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Obsessive-Compulsive Disorder (OCD) is a Distressful, Anxiety-Provoking, Neuropsychological Disorder
“Obsessive-compulsive disorders are characterized by repetitive thoughts, or obsessions, that intrude into a person’s consciousness and ritualized behaviors that are performed repeatedly (compulsions). These obsessions and compulsions disrupt the affected individual’s normal activities.” (Wilson, 2013a, p. 11.3)
Over the years, studies have been conducted on the neuropsychological disorder known as obsessive-compulsive disorder. In this paper, relevant and valid information regarding the symptoms of the disorder, its new classification in the DSM-5, pathological features, clinical criteria for diagnosis, nervous system, neurotransmitters, receptors, pathways present, etiology, epidemiology, clinical presentation and history of disorder, potential complications, causation factors, pathology, treatment options, diagnostic and research technologies, future directions for research and clinical management of OCD.
A Description of the Pathological Features and Clinical Criteria for Diagnosis
In previous DSM manuals, the obsessive-compulsive disorder was categorized as an “anxiety disorder.” In the DSM-5 manual, OCD is categorized as “obsessive-compulsive and related disorders.” (Abramowitz & Jacoby, 2014, p. 221)
Diagnostic guidelines for obsessive-compulsive disorder (OCD) require that “obsessional symptoms and “compulsive” symptoms (one or both) have become distressful or is causing extreme interferences in one’s life. These symptoms and/or acts must be present on most days for at least two weeks. These symptoms and acts must have these characteristics: (1) the individual knows realizes these thoughts and/or acts are their own; (2) the individual is unable to resist these obsessive thoughts and/or compulsive acts; (3) the individual receives no pleasure at all from these thoughts and/or acts; and (4) these thoughts and/or acts are unpleasant and repetitive. (Simpson & Reddy, 2014)
The Neuropsychological/Bio-Psychological Theories of the Pathology
OCD is very debilitating and very distressful for the individual. It “is a highly debilitating neuropsychiatric condition with estimated lifetime prevalence of 2-3 percent.” Little is yet known or “understood about the etiology, neural substrate and cognitive profile of OCD. Until recently, OCD was described as a neurotic illness or a manifestation of psychodynamic conflict. Current approaches to OCD suggest that neurobiological abnormalities are involved in its pathogenesis.” (Kohli, Rana, Gupta, & Kulhara, 2015a, p. 206)
There has been new interest in learning more about the neuropsychological shortages that are present in OCD. Brain imaging technology has pointed to the likelihood that “a putative frontostriatal biological basis for the condition. Functional neuroimaging studies has demonstrated an abnormal neuronal activity in the orbitofrontal cortex, anterior cingulate cortex, dorsolateral prefrontal cortex, caudate nucleus, and thalamus evidence for frontostriatal dysfunction in OCD. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, motor speed and memory.” (Kohli, Rana, Gupta, & Kulhara, 2015b, p. 206)
Nervous System Structure(s), Neurotransmitter(s), Receptor(s), and Pathways Implicated in Obsessive-Compulsive Disorder
“Research and treatment trials suggest that abnormalities in serotonin (5-HT) neurotransmission in the brain are meaningfully involved in this disorder. This is strongly supported by the efficacy of serotonin reuptake inhibitors (SRIs) in the treatment of OCD, which was confirmed in our study. The obsessive-compulsive symptomatology was improved after six months and after one year.” (Sushevska, Olumchev, & Saveska, 2011a, p. 91-92)
Possible Causes (Etiology), including Genetic, Environmental, Familial, Lifestyle,
and Other Identifiable Risk Factors
In the 1930s and forward, there has been a lot written about family studies where OCD is present. Studies have found that biological and environmental factors play a role in the etiology of OCD. These studies have also found that there is a “four to tenfold risk increase among first-degree relatives of OCD-affected children and adults, respectively, as compared with relatives of controls.” (Stewart, Yu, Scharf, Neale, Fagerness, Mathews, & … Tikhomirox, 2013a, p. 789)
“A review of twin studies concluded that obsessive-compulsive (OC) symptoms are heritable, with greater genetic influences in child-onset (45--65%) than in adult-onset OCD case for OCD. In addition, more than 80 positional and functional candidate gene studies of OCD have been reported, predominantly for variants within genes in the serotonin, dopamine and glutamate pathways and within those involved in immune and white matter pathways, which encodes a neuronal glutamate transporter and which is located within the linkage peak on chromosome 9p, is the only candidate gene observed to be associated in multiple independent samples, although the specific associated variant has varied.” (Stewart, Yu, Scharf, Neale, Fagerness, Mathews, & … Tikhomirox, 2013b, p. 789)
“Excessive grooming and anxiety-like behaviors have been observed in mice lacking expression of SAPAP3, a postsynaptic scaffolding protein located at excitatory synapses. This finding, coupled with high SAPAP3 expression levels in the striatum, identify its human orthologue (DLGAP3) as an appealing candidate gene in OCD. Human studies have provided some support for a possible role of DLGAP3 in OCD-related disorders, suggesting increased rare non-synonymous variant frequencies in OCD/trichotillomania subjects34 and association of common DLGAP3 variants with pathological grooming in a family-based study, 35 albeit with some inconsistencies.” (Stewart, Yu, Scharf, Neale, Fagerness, Mathews, & … Tikhomirox, 2013c, p. 789)
Epidemiology of the Disorder (Demographics of Those Affected)
The characteristics of OCD consists of having persistent, unwanted thoughts (obsessions) and ritualistic behavior (compulsions) solely to reduce one’s misery or to prevent harm from occurring. The person who has OCD think that harm will happen if he does not wash his hands over and over again, or recheck over and over again that a door is locked. There are many OCD rituals, but repeated hand washings are the most mentioned.
