I searched Medline up to 2001 for relevant articles using the terms obsession, compulsion, and obsessive-compulsive to aim at objective coverage; but references for this article were chosen more subjectively to illustrate data and themes in description, pathogenesis, pharmacotherapy, and psychotherapy of obsessive-compulsive disorder
SeminarObsessive-compulsive disorder
Section snippets
Symptoms
Obsessive-compulsive disorder is characterised by intrusive thoughts or images (obsessions), which increase anxiety, and by repetitive or ritualistic actions (compulsions), which decrease anxiety. The most recent revision of the diagnostic criteria for obsessive-compulsive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)4 emphasises that compulsions can be observable behaviours or mental rituals (panel 1).
The most frequent symptoms in obsessive-compulsive disorder
Epidemiology
The Epidemiological Catchment Area study16 provided the first epidemiological data for obsessive-compulsive disorder that were based on a nationally representative sample and reliable diagnostic criteria. Obsessive-compulsive disorder was the fourth most prevalent psychiatric disorder, with a lifetime prevalence of 2·5%.16 Results of a cross-national study1 with similar methods showed that prevalence did not differ by much across many different populations. A review17 of community studies
Neuroanatomy
The earliest indication that obsessive-compulsive disorder is mediated by specific neuronal circuits probably came from work showing an association between postencephalitis parkinsonian and obsessive-compulsive symptoms together with striatal lesions.33 Symptoms of obsessive-compulsive disorder have also been documented in various neurological disorders with striatal involvement, including Tourette's syndrome, Sydenham's chorea, Huntington's disorder, and Parkinson's disorder.34
Conversely,
Pharmacotherapy
Introduction of selective serotonin reuptake inhibitors provided the potential for agents that are not only effective for obsessive-compulsive disorder, but that also have a better safety and tolerability profile than does clomipramine. Indeed, all available serotonin selective reuptake inhibitors are effective and well tolerated in randomised controlled studies of obsessive-compulsive disorder,88 and several are also effective in obsessive-compulsive disorder in children.89 By contrast,
Psychotherapy
Psychoanalytical treatment for obsessive-compulsive neurosis was suggested by Freud,3 and for a long time was thought to be an effective approach to management. However, despite the contribution of investigators in delineation of the characteristics and psychology of obsessive-compulsive disorder, at present, insufficient data support use of psychoanalytical treatment.
Behavioural therapy was the first psychotherapy for which careful empirical support was obtained,100 and is useful in
The spectrum of obsessive-compulsive disorders
Disorders that overlap with obsessive-compulsive disorder are postulated to lie on an obsessive-compulsive disorder spectrum of conditions. Several different approaches to such a spectrum have been formulated.110 Freud postulated that there was a spectrum from obsessive-compulsive personality to obsessive-compulsive neurosis to psychosis. Although this idea is no longer popular, there is still an interest in patients with obsessive-compulsive disorder and poor insight, and in psychotic patients
Recommendation
Although many advances have already been made in treatment of obsessive-compulsive disorder, in the future a better understanding of the pathogenesis of obsessive-compulsive disorder will hopefully lead to further expansion of the present range of treatments, including innovations in psychopharmacology, psychotherapy, and other modalities of intervention.119, 120
Selection criteria and search strategy
References (120)
The epidemiology of obsessive-compulsive disorder in children and adolescents
Child Adolesc Psychiatr Clin N Am
(1999)- et al.
Childhood-onset obsessive-compulsive disorder: a tic-related subtype of OCD?
Clin Psychol Rev
(2001) - et al.
The concealment of obsessions
Behav Res Ther
(2001) - et al.
Cognitive deficits in obsessive-compulsive disorder on tests of frontal-striatal function
Biol Psychiatry
(1998) - et al.
Toward a neurodevelopmental model of obsessive-compulsive disorder
Biol Psychiatry
(1998) - et al.
FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder
Psychiatry Res
(1998) - et al.
Alteration of serotonin release in the guinea pig orbito-frontal cortex by selective serotonin reuptake inhibitors
Neuropsychopharm
(1995) - et al.
