Obsessive-compulsive disorder (DOC) is a psychic disorder characterized by the presence of obsessions and compulsions that affects from 1 to 3% of children and adults in the world without distinctions of cultural or geographical. According to the World Health Organization (WHO), the DOC would be included among the main causes of disability in the developed world, ranking in eighth place among the main causes of illness in the adult population of developed countries.
Obsessions are thoughts, images, or impulses that the individual recognizes as illogical or unnecessary and that reach their consciousness involuntarily, causing discomfort and anguish. Despite the lack of control, the individual can recognize that they originate in their own mental processes. Obsessions can be simple repetitive words, thoughts, fears, memories, images, or detailed dramatic scenes.
Compulsions are acts that respond to an obligation internally perceived to follow certain rituals or rules and that also cause functional deterioration. They can be motivated directly by obsessions or by efforts to ward off certain thoughts, impulses, and fears. They lead to elaborate a variety of precise rules for the chronology, speed-rhythm, order, duration, and a number of repetitions of said acts. The individual also sees them as unnecessary, excessive or illogical, and involuntary or forced. Children often report compulsions without the perception of a mental component.
The treatment of the obsessive-compulsive disorder (OCD) can present a challenge for clinical psychiatrists. It is estimated that 1.3% of the population suffers from this disease every year, and 2.7% do so at some point in their lives. The symptoms consist of the appearance of obsessions and compulsions, and although any of these is sufficient to establish the diagnosis, it is common for patients to suffer both. Obsessions are repetitive and stereotyped thoughts that provoke anxiety or anguish and are usually experienced as intrusive or egodistonic phenomena generally recognized as excessive or unrealistic (what distinguishes them from delusions, although in severe cases the difference becomes less clear). Compulsions are ritual actions that are carried out to mitigate the anguish, often in response to obsessions. Obsessions and typical compulsions are, for example, concern for contamination, with rituals and repeated washing, the fear of hurting oneself or others with control rituals, or the need for symmetry and order (with the compulsion to order and accommodate objects). OCD can be treated through pharmacotherapy, specialized psychotherapy, treatments directed towards specific anatomical points, or a combination of these. The first line of treatment includes cognitive-behavioral therapy (CBT) and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs). There are three major essential elements when it comes to differentiating the touch of other disorders. The three basic criteria used to make the differential diagnosis of OCD are:
The most essential criterion is functional deterioration as a consequence of the symptoms.
Feeling of being forced or invaded by symptoms.
The individual recognizes the illogical and excessive nature of these thoughts or acts at some time. This parameter does not apply to children.
The validity of the fact that these patients recognize their acts as unnecessary or their thoughts as illogical has been questioned and seems to be somewhat inconstant since it has seen severely deteriorated patients who doubt the need to perform their rituals, while others are convinced of their need to almost psychotic proportions. In fact, the DSM IV has modified the criteria for OCD, so that the awareness of the illogical and excessive symptoms, should only be present at some stage of the disease. In children, this criterion does not apply.
Causes of Obsessive-Compulsive Disorder
There are probably many causes of Obsessive-Compulsive Disorder. No specific causes have yet been identified, and it may be that OCD is simply a way of responding to the brain to multiple problems. This response is similar to the unique and limited way of the intestines to produce diarrhea when it reacts to a wide variety of problems such as bacterial infections, parasites, contaminated food, anxiety, and poor absorption of food. But one thing is clear: OCD is a biological disease of the brain. Let us add to this biological element the environmental factors that also fulfill their role in OCD. Therefore, even if the true causes of OCD are not well understood, a mixture of both environmental and biological factors seems to be the ones that produce it. Some of the best-known causes are the following. The cause that seems to be best understood as that which is related to biochemical factors.
Injuries to certain areas of the brain can produce the symptoms of OCD. Through CT scans, magnetic resonance, and positron emission tomography, several abnormalities can be localized in the prefrontal cortex and other areas of the brain. Some studies show an increase or decrease in metabolic activity in various parts of the brain. Other studies show defects in one of the electrical circuits that transmit nerve impulses to various parts of the brain.
The brain is obviously a very complex structure. It contains billions of nerve cells (neurons) that communicate and work together. They communicate through electrical signals from one nerve cell to another. Some chemicals, called neurotransmitters, transmit electrical messages from one neuron to another. Neurotransmitters travel from the "end" of a nerve cell (the messenger) to the "start" of another cell (the receptor), through microscopic spaces filled with fluid between cells called synapses. In TOC, there are several neurotransmitters that play an important role: dopamine, serotonin, glutamate, and possibly others. Evidence shows that serotonin is a key element in OCD. The drugs that affect the serotonin system produce an improvement in the symptoms of OCD. Children who receive serotonin in certain areas of the brain (i.e., caudal core) show improvement in OCD symptoms.
