Obsessive-compulsive syndrome (obsessive-compulsive disorder). Obsessive Compulsive Disorder: Signs and Treatment

Obsessive compulsive disorder (OCD) is a group of pathopsychological syndromes that manifests itself as obsessive thoughts and actions that prevent patients from leading a fulfilling life. This state is characterized by the inability of a person to control his thoughts (ideas) or actions, which become habitual, stereotypical and constant fear and anxiety. Obsessive Compulsive Disorder is considered one of the most common mental disorders According to some sources, one in three adults suffers from obsessive thoughts or actions, and 1 out of a thousand children suffer from severe disorder.

The reasons for the development of obsessive compulsive disorder in children and adults are still not clear. It has been proven that the onset of the disease is influenced by both physiological and psychological factors. It is impossible to say exactly which factors can cause the disorder and which ones cannot, since each organism individually reacts to stimuli.

Risk factors for developing OCD are:

Obsessive compulsive disorder develops when a person has a pattern of certain behavior. For example, having experienced fear or anxiety, the patient walked around the room, or to get rid of the fear, he turned on the light and checked if anyone was in the room.

This reaction is fixed in the brain as a possible response to any dangerous situation, and in the future the patient cannot get rid of this behavior, continuing to perform certain rituals every day. Sometimes, such behavior does not seem strange to others, but the patients themselves experience constant anxiety, from which they try to get rid of new rituals, which are gradually becoming more and more.

What happens with obsessive-compulsive disorder

The development of OCD is influenced by many factors, under their influence, the patient begins to constantly focus on certain thoughts, events, attaching excessive importance to them.

Obsessive thoughts arise from events or things that are of great value to a person, from his fears and experiences. From time to time, such thoughts or actions, which cannot be dealt with, appear in everyone - for example, while waiting and worrying about a loved one who is late in the evening or the habit of constantly checking the keys to the apartment.

But with OCD, patients do not try to cope with the influx of thoughts, because they consider them too important, and their behavior is the only correct and possible in such a situation.

Certain rituals and behavioral patterns help them feel safe and "cope" with anxiety, but gradually, they become more and more and the patient falls into a vicious circle - any unfulfilled or improperly performed ritual causes even more severe anxiety, and in order to get rid of her, you need to perform some other ritual.

Rituals and habits can be very different, from harmless - "knock on wood so as not to jinx" or spit over the left shoulder if a black cat crossed the road "to complex, multicomponent: in order to avoid bad things, you must definitely avoid the blue color, and if I saw a blue object, it is imperative to return home, change clothes and leave the house only in the dark.

People suffering from neurosis are characterized by exaggeration of danger and "fixation" on it, any event in life turns into a problem or even a catastrophe, which a person is not able to cope with. This maintains a constant feeling of anxiety and tension, interfering with the patient's normal life.

Symptoms

The main symptoms of obsessive-phobic disorder are obsessive thoughts and compulsive actions (rituals). These two combinations give a huge number of different options for the clinical picture of the disease.

OCD can be suspected and diagnosed as follows:

1. Rituals are one of the most common signs of OCD. Rituals are repetitive activities whose main purpose is to calm anxiety or trying to "avoid" something terrible. The patients themselves realize that such actions are incorrect and abnormal, but they cannot cope with these impulses. For some, this becomes the only way to calm down, while others believe that this is the only way to avoid various misfortunes. Rituals can be very different: from the habit of arranging all objects according to size, to daily cleaning of the whole house with disinfectants, there can also be stranger habits: for example, before going to bed, read the same page in a book every day, turn off and then turn on the light. in the room 10 times and so on.
2. Obsessive ruminations are the second hallmark of the disease. Patients spend hours thinking about the same event, “chewing” it in the brain, not finding the strength to interrupt this stream of thoughts. "Mental gum" can be associated with the need to perform any action: call someone, talk, do something or perform an ordinary, everyday action that a healthy person performs without any thought. Such thoughts can also relate to relationships and unfinished activities: whether the lights are off, whether a thief is entering the house, and so on.
3. Anxiety - with obsessive compulsive disorder, anxiety is always present in patients. It can arise because of small, everyday situations (the child was delayed for 10 minutes) or because of "global", but not amenable to control - terrorist attacks, environmental degradation, and so on.
4. Obsessive thoughts - Negative thoughts or a desire to harm other people can occur in certain situations or appear intermittently. Patients try to control such thoughts, but there is always a risk that they will do something like this.
5. or obsessive states - can be sensual and imaginative. Sensual obsessions are feelings that one's own thoughts, feelings and desires are imposed by someone, "not their own." The imposed images can relate to any imaginary situations: patients "see" how they commit an act, usually illegal or aggressive, or vice versa, unreal images seem to them to be valid, already happened.
6. Obsessive impulses are a sudden desire to perform an action that may not be appropriate or even dangerous. Sometimes in this way the patient tries to cope with obsessive thoughts or anxiety, doing strange, often destructive or dangerous actions.
7. Obsessive drives - the patient feels an irresistible desire to do something, regardless of whether it is feasible, whether such actions are allowed, and so on. Attraction can be quite harmless: the desire to eat something or absolutely unacceptable: to kill someone, commit arson, and so on. But in any case, the patient's inability to cope with his feelings causes great discomfort and becomes another cause for anxiety and concern.
8. Is a very characteristic symptom of obsessive disorder. Fears and phobias can be of very different nature, often there are nosophobia (obsessive fear of a serious or fatal illness), fear of heights, open or enclosed space, fear of pollution. Various rituals help temporarily cope with fear, but then it only intensifies.

In severe OCD, the person may have all of the symptoms at the same time, but more often than not, there is increased anxiety, obsessive thoughts and rituals. Sometimes they are joined by obsessions: aggressive thoughts and behavior, as well as phobias.

OCD in children

Unfortunately, today the number of children suffering from such pathologies as obsessive compulsive disorder continues to increase. It is difficult to diagnose, especially in primary school children, and the manifestations of the disease are often mistaken for a cider of attention deficit hyperactivity disorder, depression, conduct disorder, or autism. This is due to the smaller number of characteristic symptoms that the child demonstrates and the fact that he cannot and does not know how to accurately characterize and describe his condition.

Children with OCD also suffer from obsessive thoughts and anxiety, but they can only formulate their condition at an older age; young children can be very restless, overly irritable, aggressive and hyperactive.