“Obsessive-compulsive disorder has a lifetime prevalence estimated at 1–3%, constitutes the fourth most common psychiatric disorder (Rasmussen and Eisen, 1992) and is among the leading causes of disability in the world (Murray and Lopez, 1996). The most recent national Australian survey found that there was a 12-month prevalence of 1.6% in men and 2.2% in females (Australian Bureau of Statistics, 2007). OCD is associated with high degrees of personal disability, psychiatric comorbidity (e.g. around half of individuals with OCD present with major depression), and relatively poor long-term outcomes (Rasmussen and Eisen 1992; Eisen et al. 1999).” (Kyrios & Moulding, 2010a, p. 167)
Clinical Presentation and Natural History of the Condition
The present examination looked to analyze the pervasiveness of essential mental ceremonies and their related clinical qualities in a huge longitudinal example of grown-ups who suffered from OCD. As were our expectations, the prevalence of OCD symptoms in the example was 12.9%, which is tantamount to existing research showing predominance somewhere around nine and 25%. Impulsive supplicating and the demonstration of fixing awful contemplations with great musings were accounted for as the most successive essential mental ceremonies, with the topics of over-obligation and disrespect rising as the dominating fixations. (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011a)
This discovery shows that there is a significant quantity of patients with obsessive-compulsive who experience mental obsessions in a fanatical manner. The findings from the two studies showed different results in clinical measures, such as YBOCS, PSR, and possibly on GAF scores. (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011b)
Essentially, patients who had essential mental ceremonies basically experienced more psychological distress. These discoveries propose that people who have essential thought obsessions as a major aspect of their OCD manifestation may have a more extreme type of the issue. Not just did people with essential mental customs show more prominent general seriousness at gauge additionally they reported more noteworthy manifestation chronicity. People with essential mental customs spent about a year longer within the subsequent time span displaying full symptoms of OCD, 11.3 more months with poorer worldwide working (23.5% of the subsequent period), which showed a much less than idealistic outlook for patients who were suffering with OCD mental obsessions in respect to those obsessive-compulsive patients who did not have mental obsession rituals. Moreover, there were not any distinctions in successful outcomes in respect to the usage of psychotherapy or pharmacological therapy. These discoveries point out that the negative effects these mental obsessions have on the lives of OCD patients are detrimental to their well-being. More studies in this area need to be carried out for the well-being of people who suffer from OCD. (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011c)
Notwithstanding the chronicity discoveries, members with essential mental ceremonies started to encounter OCD side effects at an earlier age than the OCD patients who did not have essential mental obsessions. The onset of starting OCD manifestations was accounted for more than 3.5 years prior for patients encountering mental ritualistic thought patterns that caused distressing side effects. Bunch contrast in the time spent at full-criteria DSM-IV OCD was more than four years postliminary. (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011d)
Despondency and anxiety happening more than eight years sooner than the OCD patients who did not suffer from essential mental symptoms. New discoveries and results from research studies pointed to the fact that there are definite difficulties in finding and providing beneficial treatment to OCD patients who display essential mental obsessions. Also, the time of onset of essential cerebral obsessions could be connected to an even more debilitating type of OCD. People who experience these distressing mental rituals earlier in life become disabled sooner due to mental rituals taking up more and more of their daily life. These discoveries highlight the necessity for early detection of the illness and enhanced interventions for essential mental obsessions while keeping in mind the end goal which is to counteract conceivably poorer results and a general lower personal satisfaction. (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011e)
Potential Complications (Neurologic, Psychiatric, and Other Medical or Non-Medical)
“Although previous studies have found that suicide risk was high in patients with OCD and the important predictor for suicide behavior in patients with OCD was depression, our study provides additional evidence showing OCD patients with higher levels of obsessive-compulsive symptoms are also are likely to have higher levels of anxiety, depressive symptoms, and suicidal ideation. The standard nursing care of the patients with OCD should incorporate assessment of obsessive-compulsive symptom levels to identify the severity of anxiety, depressive symptoms, and suicidal ideation more accurately.” (Hung, Tang, Chiu, Chen, Chou, Chiou, & Chang, 2014a, p. 3099-3100)
