IJRPC 2013, 3(4) Rajesh Kumar et al. ISSN: 22312781 INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY Available online at www.ijrpc.com Review Article A REVIEW ON OBSESSIVE COMPULSIVE DISORDER D. Rajesh Kumar*, P. Prathap Reddy, V. Sai Krishna and B. Manikanta Siddhartha Institute of Pharmaceutical Sciences, Narsaraopet, Guntur District, Andhra Pradesh, India. ABSTRACT Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviours. It is a good example for neuropsychiatric disorder. It can vary from mild to severe forms. There is no known specific cause for OCD. However, genes and chemical imbalances in the brain may contribute to the illness. Symptoms include obsessions and compulsions, sometimes any one or other. It can be treated by pharmacotherapy, psychotherapy and finally by using psychosurgery. In the future we can expect the exact origin of this disorder. Keywords : Obsessive compulsive disorder, Anxiety, Neuropsychiatric. obsessions and compulsions. DESCRIPTION complete a compulsive behavior, harm is Obsessive-compulsive disorder (OCD) is one imminent. of the more disabling and widespread mental disorder. This disorder is characterized by two WHAT CAUSES OCD? central features -- obsessions and Brain imaging studies have also shown that compulsions. Obsessions are unwanted ideas people with OCD have abnormalities, such as or impulses that repeatedly pop up in a increased blood flow and activity, in some person's mind. According to the National parts of their brain. The areas of the brain Institute of Mental Health (NIMH), "Persistent affected deal with strong emotions and the fears that harm may come to self or a loved response to them. one, an unreasonable concern with becoming contaminated, or an excessive need to do SIGNS AND SYMPTOMS things correctly or perfectly, are Common obsessions include the following common."Examples of common obsessions Contamination include: "My hands may be contaminated -- I Safety must wash them"; "I may have left the gas on Doubting one's memory or perception in the house"; or "I am going to injure my Scrupulosity (need to do the right child." These thoughts are often intrusive, thing, fear of committing a unpleasant and produce a high degree of transgression, often religious) anxiety. Sometimes the obsessions are of a Need for order or symmetry violent or a sexual nature, or concern illness. Unwanted, intrusive sexual/aggressive Compulsions are repetitive behaviors to which thought. people who suffer from OCD resort. The two most common compulsions are washing Common compulsions include the following: (hands, usually) and checking (e.g., gas is off Cleaning/washing on stove). Other common compulsions include Checking (e.g., locks, stove, iron, counting (often while performing another safety of children) compulsive action such as hand washing), Counting/repeating actions a certain repeating, hoarding and endlessly rearranging number of times or until it "feels right" objects in an effort to keep them in precise alignment with each other. Arranging objects A person who has OCD often believes that Touching/tapping objects these behaviors will keep harm away from Hoarding them or their loved ones and that if they fail to Confessing/seeking reassurance List making 870 IJRPC 2013, 3(4) Rajesh Kumar et al. ISSN: 22312781 Many patients with OCD have other treatment success. The symptom checklist psychiatric comorbid disorders, and may includes obsessions and both physical and exhibit any of the following mental compulsions. The severity scale is Mood and anxiety disorders based on time spent on obsessions and Somatoform disorders, especially compulsions, resistance to these symptoms, hypochondriasis and body dysmorphic interference from symptoms, related distress, disorder and level of control. Increasing numbers of Eating disorders points are assigned for increasing levels of Impulse control disorders, especially impact. The scale is scored as follows kleptomania and trichotillomania Mild: 8–15 points Attention deficit–hyperactivity disorder Moderate: 16–23 points (ADHD) Severe: 24–31 points Obsessive-compulsive personality Extreme: 32–40 points disorder Tic disorder EPIDEMIOLOGY Suicidal thoughts and behaviours. Obsessive-compulsive disorder (OCD) among adults in the United States has an estimated Skin findings in OCD patients may include the 12-month prevalence of 1.2 % and an following estimated lifetime prevalence of 2.3. Females Eczematous eruptions related to are affected at a slightly higher rate than excessive washing males in adulthood, although males are more Hair loss related to trichotillomania or commonly affected in childhood. compulsive hair pulling The exact prevalence of OCD is unknown. The Excoriations