Anxiety and fears are manifested by the fear of being left without parents, alone, fear of strangers, new premises, situations and even clothes.

Ritual is considered to be the most common symptom of obsessive compulsive disorder in childhood. It can be a multiple repetition of the same actions that seem meaningless to adults, excessive neatness and disgust (after any contamination of hands, you need to wash your hands for a long time with soap and water), attachment to the same things or a sequence of events (lullaby before bedtime, obligatory glass of milk for breakfast ).

Moreover, the child categorically refuses to replace the old thing with a new one, change anything in the ritual or abandon it. Attempts by parents or others to "break" the ritual are perceived extremely aggressively, children with OCD cannot be switched to something else or distracted from performing actions.

At an older age, pronounced fears or phobias may appear, as well as anxiety and obsessive movements. Young children with this disorder are usually considered hyperactive or suffering from neurological disorders.

It is very difficult to diagnose obsessive-phobic disorder in children, since the clinical picture, due to age characteristics, is unclear and it is difficult to make a differential diagnosis with other diseases.

Treatment

How is obsessive compulsive disorder treated? great efforts on the part of the patient and the doctor. Until recently, this disease was considered extremely resistant to treatment and doctors, first of all, tried to cope with the most pronounced symptoms of the disease, without trying to rid the patient of the disorder itself. Today, thanks to fairly effective and safe medicines and new methods of psychotherapy, it is possible to stabilize the condition of a patient with OCD in most cases.

To do this, use:

• drug therapy: antidepressants, antipsychotics, anti-anxiety and sedatives;
• psychotherapy: prevention method, 4-step therapy, “thought stopping” method and cognitive-behavioral therapy, family psychotherapy, personal and other methods can be used as an auxiliary therapy;
• home treatment - this disease requires medication and psychotherapeutic treatment, but if the patient does not fight his disorder at home on his own, the effect of treatment will be minimal.

Drug therapy

For treatment, antidepressants are used: Fluvoxamine, Paroxetine, Clomipramine; atypical antipsychotics: Olanzapine, Lamotrigine; anxiolytics: Clonazepam, Buspirone; normotimics: lithium salts and others. All these drugs have contraindications and side effects, therefore, should be used only when indicated and under medical supervision.

Treatment of OCD begins with a 2-3 month course of antidepressants, they help to cope with anxiety, worries, normalize the mood and general condition of the patient. After or simultaneously with taking antidepressants, psychotherapy is started. It is very important to control the intake of antidepressants, especially at the initial stage of treatment, when there is no apparent effectiveness from taking drugs, and the patient's psyche continues to be depressed. Only after 2-3 weeks of taking the first pronounced changes in the mood and well-being of a person appear, after which it becomes much easier to control the treatment.

In addition to antidepressants, sedatives and hypnotics are used, as well as antipsychotics and normotics - these drugs are used only for the treatment of concomitant disorders. Antipsychotics are indicated for pronounced aggressive intentions, thoughts or actions, and normotimics are indicated for decreased mood, fears and phobias. The drugs are prescribed for 10-30 days, depending on the severity of the symptoms.

Psychotherapy

The main goal of psychotherapy for OCD is the patient's awareness of his problem and how to deal with anxiety and obsession with thoughts and actions.

The 4-step therapy is based on replacing or simplifying rituals that help patients relieve anxiety. Patients should be clearly aware of what and when they provoke attacks of compulsions and control their actions.

The method of "Stop thoughts" teaches the patient the ability to stop and "look" at their actions and thoughts "from the outside." This helps to realize the absurdity and fallacy of their fears and delusions and teaches us to cope with them.

Home treatment

The help and support of relatives and friends of the patient is very important for successful treatment. They must understand the causes and manifestations of the disease and help him cope with anxiety attacks and anxiety.

The patient himself learns to control his thoughts and actions, avoiding situations in which obsessions may appear. This includes quitting bad habits, reducing exposure to stressors, relaxation and meditation techniques, and so on.

Treatment of OCD can take a long time, and the patient and his family need to tune in to long-term therapy - it takes 2 to 6 months to stabilize the condition, and sometimes more. And in order to exclude the possibility of a relapse of the disease, you need to periodically visit your doctor and repeat the course of medication and psychotherapy.

Obsessive compulsive disorder(from lat. obsessio- "siege", "embracing", lat. obsessio- "obsession with an idea" and lat. compello- "I compel", lat. compulsio- "coercion") ( OCD, obsessive-compulsive neurosis) - mental disorder . May be chronic, progressive, or episodic.

In OCD, the person has an involuntary obsessive, disturbing, or frightening thought (called obsession). He constantly and unsuccessfully tries to get rid of the anxiety caused by thoughts through the same obsessive and tedious actions (compulsions). Sometimes it stands out separately obsessive(predominantly obsessive thoughts - F42.0) and separately compulsive(predominantly compulsive actions - F42.1) disorders.

Obsessive-compulsive disorder is characterized by the development of obsessive thoughts, memories, movements and actions, as well as a variety of pathological fears (phobias).

To identify obsessive-compulsive disorder, the so-called Yale-Brown scale is used.

Epidemiology

CNCG study

OCD and intelligence

intelligence

OCD, 5.5% - alcoholism, 3% - psychoses and affective disorders

History

bipolar disorder

Antiquity and the Middle Ages

Obsessive27 phenomena have been known for a long time. From the 4th century BC. NS. obsessions were part of the structure of melancholy. So, her Hippocratic complex included:

"Fears and discouragement that exist for a long time."

In the Middle Ages, such people were considered possessed.

New time

The first clinical description of the disorder belongs to Felix Plater (1614). In 1621, the obsessive fear of death was described by Robert Barton in his Anatomy of Melancholy. Similar obsessive doubts, fears, were described in 1660 by Jeremy Taylor and John Moore, Bishop of El. In 17th century England, obsessive states were also referred to as "religious melancholy," however, on the contrary, they believed that they occurred due to excessive dedication to God.

19th century

In the 19th century, for the first time, the term "neurosis" became widespread, to which obsessions were included. Obsessions began to be differentiated from delusions, and compulsions from impulsive actions. Influential psychiatrists have debated whether to attribute OCD to a disorder of emotion, will, or intelligence.

folie de doute

obsession Zwangsvorstellung obsession, and in the USA - English. compulsion

XX century

neurasthenia Pierre Maria Felix Janet singled out this neurosis as psychasthenia in his work fr. psychasthenia phobic anxiety disorders Sigmund Freud paranoia psychoses such as schizophrenia neuroses.

