimostrato che il DOC è molto più comune di quanto si pensasse. Circa 1 su 50 tra adolescenti e adulti è affetto da disturbo ossessivo-compulsivo. A causa della natura molto personale di questo disordine, and also because of fear of being judged, there may be many people afflicted with OCD who are hiding, and the percentage could be even higher.
Rituals anancastici [edit]
DOC The patient does not complain in particular anxiety, but rather of obsessions and compulsions. Anxiety manifests itself only if it interferes in the "ritual" put in place to guard against obsession. For others, these "rituals," said anancastici rituals may seem strange and unnecessary, but for these individual actions are profoundly important and must be performed in particular ways to avoid bad consequences and to prevent anxiety to grieve. Examples of these actions are: *
repeatedly check that the car is parked well-locked before leaving it;
* turn off the lights and a number of times before exiting a room;
* climb a ladder or walk into a room always and only with one foot rather than the other;
* constantly raise and lower the volume of a radio or TV because you are convinced that no shade is suitable;
* repeatedly washing hands at regular intervals during the day or fail stop shaving lavarsele once.
These are just some examples. The exact symptoms can include, more specifically, all or only some of the following: *
continuous wash their hands
* A system of special account (count in groups of four, put things in groups of three, placing objects into sets or odd) *
control disorder: is These obsessions and compulsions involving protracted and repeated without controls, designed to repair or prevent disasters or serious accidents;
* a serious symptom that differs from the previous count steps (for example, you have to reach their cars with twelve steps , etc.).
* precisely align objects together, in perfect angles (this symptom is also in the personality disorder and can be confused with this condition);
* turn its gaze towards objects or the corners of the room *
in a tiled floor, unable to walk on the "lines" of separation;
* be forced to delete the "bad thoughts" with " good thoughts, "for example watching a sick child can force you to think of a happy child at play every time he comes to mind the image of the sick child, or having unwanted sexual thoughts (classic examples are fear of being homosexual or pedophiles);
* fear of contamination (such as fear of the secretions of the human body such as saliva, sweat, tears, mucus, urine and faeces: some cases of DOC also dimostrato la paura che il sapone che stanno usando sia contaminato) fisica o anche metafisica (contaminazione da pensiero);
* paura ossessiva delle malattie (cfr. ipocondria);
* il bisogno che entrambe le parti del corpo siano uguali: una persona con DOC che calpesta un pezzo di carta con il piede sinistro può sentire il bisogno di calpestarne un altro con il piede destro, o di tornare indietro e pestarlo nuovamente;
* superstizione eccessiva o pensiero "magico" (anche se il paziente è convinto che sia solo un effetto del disturbo non riesce comunque a ignorarlo): convinzione che la realtà possa essere modificata in peggio o in meglio mettendo in atto certi rituali o facendo certe azioni in modo sbagliato (Eg. Thinking about a bad thing or having the fear of offending someone or something) or obsessions such facts do not really connected, and such "effects" in some cases can be averted only by repeating the act (eg by deleting and rewriting the same word, thinking about positive things), or by some other ritual "anti-bad luck."
There are many other symptoms. Everyone can take to avoid situations of "danger" or discomfort, and then affect the lives of the affected person with the avoidances of the symptoms in the same way. It is important to remember that having some of the symptoms listed is not an absolute sign of DOC and vice versa and that the diagnosis of DOC should be made by a psychiatrist to make sure to suffer from this disorder. Obsessions are ideas and thoughts which the patient can not stop thinking. Common obsessions include fear of some discomfort, of being hurt or cause pain to someone else. Obsessions are typically automatic, frequent and difficult to control or eliminate on its own.
Compulsions refer to actions executed by the person, usually on a repetitive basis, the purpose of opposing (unsuccessfully) to think or obsessive thoughts. In most cases, this behavior becomes so regular that the individual is not deemed a problem worthy of note. The common compulsions include, but are excessive behaviors such as washing, checking, touching, counting or arranging and order, others may be ritualistic behaviors that the individual performs as convinced that lower the probability that an obsession manifests itself. Compulsions can be observable (such as hand washing), but can also be mental rituals such as repeating words and phrases or account.
Given that all individuals who suffer from DOC are aware that these thoughts and behaviors are not rational and that, while fighting against them with all their hearts rational, can not in any way to get rid of, the untreated cases DOC is one of the most frustrating and irritating anxiety disorders.
The disorder is recognized as such only if it compromises the normal rhythm of daily activities and social and occupational functioning of the subject and if it can not be better accounted for by other anxiety disorders or psychiatric disorders due to general medical conditions.
Sometimes the patient has a depressive component not recognized that has sharpened his obsessive-compulsive symptoms and a voltage-like state of meditation. These patients are usually agitated and depressed patients respond to treatment of agitated depression with a return of the dominant obsession.
In view of the fact that often the patient's obsessive-compulsive disorder is imposed a strict moral and is deeply concerned about the contamination, sexuality is often hampered, or at least strongly charged and confrontational.