related to neurodermatitis National Comorbidity Survey Replication or compulsive skin picking. (NCS-R), a nationally representative household survey designed to assess the prevalence, severity, and comorbidity of DIAGNOSIS various psychiatric disorders in the United Formal diagnosis may be performed by a States, found that OCD affects roughly 2.2 psychologist, psychiatrist, clinical social million American adults, or about 1% of adults worker, or other licensed mental health in any given year . The NCS-R researchers professional. To be diagnosed with OCD, a used criteria from the Diagnostic and person must have obsessions, compulsions, Statistical Manual of Mental Disorders Fourth or both, according to the Diagnostic and Edition (DSM-IV) to make the diagnosis, Statistical Manual of Mental Disorders (DSM). based on responses to a version of the World The Quick Reference to the 2000 edition of the Health Organization's Composite International DSM states that several features Diagnostic Interview (CIDI). The Epidemiologic characterize clinically significant obsessions Catchment Area Study, conducted in the and compulsions. Such obsessions, the DSM 1980s, found an OCD lifetime prevalence of says, are recurrent and persistent 1.94% to 3.29% across five study sites. The thoughts, impulses, or images that are NCS-R found a median age of onset of 19 experienced as intrusive and that cause years, with about one-fifth of cases starting marked anxiety or distress. These thoughts, before 10 years of age. Other studies suggest impulses, or images are of a degree or type a mean age of onset between 22 and 35 that lies outside the normal range of worries years, with one-third beginning before 15 about conventional problems. A person may years of age. Younger age at onset appears to attempt to ignore or suppress such be associated with more severe symptoms obsessions, or to neutralize them with some and higher rates of specific comorbidities, other thought or action, and will tend to including attention deficit hyperactivity recognize the obsessions as idiosyncratic or disorder, tic disorders, and other anxiety irrational. disorders. These patients may be less Once OCD is suspected, the following should responsive to first-line pharmacologic be performed treatment as adults. Screening tools are available to help evaluate the impact of OCD. One of the best-known is ETIOLOGY: BIOLOGICAL MODELS the Yale-Brown Obsessive-Compulsive Scale FUNCTIONAL NEUROANATOMY (Y-BOCS). The Y-BOCS includes two Many investigators have contributed to the components: a symptom checklist and a hypothesis that OCD involves dysfunction in a severity scale. The Y-BOCS is widely used in neuronal loop running from the orbital frontal research studies of OCD treatment, with cortex to the cingulate gyrus, striatum reductions in severity used as markers of (cuadate nucleus and putamen), globus 871 IJRPC 2013, 3(4) Rajesh Kumar et al. ISSN: 22312781 pallidus, thalamus and back to the frontal caused significant distress or social cortex. Organic insult to these regions can impairment) in monozygotic twins; the produce obsessive and compulsive symptoms. concordance of dizygotic twins was only half The results of neurosurgical treatment of OCD as large. On the other hand, none of eight strongly support this hypothesis. Surgical monozygotic twin pairs in another study were interruption of this loop by means of concordant for OCD, according to Andrews et cingulotomy, anterior capsulotomy or al. in 1990. A recent review notes that in Pauls' subcaudate tractotomy brings about study in 1992, 10% of the parents of children symptomatic improvement in a large and adolescents with OCD themselves had proportion of patients unresponsive to all other the disorder, and in another study, OCD was treatments. Cingulotomy interrupts this loop at present in 25% of fathers and 9% of mothers. the anterior cingulate cortex, thereby The symptoms of parents and children usually disrupting frontal cortical input into the Papez differed, arguing against social or cultural circuit and limbic system, which are believed transmission. The recent finding, by Murphy et to mediate anxiety and other emotional al. in 1997 and Swedo et al. in 1997, that an symptoms. Anterior capsulotomy (lesions antigen which is a genetic marker for within the anterior limb of the internal rheumatic fever susceptibility is also a marker capsules) and subcaudate tractotomy (lesions for susceptibility to an autoimmune form of in the substantia innominata, just under the childhood onset OCD will undoubtedly spur head of the caudate nucleus) interrupt fronto- progress in unravelling genetic contributions to thalamic fibers, which may mediate the the pathogenesis