• fear of contamination or pollution;
• fear of harming yourself or others;

Treatment

• b) There must be at least one thought or action that the patient unsuccessfully resists, even if there are other thoughts and / or actions that the patient no longer resists.
• c) The thought30 of performing an obsessive action should not be pleasant in itself (a simple reduction of tension or anxiety is not considered pleasant in this sense).
• d) Thoughts, images or impulses should be unpleasantly repetitive.

It should be noted that the performance of compulsive actions is not in all cases necessarily correlated with specific obsessive fears or thoughts, but may be aimed at getting rid of a spontaneously arising feeling of internal discomfort and / or anxiety.

It includes:

• obsessive-compulsive neurosis
• obsessive neurosis
• anankastny neurosis

Anankastic personality disorder (F60.5) must first be ruled out for a diagnosis to be made.

Differential diagnosis according to ICD-10

The ICD-10 notes that the differential diagnosis between obsessive-compulsive disorder and depressive disorder (F 32., F 33.) Can be difficult, since the two types of symptoms often occur together. In an acute episode, preference is given to the disorder with the first onset of symptoms. When both are present, but neither is dominant, it is advisable to assume that the depression was primary. In chronic disorders, it is advisable to give preference to the one with symptoms that persist most often in the absence of symptoms of the other.

Occasional panic attacks (F41.0) or mild phobic (F 40.) Symptoms are not considered an obstacle to the diagnosis of OCD. However, obsessive symptoms that develop in the presence of schizophrenia (F 20.), Gilles de la Tourette's syndrome (F 95.2.), Or organic mental disorder, are regarded as part of these conditions.

It is noted that although obsessions and compulsions usually coexist, it is advisable to establish one of these types of symptoms as dominant, since this may affect how patients respond to different types therapy.

Etiology and pathogenesis

Symptoms and behavior of patients. Clinical picture

Patients with OCD are suspicious people, prone to rare maximum-decisive actions, which is immediately noticeable against the background of their dominant calmness. The main signs are painful stereotyped, obsessive (obsessive) thoughts, images or drives, perceived as meaningless, which in a stereotyped form again and again come to the patient's mind and cause an unsuccessful attempt to resist. To their specific themes relate:

• fear of contamination or pollution;
• fear of harming oneself or others;
• sexually explicit or violent thoughts and images;
• religious or moral ideas;
• fear of losing or not having some things that you may need;
• order and symmetry: the idea that everything should be arranged “right”;
• superstition, excessive attention to something that is considered to be luck or bad luck.

Compulsive actions or rituals are stereotyped actions that are repeated over and over again, the meaning of which is to prevent any objectively unlikely events. Obsessions and compulsions are more often experienced as alien, absurd and irrational. The patient suffers from them and resists them.

The following symptoms are indicative of obsessive-compulsive disorder:

• obsessive, repetitive thoughts;
• anxiety following these thoughts;
• certain and, in order to eliminate anxiety, often repeated identical actions.

A classic example of this disease is the fear of pollution, in which every contact with dirty, in his opinion, objects causes discomfort and, as a result, obsessive thoughts. To get rid of these thoughts, he begins to wash his hands. But even if at some point it seems to him that he has washed his hands enough, any contact with a “dirty” object forces him to start his ritual anew. These rituals allow the patient to achieve temporary relief from the condition. Despite the fact that the patient realizes the meaninglessness of these actions, he is not able to fight them.

Obsessions

People with OCD experience obsessive thoughts (obsessions) that are usually unpleasant. Any insignificant events are capable of provoking obsessions - such as an extraneous cough, contact with an object that is perceived by the patient as non-sterile and non-individual (handrails, door handles etc.), as well as personal concerns not related to cleanliness. Obsessions can be scary or obscene, often alien to the patient's personality. Exacerbations can occur in crowded places, such as on public transport.

Compulsions

To combat obsessions, patients use protective actions (compulsions). Actions are rituals designed to prevent or minimize fear. Actions such as constant hand washing and washing, spitting saliva, repeated prevention of potential danger (endless checking of electrical appliances, closing the door, closing the zipper on the fly), repeating words, counting. For example, in order to make sure that the door is closed, the patient needs to pull the handle a certain number of times (while counting the times). After performing the ritual, the patient experiences temporary relief, passing into the "ideal" post-ritual state. However, after some time, everything is repeated anew.

Etiology

At the moment, the specific etiological factor is unknown. There are several valid hypotheses. There are 3 main groups of etiological factors:

1. Biological:
   1. Diseases and functional and anatomical features of the brain; features of the functioning of the autonomic nervous system.
   2. Disturbances in the exchange of neurotransmitters -5, first of all, serotonin and dopamine, as well as norepinephrine and GABA.
   3. Genetic - increased genetic concordance.
   4. Infectious factor (theory of the PANDAS syndrome).
2. Psychological:
   1. Psychoanalytic theory.
   2. Theory of I.P. Pavlov and his followers.
   3. Constitutional and typological - various accentuations of personality or character.
   4. Exogenous-psychotraumatic - family, sexual or industrial.
3. Sociological (micro- and macro-social) and cognitive theories (strict religious education, modeling of the environment, inadequate response to specific situations).

Psychological theories

Psychoanalytic theory

In 1827, Jean-Etienne Dominique Eskirol described a form of neurosis obsessions- "disease of doubt" (fr. folie de doute). He hesitated between classifying her as a disorder of intelligence and will.

I.M.Balinsky in 1858 noted that all obsessions have common feature- alienation to consciousness, and suggested the term “ obsession". The representative of the French psychiatric school Benedict Augustin Morel in 1860 considered the cause of obsessive states to be a violation of emotions through the disease of the autonomic nervous system, while the representatives of the German, V. Griesinger and his student Karl-Friedrich-Otto Westphal in 1877, pointed out that they emerge when unaffected in other respects, the intellect cannot be expelled from consciousness by it, and they are based on a disorder of thought, like paranoia. It is the term of the latter that is dumb. Zwangsvorstellung, translated into English in UK as English. obsession, and in the USA - English. compulsion gave the modern name of the disease.