“In addition to depression, our study found that anxiety symptoms contribute significantly to suicidal ideation among patients with OCD. Proper assessment and intervention in anxiety and depressive symptoms play an important role in suicide prevention for patients with higher levels of obsessive-compulsive symptoms. Many patients with OCD hide their symptoms and hesitate to seek medical services because of shame about their condition. OCD is, therefore, referred to as a ‘hidden disease,’ leading to underestimates of suicidal ideation (Torres et al. 2006).” (Hung, Tang, Chiu, Chen, Chou, Chiou, & Chang, 2014b, p. 3099-3100)
Pathology (Abnormalities of Physical Structure and Function,
including Genetic and Biochemical Aspects)
“In obsessive-compulsive disorder (OCD), individuals feel compelled to perform certain security-related behaviors over and over again, such as washing their hands or checking that a door is locked, even though these repetitive behaviors typically seem excessive and unwarranted to them. Except for their intensity and persistence, these pathological acts closely resemble normal security-related behavior. Accordingly, Szechtman and Woody proposed that OCD is a dysfunction of a biologically primal motivational system that normally helps to protect organisms from potential dangers like disease and attack by predators. Cues that suggest potential threat activate this Security Motivation System (SMS), which motivates preventative behaviors such as washing and checking, and the performance of these behaviors in turn typically provides negative feedback to terminate the security motivation. From this framework, OCD is basically a disorder in the regulation of a normal motivational system.” (Hinds, Woody, Van Ameringen, Schmidt, & Szechtman, 2012, p. 1)
Treatment Options (Pharmacologic and Non-Pharmacologic, with Rationales for Use Based on Current Understanding of the Disorder)
Pharmacologic: Antidepressants, known as SSRI (selective serotonin reuptake inhibitor), do help to provide relief for people who suffer from obsessive-compulsive disorder. Even though there is extreme anxiety present with this disorder, benzodiazepines do not seem to be beneficial for people who have this disorder. (Wilson, 2013b)
Non-pharmacologic: Educating people about this disorder, especially the people who have this disorder and their loved ones and caregivers, is extremely important. They should become educated about what OCD is, how it affects the person who has the disorder, and about beneficial treatment. Patients should be informed about the best ways to alleviate their symptoms, hopefully, so that these symptoms go away. Patients and close family members or caregivers should be informed that in order for the treatments to be beneficial, the patient must be persistent and must stay persevere with the treatments. (Sushevska, Olumchev, & Saveska, 2011b)
Cognitive behavioral therapy is very beneficial. CBT can teach a person how to change their thoughts in order to reduce the distressful recurring thoughts and ritualistic behavior. Patients and those close to them do not know all about the disorder and can have many misconceptions about OCD and the best strategies to manage the disorder. Talk therapy helps patients and their families to learn more about the disorder, best treatment methods and helps families stop the unnecessary blaming of themselves for the disorder. (Sushevska, Olumchev, & Saveska, 2011c)
Support groups are beneficial for many people. They learn ways to cope from one another, and learn new ways that work for someone else in reducing or stopping their symptoms. These support groups do help people to realize that they are not alone with this disorder – which helps a lot. Patients and family members should also be given the opportunity to discuss with others the impact that OCD has put on themselves and on their relationships with others. (Sushevska, Olumchev, & Saveska, 2011d)
Diagnostic and Research Technologies Employed
in Clinical Diagnosis, Care, and Basic Science Research
A research study was conducted to evaluate the neuropsychological well-being of patients who had OCD. The purpose of this research study was to contrast the neuropsychological profile of people who had OCD with people who did not have OCD. There were twenty outpatients who had the ICD-10 analysis of OCD. There was a control for age, training, sexual orientation and handedness. There was a full range of neuropsychological testing. Those tests comprised of verbal and execution tests of insight, memory, perceptual engine capacities, set test and Wisconsin Card Sorting Test (WCST). On perceptual-engine capacities, verbal familiarity, official capacities (WCST), insight and memory patients who had OCD showed no indication of hindrances almost identical to the sound controls. An endeavor to associate the test discoveries with the span of ailment, strength of sickness and the normal medication dosage was made; and it was found that there was no connection between the two. (Kohli, Rana, Gupta, & Kulhara, 2015a)
The most recent study gave no proof that there was any limited neuropsychological/subjective hindrance in OCD in cases that were steady for three months or longer. Unfortunate deficiency in perceptual-engine capacities, verbal familiarity, official capacities (WCST), insight, and memory does not agree with the results of other studies that utilized those same tests. Neuropsychological evaluation in over the top impulsive issue hyper-initiation of the orbitofrontal cortex, cingulate gyrus, and caudate core. On the other hand, auxiliary neuroimaging studies have not been as predictable, with a few examinations reporting strange amounts of the caudate core and orbitofrontal cortex in respect to solid controls. Neuropsychological research on OCD has added to a superior comprehension of the neurobiological premise of OCD. Research on the neuropsychological workings in OCD has recorded shortfalls in a few psychological areas, especially visuospatial capacities, official working, engine rate and memory. Clinical perceptions have additionally proposed the vicinity of major preparing deficiencies, yet variations from the norm in a few other psychological areas including official capacities, memory, and visuospatial abilities are conflicting. (Kohli, Rana, Gupta, & Kulhara, 2015b)
