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Case-Based Differential Diagnostic Mental Health Evaluation for Adults
Published in Kunsook S. Bernstein, Robert Kaplan, Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses, 2023
Kunsook S. Bernstein, Robert Kaplan
Obsessive-compulsive disorder (OCD) is characterized by the presence of (1) obsessions, which are recurrent, persistent, and intrusive thoughts, urges, or images; and (2) compulsions, which are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. A person with OCD may have an obsession, a compulsion, or both (APA, 2013). There are a variety of OCD-related disorders, such as body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking). OCD is the fourth most common psychiatric disorder, and the lifetime prevalence of OCD in the general US population is estimated at 1–3%. The mean age of onset is approximately 20 years, and among adults, women are affected at a slightly higher rate than are men. Approximately 50–70% of clients with OCD have a sudden onset of symptoms following a stressful event, such as the death of a loved one, a serious illness, or a sexual problem (Sadock et al., 2019). Many OCD clients have full insight that their behaviors are senseless and excessive.
Obsessive-Compulsive Disorder (OCD)
Published in Judy Z. Koenigsberg, Anxiety Disorders, 2020
Different approaches have characterized the etiology of obsessive-compulsive disorder (OCD). Several theories of etiology and their variables have been implicated in the development of OCD (e.g. psychological, genetic, neuropsychological, environmental, biological) (Doron, Mikulincer, Sar-El, & Kyrios, 2015; Ingersoll & Marquis, 2014). Similarly, Meyerson & Konichezky (2011) categorized the subtypes of OCD into cognitive, biological, and emotional dimensions. They explain that whereas proponents of the cognitive subtype suggest that information-processing impairments may be implicated (e.g., Chamberlain, Blackwell, Fineberg, Robbins, & Sahakian, 2005), the biological subtype includes genetic components that emphasize heredity (e.g., Hettema, Neale, & Kendler, 2001; Jonnal, Gardner, Prescott, & Kendler, 2000), and the emotional subtype can include the existential etiology (e.g., Yalom, 1980). Ingersoll and Marquis (2014) point out that an integral psychotherapy model is consistent with Barlow’s (2000, 2002) triple vulnerability perspective (discussed in Chapter 6) in recognizing that both biological predispositions and psychological vulnerabilities, general as well as specific, can be implicated in the unfolding of OCD.
Psychological Disorders
Published in Mohamed Ahmed Abd El-Hay, Understanding Psychology for Medicine and Nursing, 2019
In their review, van Grootheest et al. (2005) concluded that OCD symptoms are heritable, with genetic influences in the range of 45–65 percent in children, and 27–47 percent in adults. Most candidate genes that have been studied are involved in the metabolism of neurotransmitters, especially catechol-O-methyl-transferase (COMT), monoamine oxidase-A (MAO-A), dopamine transporter (DAT), dopamine receptors DRD1, DRD2, DRD3, DRD4, serotonin transporters 5-HT2A and 5HT1B. Of these, the most promising for OCD transmission and expression belongs to ones in the serotonin systems (5HTTLPR and 5HT1B) and the glutamate systems (Hollander, Braun, & Simeon, 2008).
Serotonin reuptake inhibitor-cognitive behavioural therapy-second generation antipsychotic combination for severe treatment-resistant obsessive-compulsive disorder. A prospective observational study
Published in International Journal of Psychiatry in Clinical Practice, 2022
Antonio Tundo, Loretta Salvati, Luca Cieri, Viviana Balestrini, Daniela Di Spigno, Floriana Orazi, Marica Iommi, Roberta Necci
Obsessive-compulsive disorder (OCD) is a chronic disorder affecting 2–3% of the general population (Ruscio et al., 2010) and worsening the working, social and family life of patients (Vos et al., 2012). The first line treatments for OCD are cognitive behavioural therapy including exposure and response prevention (CBT/ERP) or Serotonin Reuptake Inhibitors (SRIs) (Koran et al., 2007). Even when an appropriate treatment with psychotherapy or pharmacotherapy is established, up to 60% of patients do not respond or only partially respond (Skapinakis et al., 2016). For these patients two augmentation strategies have been proposed, combining SRI and CBT/ERP or SRI and second-generation antipsychotic (SGA), mostly aripiprazole or risperidone. Both strategies proved to be effective (Albert et al., 2018) but, according to the current evidence, 2 of 3 patients do not respond to SRI-SGA combination (Thamby & Jaisoorya, 2019) and 1 of 2 do not remit with SRI-CBT/ERP combination (Vyskocilova et al., 2016).
Obsessive-compulsive symptoms in schizophrenia patients and their first-degree relatives and the association with subclinical psychotic symptoms
Published in Nordic Journal of Psychiatry, 2022
Barış Sancak, Güliz Özgen Hergül
The relationship between schizophrenia and obsessive-compulsive symptoms (OCS) has been studied for many years [1]. Early studies on this subject suggested that OCS were present in 1–3.5% of individuals with schizophrenia and may be a protective factor [2]. However, a subsequent study by Fenton and McGlashan showed that OCS were present at a frequency of 12.9% in schizophrenia and adversely affected the prognosis [3]. More recent studies have indicated that 25–59% of schizophrenia patients have OCS [1,4–6] and 12.1–23% of patients meet the clinical criteria for obsessive-compulsive disorder (OCD) [7,8]. A study based in Japan found the prevalence of OCS and OCD as 14.1% and 51.1% in chronic schizophrenia patients and suggested that there is a subtype of schizophrenia with OCS that starts at a younger age and progresses with more severe symptoms [9]. A Nigeria-based study found the prevalence of OCS in schizophrenia at a similar rate of 54.3% [10], while an India-based study showed it as 18.1% [11]. In a meta-analysis by Swets et al. the prevalence of OCS was 30.3% and the prevalence of OCD was 13.6% among patients with schizophrenia [12]. This is much higher than the prevalence of OCD in the general population (1.9–3.3%) [13]. The substantial differences in the results obtained in these studies can be attributed to variations in the selected samples (such as age, gender, chronicity, ethnicity, social and cultural differences), changes in diagnostic criteria and assessment tools over time, and other methodological differences [1,14].
Elevated serum S100B levels in medication naïve children and adolescents with obsessive-compulsive disorder
Published in Nordic Journal of Psychiatry, 2021
Bürge Kabukçu Başay, Ömer Başay, Çiğdem Tanriverdi, Melek Tunç-Ata, Sezai Üstün Aydin
The etiology of OCD is not fully known. It is a heterogeneous disorder comprised of different subtypes with different underlying etiological factors [11]. OCD symptoms are most likely due to a complex interaction of various biopsychosocial factors [12]. Genes (especially polymorphisms related with serotonin or involved in catecholamine modulation), environmental factors (e.g. learning experiences, parenting practices, life stressors, exposure to traumatic events), and functional abnormalities affecting brain networks (e.g. cortico-striato-thalamo-cortical circuit overactivity, limbic system-particularly the amygdala-association, reduced interconnectivity in default mode network and salience network) and neurotransmitter systems can cause OCD [12–15]. A recent review study has highlighted the association between low-grade inflammation, neural antibodies, neuro-inflammatory and autoimmune disorders, namely the immune system and OCD [16].