XX century

In the last quarter of the 19th century, neurasthenia included a huge list of different diseases, including OCD, which was still not considered a separate disease. In 1905, Pierre Maria Felix Janet singled out this neurosis from neurasthenia as a separate disease and called it psychasthenia in his work fr. Les Obsessions et la Psychasthenie(Obsessions and Psychasthenia). In the same year, data about him were systematized by S. A. Sukhanov. The term "psychasthenia" has become widely used in Russian and French science, while in German and English the term "obsessive-compulsive disorder" was used. In the United States, it began to be called obsessive-compulsive neurosis. The difference is not only in terminology. In Russian psychiatry, obsessive-compulsive disorder is understood not only as obsessive-compulsive disorder, but also phobic anxiety disorders (F40.), Which both in ICD-10 and DSM-IV-TR have different designations. P. Janet and others have considered OCD as a disease caused by innate features of the nervous system. In the early 1910s, Sigmund Freud classified obsessive-compulsive behavior as an unconscious conflict that manifests itself as symptoms. E. Kraepelin put him not to psychogenias, but to "constitutional mental illness" along with manic-depressive psychosis and paranoia. Many scientists attributed it to psychopathies, and K. Kollei and some others - to endogenous psychoses such as schizophrenia, but at the moment it is referred to as neuroses.

Treatment and therapy

Modern therapy of obsessive-compulsive disorders must certainly provide for a complex effect: a combination of psychotherapy with pharmacotherapy.

Psychotherapy

The use of cognitive-behavioral psychotherapy is giving its results. The idea of ​​treating OCD with cognitive behavioral therapy is promoted by the American psychiatrist Jeffrey Schwartz. The technique he developed allows the patient to resist OCD by modifying or simplifying the “rituals” procedure, minimizing it. The basis of the technique is the patient's awareness of the disease and step-by-step resistance to its symptoms.

According to Jeffrey Schwartz's four-step method, it is necessary to explain to the patient which of his fears are justified and which are caused by OCD. It is necessary to draw a line between them and explain to the patient how a healthy person would behave in a given situation (it is better if an example is a person who represents an authority for the patient). As an additional technique, the method of "stopping thought" can be used.

According to some authors, the most effective form of behavioral therapy for OCD is exposure and prevention. Exposure involves placing the patient in a situation that provokes obsessional discomfort. At the same time, the patient is instructed on how to resist performing compulsive rituals - preventing a reaction. According to many researchers, most patients achieve sustained clinical improvement after this form of therapy. Randomized controlled trials have shown that this form of therapy is superior to a number of other interventions, including placebo medications, relaxation and anxiety management training.

Unlike drug therapy, after the abolition of which the symptoms of obsessive-compulsive disorder often worsen, the effect achieved by behavioral psychotherapy lasts for several months or even years. Compulsions tend to respond better to psychotherapy than obsessions. The overall effectiveness of behavioral psychotherapy is approximately comparable to drug therapy and is 50-60%, but many patients refuse to participate in it because of fear of increased anxiety.

Group, rational, psychoeducational (teaching the patient to be distracted by other stimuli that alleviate anxiety), aversive (using painful stimuli when obsessions appear), family and some other methods of psychotherapy are also used.

In the presence of severe anxiety in the first days of pharmacotherapy, it is advisable to prescribe benzodiazepine tranquilizers (clonazepam, alprazolam, gidazepam, diazepam, phenazepam). In chronic forms of OCD that cannot be treated with antidepressants of the serotonin reuptake inhibitor group (about 40% of patients), atypical antipsychotics (risperidone, quetiapine) are increasingly used.

According to numerous studies, the use of benzodiazepines and antipsychotics has a mainly symptomatic (anxiolytic) effect, but does not affect nuclear obsessive symptoms. Moreover, extrapyramidal side effects classic (typical) antipsychotics can lead to increased obsession.

There is also evidence that some of the atypical antipsychotics (with antiserotonergic effects - clozapine, olanzapine, risperidone) can cause and increase obsessive-compulsive symptoms. There is a direct relationship between the severity of such symptoms and the doses / duration of use of these drugs.

To enhance the effect of antidepressants, you can also use normotimics (lithium preparations, valproic acid, topiramate), L-tryptophan, clonazepam, buspirone, trazodone, gonadotropin-releasing hormone, riluzole, memantine, cyproterone, N-acetylcysteine.

Biological therapy

It is only used for severe OCD refractory to other types of treatment. In the USSR, atropinocomatous therapy was used in such cases.

In the West, electroconvulsive therapy is used in these cases. However, in the CIS countries, the indications for it are much narrower, and with this neurosis it does not apply.

Physiotherapy

According to data for 1905, for the treatment of obsessive-compulsive disorder in pre-revolutionary Russia, they used:

1. Warm baths (35 ° C) lasting 15-20 minutes with a cool compress on the head in a well-ventilated room 2-3 times a week with a gradual decrease in water temperature in the form of rubdowns and douches.
2. Rubbing and dousing with water from 31 ° C to 23-25 ​​° C.
3. Swimming in river or sea water.

Prophylaxis

1. Primary psychoprophylaxis:
   1. Prevention of traumatic influences at work and at home.
   2. Prevention of iatrogeny and didactogeny (correct upbringing of a child, for example, do not instill in him opinions about his inferiority or superiority, do not generate a feeling of deep fear of Ivy when committing "dirty" acts, healthy relationships between parents).
   3. Preventing family conflicts.
2. Secondary psychoprophylaxis (relapse prevention):
   1. Changing the attitude of patients to psycho-traumatic situations through conversations (treatment by persuasion), self-hypnosis and suggestion; timely treatment if detected. Conducting regular medical examinations.
   2. Contributing to an increase in brightness in a room - remove blackout curtains, use bright lighting, make the most of daylight hours, phototherapy. Light promotes the production of serotonin.
   3. General tonic and vitamin therapy, adequate sleep.
   4. Diet therapy (good nutrition, refusal from coffee and alcoholic beverages, include in the menu foods with a high content of tryptophan (the amino acid from which serotonin is formed): dates, bananas, plums, figs, tomatoes, milk, soy, dark chocolate).
   5. Timely and adequate treatment of other diseases: endocrine, cardiovascular, especially cerebral atherosclerosis, malignant neoplasms, iron and vitamin B12-deficiency anemia.
   6. It is imperative to avoid the occurrence of drunkenness and especially alcoholism, drug addiction and substance abuse. The use of alcoholic beverages irregularly in small quantities has a sedative effect, therefore it cannot provoke a relapse. The effect of using "soft drugs" such as marijuana on OCD relapse has not been studied, so they are best avoided as well.
3. All of the above referred to individual psychoprophylaxis. But it is necessary at the level of institutions and the state as a whole to carry out social psychoprophylaxis - healthier work and living conditions, service in the armed forces.