Possible causes: heredity and environment [edit]
The DOC is a mental disorder serotonininergico, as has been shown in patients with this disorder, showed a malfunction in the transmission of serotonin in the brain neurons. This may have a case only biological or even be aggravated by learned behaviors (which are also reflected in the structure of CNS, as if learned habits) in genetically predisposed individuals [3].
genetic basis [change]
The genetic origin, although this explains some of the cases: studies of identical twins have shown that if they are separated and placed in different conditions, can not collapse all but the DOC, for example, can be affected only one of two or more brothers.
autoimmune hypothesis and connection with Tourette's syndrome [edit]
According to some studies, at an early stage, there could also be autoimmune in origin, following an infection that caused a physical illness (as in other anxiety disorders of the sphere). This may be caused by the overreaction to the B-haemolytic streptococcus group A. This syndrome, called PANDAS, which sometimes occurs with Korea's Sydenam, a neurological manifestation of rheumatic fever, it causes some people in the preparation the DOC. The doc files appearing early, before age 14, tics and motor impairment, and often persists even after the infection [4] Other studies (Rauch, Rapoport) would lead to hypothesize dysfunction localized in the basal ganglia (as well as possible because of Tourette's syndrome is often associated with OCD) and in the frontal lobes [5].
behavioral development [edit]
However, the fact of having parents or important figures during childhood and adolescence with OCD or obsessive personality traits have a significant impact on the development of obsessive-compulsive disorder, usually determining the genetic predisposition, chemical imbalance related to the mentioned above [6]. Like many anxiety disorders (including phobias), which can occur before, during and after the DOC and its first manifestations establishing a relationship between them, it seems that the DOC is unleashed from having parents absent, ie ipoprotettivi, or, above all, unsafe and over-protective towards the world.
Moreover, the symptoms can have fun the first time or increase, even temporarily, in conditions of excessive stress or because of an emotional shock or trauma.
Course [edit]
In the absence of appropriate therapy, there are four types of course [7]: *
episode with symptoms present only during certain periods of the life of a person, or even a single episode in a lifetime. In some cases, it may not even be diagnosed with a disorder, chronic fluctuating
*: symptoms are unfriendly over time, with better and worse, but never disappear completely, depending on the general level of stress;
* chronic stable symptoms occur gradually, but then remain stable over time, worsening chronic
*: is the most serious and common. Generally, symptoms begin gradually and there are periods of worsening and periods of stability followed, then, from further deterioration.
With therapy can make the symptoms disappear or revert to a lighter stage (remission) similar to a lighter course with DOC (eg, from stable to worsening or fluctuating), and keeping the noise.
Comorbidities [edit] The DOC has
comorbidity, that can live as a disturbance in the psyche of the patient with various diseases, such as [8]:
* Social Phobia
* Depression * Personality Disorders * Disorders of
' mood
* Panic attacks *
Other anxiety disorders and phobias
* Other psychiatric treatment
[edit]
The DOC is traditionally considered a chronic course and disabling disorder, often refractory to any kind therapeutic intervention (especially when it comes to treating the disease in people with over 35 years of age [9]). It must be said, however, that today the prognosis is certainly improved as the therapeutic approach to disease has changed radically: psychoanalysis is no longer considered standard care for these patients, and is currently at a grade different forms of treatment, more effective and applicable on a larger scale. Among these, in particular, the psychopharmacological therapy and cognitive-behavioral psychotherapy (PCC) have developed protocols and specific interventions for OCD, both methods of evaluation of clinical results that allow verification and experimental [10].
Before the advent of clomipramine, the psychopharmacological approach to obsessive-compulsive result was disappointing. In practice, it was established the effectiveness of any agent in this situation. The reason for this peculiarity is that the DOC is often greatly exacerbated by the occurrence of an agitated depression. By virtue of this, it happens, for example, that patients will increase by ten to one hundred times, in a day, wash their hands (so much so that the diagnosis may mistakenly consider the considerable emphasis on the compulsion to wash their hands as the central issue psychopathology, thus ignoring the affective disorder). E quindi tutto quanto può alleviare quest'ultimo, per esempio le fenotiazine o gli agenti triciclici, riduce la sintomatologia coattiva acuta. Tuttavia, il paziente torna allo stato di base[11].
Successivi rapporti hanno invece dimostrato che la clomipramina ha un valore specifico negli stati ossessivo-compulsivi al di là del suo effetto antidepressivo[12]. E che questa azione anti ossessiva è presente anche negli SSRI (Selective Serotonin Reuptake Inhibitors, lett. "inibitori selettivi della ricaptazione della serotonina", detti anche antidepressivi di nuova generazione o atipici)[13], in particolare fluoxetina, fluvoxamina, paroxetina e sertralina[14], se usati a dosaggi vicini o uguali a quelli massimali[15] (Eg 60 mg / day for fluoxetine, 300 mg / day for fluvoxamine, 60 mg / day for paroxetine and 200 mg / day for sertraline [16]). The drug tends to recognize the DOC as a specific disease serotonin [17]. The latency of the effect of SSRIs antiossessivo is about ten to twelve weeks at the three or four of the antidepressant [18]. The percentage of non-responders to this type of treatment is about 30-40% [19].
not yet established, however, if the effectiveness of SSRIs in obsessive-compulsive disorder is larger than the benzodiazepines (or more generally of the whole group of anti-anxiety drugs, even non-benzodiazepines) for which they are often prescribed in combination [20] [21 ]. Some authors, however, advise against their use in the treatment of OCD in that, while giving an attenuation of anxiety, also create dependence and tolerance and prevent the cognitive-behavioral psychotherapy [22].
The combination of SSRIs with antipsychotics such as haloperidol and incisors clopentixolo (and also the one with the latest generation neuroleptics such as risperidone and olanzapine), supported by psychiatrists [23], it is not usually considered a rational practice except in the presence of DOC of considerable gravity, often with borderline personality disorder, early-onset [24] or in those patients who also had a tic disorder [25].
part of behavioral psychotherapy particularly using the technique of exposure and response prevention but also stop (suspension) of thoughts, imitation of models, systematic desensitization and paradoxical intention [26].
cognitive psychotherapy for DOC instead focuses his attention on changes in particular the following processes and dysfunctional automatic thoughts: excessive sense of responsibility, excessive importance given to the thoughts, overestimation of the ability to control their thoughts and overestimation of the danger of 'anxiety [27].
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