In OCD there seems to be a problem in the serotonin levels or damage in the receiving place blocking or preventing the transmission of electrical messages. A decrease of dopamine in the basal ganglia was also noted when OCD existed. Dopamine also plays an important role in OCD. Hence, psychiatrists prescribe drugs that work on the levels of serotonin and dopamine. Oxytocin and glutamate also play an important role. Some adults with OCD report a high cerebrospinal fluid of oxytocin. Some patients with Tourette syndrome show low levels of cerebrospinal fluid of oxytocin.
Some children develop symptoms of OCD after suffering a streptococcal bacterial infection. This reaction has been seen in 10-20% of children who develop OCD. It seems that there was an autoimmune disorder since by attacking the bacteria they also attack the basal ganglia of the brain. This condition is called pediatric in autoimmune neuropsychiatric disorder associated with streptococcal infections. A condition similar to liver disease after a streptococcal infection has also been seen.
Studies show that there are significant problems in the visual-spatial integration of children with OCD. There are also problems with reasoning and memory.
Although there are clear examples of family members who suffer from OCD, especially parents and their children, studies on the relationship of the genetic link with a special gene have yielded unclear results.
Not that it is the only cause especially for OCD, but if you have the knowledge that abuse of any kind, changes in housing, other medical illnesses, the death of a loved one, problems in school, relationship problems, and other stressors of life can lead to the appearance of OCD.
Prevalence and Epidemiology
The prevalence of OCD in childhood and youth should be understood in the context of the prevalence of subclinical obsessions and compulsions in this group of population. It was found when interviewing parents of children under 6 years of age, that the urgency to perform acts until "feeling good" and concern with symmetry and rules was very common these interests decrease when the child moves to school age. Another study in 97 used self-administered surveys in 1,083 children in grades 4, 6, and 8. Sixty percent of fourth-grade children reported guilty concerns about the lies and a strong tendency to be tested, while 50% reported fear of contamination and germs. In eighth grade, concerns in these respects decreased to 40%, but 60% of them reported concerns with cleanliness and 50% noticed intrusive aggressive thoughts. It was found that these behaviors and symptoms decrease with age.
There are significant disparities and varied methods in the studies, establishing a prevalence of 0.5-3% in adults and since it is already certain that the OCD of children and adults is the same disorder, these studies are perfectly applicable to children. The prevalence ranges among children populations in different studies have been 0.2%, 1.2%, and more recently a prevalence point of 0.35% was found with an average prevalence of 0.4%. Epidemiological studies in adults range from 0.5-3%, but since structured or non-clinical interviews are used exclusively, they can be unreliable and the results may vary according to the clinical criteria considered. Current valid studies estimate the prevalence around 1%.
Valid studies suggest that the sex distribution of OCD continues to be a reflection of clinical samples, where men and women are equally affected, but men are earlier in age, this has been corroborated with some studies where it was found that 35% of men had onset of symptoms between 5 and 15 years, compared to 20% beginning in this age range among the female group. In addition, men have a longer duration of the disorder before seeking care. Generally, the symptoms exist on average 5-8 years before receiving clinical attention. Typically, the patient experiences obsessions and compulsions. Few individuals have one of the two and in this case, tend to be obsessions. The type of content is very broad and may vary over time, but reports in adolescents suggest that the most common are related to dirt and germs, fear of a disease suffered by a loved one, accuracy or symmetry, and religious scruples. Body functioning, lucky numbers, fear of self-injury, and sexual and aggressive concerns are less common. In adults, the frequency of these categories is similar, except that aggressive and sexual obsessions are more common.
Although a compulsion may originate in any action, only a few are common. A cohort of adolescents showed, in descending order of frequency, cleansing rituals, repetitive actions (do's and don'ts) and verification rituals more commonly. Far fewer subjects report rituals to protect themselves from illnesses or injuries, order maneuvers, and counting behaviors. In adults, the most common compulsions are those of verification and cleaning or doing things by numbers, which has been reported as the third most common. The analysis of symptoms in independent studies suggests strong reasons to consider a division of OCD into four subgroups: 1. Aggressive, sexual, religious, and somatic obsessions with checking compulsions. 2. Symmetry obsessions with compulsions of counting, arranging, ordering, and repeating. 3. Obsessions of contamination with compulsions of washing and cleaning. 4. Obsessions of hoarding with compulsions of hoarding and collecting. The researchers propose that the course, genetic risk, neuropathology, and treatm...
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