Forecast

Chronization is most common in OCD. Episodic manifestation of the disease and complete recovery are relatively rare (acute cases may not recur). In many patients, especially with the development and preservation of one type of manifestation (arithmania, ritual hand washing), a long-term stable state is possible. In such cases, there is a gradual mitigation of psychopathological symptoms and social readaptation.

In mild forms, the disease usually occurs on an outpatient basis. The reverse development of manifestations occurs in 1-5 years from the moment of detection. Mild symptoms may remain that do not significantly disrupt vital functions, except during periods of increased stress or situations in which an Axis I comorbid disorder develops (see DSM-IV-TR), such as depression.

Heavier and more complex OCD with contrasting representations, numerous rituals, complication of phobias of infection, pollution, sharp objects, and, obviously, obsessions associated with these phobias, or drives, on the contrary, can become resistant to treatment, or show a tendency to relapse (50 -60% in the first 3 years) with disorders that persist despite active therapy. Further deterioration of these conditions indicates a gradual aggravation of the disease as a whole. Obsessions in this case may tend to expand. Common reason their strengthening - either the resumption of the traumatic situation, or the weakening of the body, overwork and prolonged lack of sleep.

Attempts are being made to establish which patients require long-term therapy. In about two-thirds of cases, OCD improvement occurs within 6 months to 1 year, more often by the end of this period. In 60-80%, the condition not only improves, but practically recovers. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of remission, lasting from several months to several years. The prognosis is worse if we are talking about an anankast personality with severe symptoms of the disease, or if there is continuous stress in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized OCD patients found that three quarters of these patients remained symptomatic after 13–20 years. Therefore, successful drug treatment must be continued for 1-2 years before considering withdrawal and discontinuation of pharmacotherapy should be carefully considered, most patients are advised to continue treatment in some form. There is evidence that CBT may have a longer lasting effect than some SSRIs after treatment is discontinued. It has also been proven that people whose improvement is based only on drug therapy tend to relapse after drug withdrawal.

Left untreated, OCD symptoms can progress to the point where it affects the patient's life and interferes with his ability to work and maintain important relationships. Many people with OCD develop suicidal thoughts and about 1% do. Specific symptoms OCD rarely progresses to physical impairment. However, symptoms such as compulsive hand washing can lead to dryness and even damage to the skin, and repeated trichotillomania can lead to crusting on the patient's head.

However, in general, OCD, in comparison with endogenous mental illness, like all neuroses, has a favorable course. Although the treatment of the same neurosis in different people can vary greatly depending on the social, cultural and intellectual level of the patient, his gender and age. So, the most successful results are in patients aged 30-40 years, women and married.

In children and adolescents, OCD, on the contrary, is more stable than other emotional disorders and neuroses, and without treatment, after 2-5 years, a very small number of them fully recover.

Between 30% and 50% of children with obsessive-compulsive disorder continue to show symptoms between 2 and 14 years after diagnosis. Although the majority, together with those who underwent drug treatment (for example, SSRIs), have a slight remission, however, it completely reaches less than 10%. The causes of the adverse effects of this disease are: a poor primary response to therapy, a history of tic disorders and psychopathy in one of the parents. Thus, obsessive-compulsive disorder is a serious and chronic illness for a significant number of children.

In some cases, a condition bordering between neurosis and anankastic personality disorder is possible, which is favored by: personality accentuation according to the psychasthenic type, personality infantilism, somatic illness, long-term psychotrauma, age over 30 years or long-term OCD, which develops in 2 stages:

1. Depressive neurosis (ICD-9: 300.4 / ICD-10: F0, F33.0, F34.1, F43.21).
2. Obsessive borderline state (according to O. V. Kerbikov) with a predominance of obsessions, phobias and asthenia.

Characteristics of cognitive (cognitive) function

A 2009 study that used a set of neuropsychological assignments to assess 9 cognitive domains with a specific center of executive function concluded that there was little neuropsychological difference between people with OCD and healthy participants when co-factors were controlled.

Labor examination

Neuroses are usually not accompanied by temporary disability. With prolonged neurotic states, the Medical Control Commission (VKK) decides on changing working conditions and transferring to an easier job. In severe cases, the VKK sends the patient to a medical-labor expert commission (VTEK), which can determine the III group of disability and give recommendations regarding the type of work and working conditions (light duty, shortened working day, work in a small team).

Foreign legislation

While research suggests that OCD sufferers tend to have a striking predisposition to keep themselves and those around them safe, some laws have general mental illness laws that can inadvertently impact the civil rights and freedoms of OCD sufferers.

Statistical data

At the moment, the information on the study of the epidemiology of OCD is very controversial. This is due to different methodological approaches to its calculation, which have developed historically in connection with different diagnostic criteria, as well as insufficient study of the disorder, dissimulation and overdiagnosis.

Quite often, the prevalence of OCD is indicated in the range of 1-3%. According to other updated data, its prevalence is about 1-3: 100 in adults and 1: 200-500 in children and adolescents, although clinically recognized cases are less common (0.05-1%), since many of them may not have this disorder diagnosed due to stigmatization.

The onset of the disease. First medical consultation. Duration. OCD severity

Obsessive-compulsive disorder most often begins between the ages of 10 and 30. Moreover, the first visit to a psychiatrist usually occurs only between 25 and 35 years old. It can take up to 7.5 years between the onset of the disease and the first consultation. Average age hospitalization - 31.6 years.