Sumatriptan, 5-HT(1D) receptors and obsessive-compulsive disorder
Eur Neuropsychopharmacol
(2001) - et al.
Treatment of severe, drug resistant obsessive compulsive disorder with the 5HT1D agonist sumatriptan
Eur Neuropsychopharmacol
(1998) - et al.
Single photon emission computed tomography of the brain with tc-99m HMPAO during sumatriptan challenge in obsessive-compulsive disorder: investigating the functional role of the serotonin auto-receptor
Prog Neuropsychopharm Biol Psychiatr
(1999)
On the role of prefrontal cortex glutamate for the antithetical phenomenology of obsessive compulsive disorder and attention deficit hyperactivity disorder
Prog Neuropsychopharmacol Biol Psychiatry
The inheritance of obsessive-compulsive disorder
Child Adolesc Psychiatr Clin N Am
Association between a catechol-o-methyltransferase polymorphism and obsessive-compulsive disorder in the Afrikaaner population
J Affect Disord
The use of antibody D8/17 to identify B cells in adults with obsessive-compulsive disorder
Psychiatry Res
Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
J Am Acad Child Adolesc Psychiatry
The psychology of perseverative and stereotyped behavior
Prog Neurobiol
The basal ganglia and chunking of action repertoires
Neurobiol Learn Mem
The cross national epidemiology of obsessive compulsive disorder
J Clin Psychiatry
Global burden of disease: a comprehensive assessment of mortality and morbidity from diseases, injuries and risk factors in 1990 and projected to 2020. vol I
Essential papers on obsessive-compulsive disorders
Diagnostic and statistical manual of mental disorders
Symptom dimensions in obsessive-compulsive disorder: toward quantitative phenotypes
Am J Med Genet
Unusual symptoms of OCD
Cross-cultural studies and obsessive-compulsive disorder
CNS Spectrums
Cerebral glucose metabolism in childhood onset obsessive-compulsive disorder
Arch Gen Psychiatry
The tic-related obsessive-compulsive disorder phenotype and treatment implications
Adv Neurol
Repetitive and compulsive behavior in frontal lobe degenerations
J Neuropsychiatry Clin Neurosci
Is the finding of obsessional behaviour relevant to the differental diagnosis of vascular dementia of the Binswanger type?
Behav Neurol
Classification and treatment of obsessional slowness
Br J Psychiatry
DSM-IV diagnostic criterion for clinical significance: does it help solve the false positive problem?
Am J Psychiatry
Quality of life in obsessive-compulsive disorder
CNS Spectrums
Obsessive-compulsive related disorders
The epidemiology of obsessive compulsive disorder in five US communities
Arch Gen Psych
Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study
Am J Psychiatry
Epidemiology of obsessive-compulsive disorder
Br J Psychiatry
Anxiety disorders following miscarriage
J Clin Psychiatry
Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum
J Clin Psychiatry
Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample
Depress Anxiety
A 40-year follow-up of patients with obsessive-compulsive disorder
Arch Gen Psychiatry
Economic costs of obsessive-compulsive disorder
Med Interface
A pharmacoeconomic and quality of life study of obsessive-compulsive disorder
CNS Spectrums
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases
Am J Psychiatry
The Yale-Brown obsessive compulsive scale. I: development, use, and reliability
Arch Gen Psychiatry
The doubting disease: help for scrupulosity and religious compulsions
Value and effectiveness of consumer advocacy groups: a survey of the anxiety disorders support group in South Africa
Depress Anxiety
Psychiatry on the internet: survey of an obsessive-compulsive disorder mailing list
Psychiatric Bulletin
Encephalitis lethargica: lessons for contemporary neuropsychiatry
J Neuropsych Clin Neurosci
Neuropsychiatry of obsessive-compulsive disorder
Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls
Arch Gen Psychiatry
Neuroimaging in obsessive-compulsive disorder and related disorders
Cited by (322)
Sex-dependent association of DNA methylation of HPA axis-related gene FKBP5 with obsessive-compulsive disorder
2023, PsychoneuroendocrinologyEarly visual processing alterations in obsessive–compulsive disorder: A marker of visual hypervigilance?
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