Many studies have demonstrated that the exhibitions of OCD patients on official working assignments were like those of sound controls. Others have reported that there was a poorer performance in regard to OCD patients doing the same work as the controls. Case in point, a few studies recommend hindered exhibitions on WCST by OCD patients, while others discovered something else entirely. While various studies neglected to discover proof of verbal memory shortfalls, others discovered huge impedances in the measurement of free review and acknowledgment in regard to verbal material. Patients who had OCD displayed deficiencies in visual spatial memory tests and verbal memory, however, they did not show impeded accomplishment on the memory retention tests. It had been proposed that verbal memory problems in people with OCD were interceded by hindered authoritative procedures utilized amid the learning procedure optional to official brokenness. (Kohli, Rana, Gupta, & Kulhara, 2015c)
Future Directions for Research and Clinical Management
Generally speaking, the obsessive-compulsive system holds guarantee in fusing mental medications for particular issues into essential consideration, albeit further research is required. With the late changes that were made to Medicare enabling patients to get discounts for administrations by therapists, the OCD treatment project has been altered to additionally incorporate a gathering organization to expand singular treatment. Given the large inclination by general practitioners for referral to an expert clinical brain research program, these late activities can possibly further enhance persistent results, and in addition, give more prominent backing to general practitioners, and to build joint effort in the middle of general practitioner and unified well-being in treating emotional sickness. (Kyrios & Moulding, 2010b)
Work will continue in the field of OCD to learn more about the causes of this disorder, find ways to determine risk factors for developing OCD, and to learn more about the pathology of this neuropsychological disorder. Studies should include the study of genetics designed to duplicate and broaden current findings, and also study chemical reactions and the factors influencing them. Studies will include identifying the genes that carry a risk for OCD and risk traits of one’s environment. (Pauls, Abramovitch, Rauch, & Geller, 2014a)
After the genes that are responsible for OCD have been found, the next step is to incorporate those risk for OCD genes into imaging and treatment studies to clarify the purpose they have in a person’s brain. This research ought to likewise fuse the way in recognizing OCD to be a multidimensional illness, one that comprises four or even five side effect groups – with every group speaking to particular segments of conduct that may be affected by particular qualities, changes, in particular, neural pathways and reactions to particular ecological occasions. At the end of the day, the distinctive indication measurements of OCD may have their own etiology and pathophysiology. (Pauls, Abramovitch, Rauch, & Geller, 2014b)
The replication of hereditary research ought to incorporate extensive sequencing trials and studies trying to distinguish uncommon duplicate number variations that may have a bigger impact on OCD, in many ways like the studies that have recognized qualities in schizophrenia. At last, there is a superior comprehension of the fundamental neuro-hardware and pathophysiology in regard to OCD, including the part of glutamatergic, serotonergic and dopaminergic pathways. Also, fear annihilation components are expected to become the focal point in regard to treatment for this debilitating disorder. (Pauls, Abramovitch, Rauch, & Geller, 2014c)
Obsessive-Compulsive Disorder: A Neuropsychological Disorder
Many studies and research have been conducted over the years regarding the obsessive-compulsive disorder. This must continue because so much more needs to be done so that people do not have to live their lives with the distressing and overwhelming symptoms (recurring thoughts and/or repetitive actions).
For the making of this research paper on the neuropsychological disorder named obsessive-compulsive disorder, much relevant and valid information about this disorder has been located, researched, and condensed. This paper provides the following information regarding OCD: DSM-5 listing, pathological features, clinical criteria for diagnosis, nervous system, neurotransmitters, receptors, pathways present, etiology, epidemiology, clinical presentation and history of disorder, potential complications, causation factors, pathology, treatment options, diagnostic and research technologies, future directions for research and clinical management of OCD. There is still very much work to do to alleviate people’s suffering from this disorder, and to make it so that even more people do not suffer from it in the future.
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