The spread of OCD increases in proportion to the observation period. For a period of 12 months, it is equal to 84: 100000, for 18 months - 109: 100000, 134: 100000 and 160: 100000 for 24 and 36 months, respectively. This rise is higher than expected for a chronic illness with essential medical care in a stable population. During the 38 months available for the study, in 43% of patients, the diagnosis made during the study was not entered in the official medical record of the outpatient. 19% did not visit a psychiatrist at all. However, 43% of patients visited a psychiatrist at least once during 1998-2000. The average frequency of visits to a psychiatrist per 967 patients is 6 times in 3 years. Based on these data, it can be concluded that patients with obsessive-compulsive disorder are not supervised enough.

At the first medical examination, only one out of 13 new cases in children and adolescents and one among 23 adults showed the degree of OCD on the Yale-Brown scale in the English study. CNCG study was heavy. If you do not take into account 31% of cases with dubious criteria, the number of such cases increases to 1: 9 for persons under 18 and 1:15 after. The proportion of mild, moderate, and severe severity was the same among newly diagnosed cases of OCD as well as among previously identified cases. It was 2: 1: 3 = mild: medium: severe.

OCD and social conditions, including family life. Gender studies

OCD occurs in individuals at all socioeconomic levels. Studies on the distribution of patients by class are inconsistent. According to one of them, 1.5% of patients belong to the upper social class, 23.81% to the upper middle class and 53.97% to the middle class. According to another, among the patients from Santiago, the lower class was more prone to disease. These studies are essential for public health, as lower class patients may not always get the care they need. The prevalence of OCD is also related to educational attainment. The incidence of the disease is lower in those who graduated from higher education (1.9%) than in those who do not have higher education(3.4%). However, among those who graduated from higher education, the frequency is higher among those who graduated with an advanced degree (respectively 3.1%: 2.4%). Most of the patients who come to the consultation cannot study or work, and if they can, they do it at a very low level. Only 26% of patients can work fully.

Up to 48% of OCD patients are single. If the degree of the disease is severe before marriage, the chance of marriage is reduced, and if it is concluded, in half of the cases, problems arise in the family.

There are certain gender differences in the epidemiology of OCD. At the age of up to 65 years, the disease was more often diagnosed in men (except for the period of 25-34 years), and after - in women. The maximum difference with the preponderance of sick men was observed in the period of 11-17 years. After 65, the incidence of obsessive-compulsive disorder fell in both groups. 68% of those hospitalized are women.

OCD and intelligence

People with OCD are most often people with a high level of intelligence. According to various sources, among patients with OCD, the frequency of high IQ is from 12% to 28.53%. At the same time, high levels of verbal IQ.

OCD and psychogenetics. Comorbidity

The twin method shows high concordance among monozygotic twins. According to studies, 18% of parents of patients with obsessive-compulsive disorder have mental disorders: 7.5% - OCD, 5.5% - alcoholism, 3% - anankastic personality disorder, psychoses and affective disorders - 2%. Among non-mental illnesses, relatives of patients with this disease often suffer from tuberculous meningitis, migraine headaches, epilepsy, atherosclerosis, and myxedema. It is not known if these conditions are related to the onset of OCD in the family members of these patients. However, there are no completely accurate studies of the genetics of non-mental illness among patients with obsessive-compulsive disorder. 31 of 40 patients were the first or only child. However, no correlation has been found between malformations and future development of OCD. The fertility rate in patients with this disease is 0-3 for both sexes. The number of premature babies in such patients is small.

25% of patients with OCD did not have comorbid conditions. 37% suffered from one more mental disorder, 38% - two or more. The most frequently diagnosed conditions were major depressive disorder (MDD), anxiety disorder (including anxiety neurosis), panic disorder, and acute stress reactions. 6% were diagnosed with bipolar disorder. The only difference in sex ratio was that 5% of women were diagnosed with an eating disorder. Among children and adolescents, 25% of patients with obsessive-compulsive disorder did not have other mental disorders, 23% had 1, and 52% had 2 or more. The most common were MDD and ADHD. At the same time, as among healthy individuals under 18 years of age, boys were more likely to have ADHD (in this particular case, 2 times). 1 in 6 was diagnosed with oppositional defiant disorder and excessive anxiety disorder (F93.8). 1 in 9 girls had an eating disorder. Boys often had Tourette's syndrome.

OCD in cinematography and animation

• In Martin Scorsese's film "The Aviator" the main character(Howard Hughes, played by Leonardo DiCaprio) suffered from OCD.
• In the movie "It Can't Be Better", the main character (Melvin Adell, played by Jack Nicholson) suffered from a whole complex of OCD. He constantly washed his hands, and in boiling water and every time with new soap, wore gloves, ate only with his cutlery, was afraid to step on a crack in the asphalt, avoided the touch of strangers, had his own ritual of turning on the light and closing the lock.
• In The Clinic, Dr. Kevin Casey, played by Michael J. Fox, suffers from ritualistic OCD.
• In Orson Scott Card's novel Xenocide, an artificially bred species of people who speak to the gods suffer from OCD, and their compulsive gestures are considered a rite of purification.
• In the movie "Dirty Love", the symptoms of OCD and Tourette's syndrome are shown quite realistically, due to which the main character Mark, played by Michael Sheen, loses his home, wife and job.
• In Girls, the main character Hannah Horvat suffers from OCD, which is expressed in a constant count of up to eight.
• The title character of Monk suffers from OCD.
• In the movie Inner Road, one of the main characters suffers from OCD.
• In The Big Bang Theory, protagonist Sheldon Lee Cooper (played by Jim Parsons) torments his friends with the rules and conditions of being around him because of OCD.
• In Glee, school psychologist Emma Pillsbury is obsessed with cleanliness due to OCD.
• In Scorpio, one of the characters, Sylvester Dodd, suffers from OCD.

Facts

• In 2000, a group of chemists (Donatella Marazziti, Alessandra Rossi and Giovanni Battista Cassano of the University of Pisa and Hagop Suren Akiscal of the University of California, San Diego) received the Nobel Prize in Chemistry for the discovery that romantic love cannot be distinguished at the biochemistry level. from severe obsessive-compulsive disorder.

