Obsessive compulsive disorder (OCD)

"The treatment should be performed by a doctor expert in children with OCD, in coordination with a psychologist for psychotherapy".

DR. FELIPE ORTUÑO SÁNCHEZ-PEDREÑO
CODIRECTOR. PSYCHIATRY AND CLINICAL PSYCHOLOGY DEPARTMENT

The obsessive compulsive disorder (OCD) is an anxiety disorder in which the child or adolescent usually presents obsessions and also compulsions, although sometimes only has obsessions or only compulsions. At least sometimes the child recognizes that the obsessions or compulsions are excessive or absurd.

These repetitive behaviors are intended to prevent or reduce anxiety or keep something bad from happening, although they have no connection with the action they are trying to prevent or are clearly excessive.

Almost 90% of the cases of patients with TOC are associated with other disorders, especially depressive episodes and less frequently with anxiety and tics (as in the syndrome of Tourette).

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What are the symptoms of OCD?

The obsessive component is words, ideas, images or repetitive beliefs, recognized by the subject as irrational or annoying.

The most frequent contents are fear of contamination (to be infected, to body secretions, etc.); doubts and insecurity (to suffer from a serious illness, moral scruples, etc.); need of symmetry and order in things and rejection of dirt.

Also frequent are obsessive impulses to hurt another person or to have sexual behaviors that he rejects; as well as mental and interminable discussions.

Compulsions are also repetitive behaviors or mental acts that the person is forced to perform in order to stop an obsession or by following strict rules. They can be simple or become more complex (rituals). Although they temporarily relieve the obsessive component, they are experienced as annoying and as irrational or disproportionate.

The compulsions to avoid contact in the face of possible contamination, or to clean-wash in the face of obsessions with dirt, or to bring order to the needs of symmetry or behavior for the component of insecurity, stand out. They are often associated with a marked inability to make decisions and to slow down.

The most common symptoms are:

  • Fear of contamination.
  • Need for symmetry.
  • To wash oneself.
  • Sorting.

Do you have any of these symptoms?

You may have obsessive-compulsive disorder

What are the causes of OCD?

We do not know yet the cause of OCD, although we do know that it does not arise as a response to an alleged "intrapsychic conflict" nor by a "repressed sexual conflict" as the ancient psychoanalytic theories said. Nor is it due to the effect of parents on the child, or the birth of a younger sibling, or the stress of school, etc. For the effectiveness of antidepressants serotonin reuptake inhibitors (SSRIs) in the treatment of OCD, it is thought that is due to an alteration of serotonin.

Genetic studies indicate that OCD is related to some tic disorders, such as Tourette's disorder (motor and vocal tics). They have also found alterations in the function of brain circuits that communicate an area of the brain, basal ganglia, with the cerebral cortex, and specifically in an area called caudate nucleus.

Some children with a throat infection by streptococcus have a subsequent outbreak of OCD, produced by an autoimmune response of antibodies against streptococcus that injure areas of the caudate nucleus.

What is the prognosis?

Generally a longer pharmacological treatment is needed (more than 1 year) and a higher dose than that needed to treat depression, but if it is done correctly, very satisfactory results are obtained.

In the cases where there is a possible origin in a streptococcus infection it can be treated with antibiotics and immunological therapy to remove the harmful antibodies that are attacking the caudate nucleus. Psychoanalytic psychotherapy does not help children with OCD and wastes months or years of valuable time.

The association of behavioral treatment to medication, increases the likelihood that the child remains symptom-free when in the future is gradually interrupted medication. It is important that parents who believe that their child may be suffering from OCD go soon to your pediatrician or child psychiatrist.

Support groups for parents of children with OCD, national or regional associations of OCD patients, and information on the Internet can also be useful.

How is obsessive compulsive disorder treated?

The symptoms may respond to psychotherapeutic and pharmacological treatment.

The first choice psychotherapeutic treatment is exposure therapy with response prevention. The response is better when the compulsive component predominates.

The aim is to achieve a tolerance to the anxiety involved in exposure to the stimulus without having to resort to ritual to mitigate it, and thus extinguish the system of compulsive response to obsessions. In a second line or as support to this technique, the cognitive therapy is also useful, directed fundamentally to correct false or overvalued ideas.

The pharmacological treatment of OCD is the serotonin reuptake inhibitors, starting with selective inhibitors (SSRIs) such as paroxetine, fluoxetine, sertraline, escitalopram or fluvoxamine.

These drugs have a better and more tolerable side effect profile than previously used drugs such as clomipramine. Approximately half of the patients do not respond satisfactorily, so strategies of empowerment are considered, among which the combination of antipsychotics, preferably second generation, stands out.

There are other biological treatments that can be used in certain circumstances such as electroconvulsive therapy, transcranial magnetic stimulation or psychosurgery. There are more and more indications of the effectiveness of deep brain stimulation in resistant cases, with a significant clinical improvement and in the quality of life.

Where do we treat it?

IN NAVARRA AND MADRID

The Department of Psychiatry and Medical Psychology of the
of the Clínica Universidad de Navarra

Through a multidisciplinary work, the Department of Psychiatry and Clinical Psychology assists patients in a comprehensive way: it identifies the main causes of the disease and provides an individual approach with the most appropriate and effective treatments. 

Thanks to the experience of its team, it is able to offer the most advanced biological therapies, as well as an adequate psychotherapeutic orientation. In this way, the patient is helped to solve both personality problems and alterations in interpersonal and family dynamics.

Organized in specialized units

  • Child Psychiatry.
  • Adolescent Psychiatry.
  • Adult Psychiatry.
  • Family therapy.
  • Psychiatric hospitalization.
  • Clinical psychology.
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