Literature

• Freud Z. Beyond the Pleasure Principle (1920)
• Lacan J. L'Homme aux rats. Séminaire 1952-1953
• Melman C. La névrose obsessionelle. Séminaire 1988-1989. Paris: A.L.I., 1999.
• V.L. Gavenko, V.S.Bitensky, V.A.Abramov. Psychiatry and narcology (handler). - Kiev: Health, 2009. - P. 512. - ISBN 978-966-463-022-8. (Ukrainian)
• A. M. Svyadosch. Obsessive-compulsive neurosis (obsessive-compulsive and phobic neurosis). // Neuroses (a guide for doctors). - 4th, revised and expanded. - St. Petersburg: Peter (publishing house), 1997 .-- S. 69-95. - 448 p. - ("Practical Medicine"). - 7000 copies. - ISBN 5-88782-156-6.

What is obsessive-compulsive disorder? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article by Dr. Bachilo E.V., a psychiatrist with 9 years of experience.

Definition of disease. Causes of the disease

Obsessive Compulsive Disorder (OCD)- a mental disorder characterized by the presence of obsessive thoughts (obsessions) and obsessive actions (compulsions) in the clinical picture.

The data on the prevalence of OCD are very inconsistent. According to some reports, the prevalence varies between 1-3%. There are no exact data on the causes of obsessive-compulsive disorder. At the same time, there are several groups of hypotheses of etiological factors.

Obsessive Compulsive Disorder Symptoms

As noted above, the main symptoms of the disease are manifested in the form of obsessive thoughts and compulsive actions. These obsessions are perceived by patients as something psychologically incomprehensible, alien, irrational.

Obsessive thoughts- these are painful ideas, images or drives that arise independently of the will. They constantly come to mind in a stereotyped form to a person, and he tries to resist them. Periodic obsessions are unfinished, endlessly considered alternatives that involve an inability to make any of the usual decisions needed in Everyday life.

Compulsive actions are stereotypical, repetitive actions that sometimes take on the character of rituals performing protective function and relieve excessive anxiety stress. A significant proportion of compulsions are associated with cleaning up contamination (in a number of cases, compulsive hand washing), as well as repeated checks in order to ensure that a potentially dangerous situation does not arise. Note that this behavior is usually based on the fear of danger, which is "expected" by the person himself or which he may cause to another.

To the most common manifestations of OCD include:

1. misophobia (when there is an obsessive fear of pollution with the ensuing consequences and human behavior);
2. “Gathering” (in the case when people are afraid to throw something away, experiencing anxiety and fear that this may be needed in the future);
3. obsessive thoughts of a religious nature;
4. obsessive doubts (when a person constantly has doubts about whether he turned off the iron, gas, light, whether the water taps are closed);
5. obsessive counting or anything related to numbers (adding numbers, repeating numbers a certain number of times, etc.);
6. obsessive thoughts in relation to "symmetry" (can manifest itself in clothing, the arrangement of interior items, etc.).

Note that the manifestations described above are permanent and painful for this person character.

Pathogenesis of obsessive-compulsive disorder

As noted above, there are different approaches to explaining obsessive-compulsive disorder. Today, the most widespread and recognized neurotransmitter theory. The essence of this theory is that there is a connection between obsessive-compulsive disorder and impaired communication between certain areas of the cerebral cortex and the basal ganglia.

The designated structures interact through serotonin. So, scientists believe that in OCD, there is an insufficient level of serotonin due to increased reuptake (by neurons), which prevents the transmission of an impulse to the next neuron. In general, it must be said that the pathogenesis of this disorder is quite complex and not fully understood.

Classification and stages of development of obsessive-compulsive disorder

Obsessive thoughts (obsessions) can be expressed in different ways: arrhythmomania, obsessive reproduction, onomatomania.

• "Mental gum" expressed in the irresistible desire of patients to pose and think about questions that have no solution.
• Arrhythmania or, in other words, compulsive counting, is expressed in the counting of objects that, as a rule, fall into the field of vision of a person.
• Obsessive reproductions are manifested in the fact that the patient develops a painful need to remember something, which, in general, has no personal meaning at the moment.
• Onomatomia- obsessive desire to memorize names, terms, titles and any other words.

As part of obsessive-compulsive disorders, there may be different options compulsions. They can be in the form of simple symbolic actions. The latter is expressed in the fact that patients form certain "prohibitions" (taboos) on the performance of any actions. For example, the patient counts the steps in order to find out if he will fail or succeed. Or the patient should only walk on the right side of the street and only open the door with his right hand. Another option may be stereotypical acts of self-harm: pulling hair on your own body, pulling hair and eating it, plucking your own eyelashes for painful reasons. However, it should be noted that in a number of cases (as, for example, in the latter), a clear and deep differential diagnosis with other mental disorders, which is carried out by a doctor, is necessary. There may also be obsessive drives that arise sporadically, are not motivated in any way and frighten patients and which are usually not realized, since they are actively opposed by a person. Obsessive drives arise suddenly, unexpectedly, in situations where adequate impulses can arise.

Complications of obsessive-compulsive disorder

Complications of the course of obsessive-compulsive disorder are associated with the addition of other mental disorders. For example, with long-term obsessions that cannot be corrected, depressive disorders, anxiety disorders, and suicidal thoughts can occur. This is because the person cannot get rid of OCD. Also, there are frequent cases of abuse of tranquilizers, alcohol, other psychoactive substances, which, of course, will aggravate the course. One cannot but mention the low quality of life of patients with severe obsessions. They interfere with normal social functioning, reduce working capacity, and disrupt communication functions.

Diagnosing obsessive-compulsive disorder

The diagnosis of OCD is based today on the International Classification of Diseases 10 revision (ICD-10). Below we will consider what signs are characteristic and necessary for the diagnosis of obsessive-compulsive disorder.

In ICD-10, there are the following diagnoses denoting the disorder we are considering:

1. OCD. Mostly obsessive thoughts or reflections;
2. OCD. Predominantly compulsive actions;
3. OCD. Mixed obsessive thoughts and actions;
4. Other obsessive-compulsive disorders;
5. Unspecified obsessive-compulsive disorder.

The general diagnostic criteria for making a diagnosis are:

• the presence of obsessive thoughts and / or actions;
• they should be observed most of the days for a period of at least two weeks;
• obsessions / compulsions should be a source of distress for a person;
• the thought of implementing an action should be unpleasant for a person;
• thoughts, ideas and motives should be unpleasantly repetitive;
• compulsive actions should not necessarily correspond to specific thoughts or fears, but should be aimed at ridding a person of spontaneously arising feelings of tension, anxiety and / or internal discomfort.

So, the diagnosis "OCD. Predominantly obsessive thoughts or reflections "is exhibited in the case of the presence of only designated thoughts; thoughts should take the form of ideas, mental images or impulses for action, almost always unpleasant for a particular subject.

Diagnosis “OCD. Predominantly compulsive actions "is exhibited in the case of a predominance of compulsions; Behavior is based on fear, and compulsive action (in fact, a ritual) is a symbolic and fruitless attempt to prevent danger, while it can take a lot of time, several hours a day.

The mixed form is exhibited when obsessions and compulsions are expressed in the same way.

The diagnoses discussed above are made on the basis of an in-depth clinical interview, examination of the patient and collection of anamnesis. Note that scientifically proven laboratory studies aimed exclusively at detecting OCD do not exist in routine practice today. One of the valid psychodiagnostic tools for identifying obsessive compulsions is the Yale-Brown scale. This is a professional tool that is used by specialists to determine the severity of symptoms, regardless of the form of obsessive thoughts or actions.

Treatment for obsessive-compulsive disorder

In terms of the treatment of obsessive-compulsive disorders, we will proceed from the principles of evidence-based medicine. Treatment based on these principles is the most proven, effective and safe. In general, the therapy of the disorders in question is carried out with antidepressant drugs. If the diagnosis is made for the first time, it is most advisable to use antidepressant monotherapy. If this option turns out to be ineffective, you can resort to drugs from other groups. In any case, therapy should be carried out under close medical supervision. Usually, treatment is carried out on an outpatient basis, in complicated cases - in a hospital.

We also note that psychotherapy is one of the methods of therapy. Currently, cognitive-behavioral therapy and its various directions have proven effectiveness. To date, it has been proven that cognitive psychotherapy is comparable in effectiveness to drugs and is superior to placebo for mild obsessive-compulsive disorder. It has also been noted that psychotherapy can be used to enhance the effect of drug therapy, especially in cases of difficult-to-treat disorders. In the treatment of OCD, both individual forms of work and group work, as well as family psychotherapy, are used. It should be said that the therapy of the disorder in question should be carried out for a long time, for at least 1 year. Despite the fact that the improvement occurs much earlier (within 8-12 weeks and earlier), it is absolutely impossible to stop therapy.

Therapy for OCD in children and adolescents generally follows adult therapy algorithms. Non-drug methods are mainly based on psychosocial interventions, the use of family psychoeducation and psychotherapy. Cognitive behavioral therapy is used, including exposure and reaction prevention, which is considered the most effective methods... The latter consists in the purposeful and consistent contact of a person with OCD with the stimuli avoided by him and deliberately slowing down the onset of pathological reactions.

Forecast. Prophylaxis

As mentioned above, the most characteristic of obsessive-compulsive disorder is the chronicity of the process. It is worth noting that a number of people with this disorder may have a long-term stable state, this is especially typical for patients with any one type of manifestation of obsessions (for example, arithmania). In this case, symptoms are alleviated, as well as good social adaptation.

Mild symptoms of OCD usually occur on an outpatient basis. In most cases, improvement occurs around the end of the first year. Severe cases of obsessive-compulsive disorders, which have in their structure numerous obsessions, rituals, complications of phobias, can be quite persistent, resistant to therapy, and tendencies to recurrence can also be found. This can be facilitated by the repetition or the emergence of new traumatic situations, overwork, general weakening of the body, insufficient sleep, mental overload.

There is no specific prevention of OCD because the exact cause of OCD has not been established. Therefore, the recommendations for prevention are rather general. OCD prevention is divided into primary and secondary prevention.

TO primary prevention measures to prevent the development of OCD symptoms. To do this, it is recommended to profile traumatic situations in family conditions and at work, to pay Special attention raising a child.

Secondary prevention is aimed at preventing the recurrence of symptoms of obsessive-compulsive disorder. For this, a number of methods are used:

It should be especially noted as a preventive measure, periodic consultations and / or examination by a doctor. This can be a preventive examination, which children with adolescence are held annually to control their mental state. It is also a periodic consultation with a doctor for people who have previously suffered from obsessive-compulsive disorder. The doctor will help to timely identify deviations, if any, and prescribe therapy, which will help to more effectively cope with the disorder and profile its appearance later.

Bibliography

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Obsessive-compulsive syndrome, obsessive-compulsive disorder (OCD) is a psychoneurotic disorder manifested by the patient's obsessive thoughts and actions. The concept of "obsession" is translated from Latin as a siege or blockade, and "compulsion" is coercion. Healthy people have no problem dismissing unpleasant or frightening thoughts, images, or impulses. People with OCD cannot do this. They constantly ponder such thoughts and get rid of them only after performing certain actions. Gradually, obsessive thoughts begin to conflict with the patient's subconscious. They become a source of depression and anxiety, and rituals and repetitive movements cease to have the expected effect.

In the very name of pathology lies the answer to the question: what is OCD? Obsession is the medical term for obsessive ideas, disturbing or frightening thoughts, while compulsion is a coercive action or ritual. Perhaps the development of local disorders - only obsessive with a predominance of emotional experiences, or only compulsive, manifested by restless actions. The disease is a reversible neurotic process: after psychotherapeutic and drug treatment, its symptoms completely disappear.

Obsessive-compulsive disorder occurs at all socioeconomic levels. Under the age of 65, men are predominantly ill. At a more advanced age, the disease is diagnosed in women. The first signs of pathology appear in patients by the age of ten. Various phobias and obsessive states arise that do not require immediate treatment and are adequately perceived by a person. In thirty-year-old patients, a pronounced clinic of the syndrome develops. At the same time, they stop perceiving their fears. They need qualified medical care in a hospital setting.

People with OCD are tormented by the thought of countless bacteria and wash their hands a hundred times a day. They are not sure if the iron is turned off, and they return home from the street several times to check it. Patients are confident that they are capable of harming loved ones. To prevent this from happening, they hide dangerous objects and avoid casual communication. Patients will check several times to see if he forgot to put all the necessary things in his pocket or bag. Most of them carefully keep order in the room. When things are out of place, emotional stress arises. Such processes lead to a decrease in working capacity and poor perception of new information. The personal life of such patients usually does not work out: they either do not create families, or their families quickly disintegrate.

Painful obsessive thoughts and similar actions lead to depression, reduce the quality of life of patients and require special treatment.

Etiology and pathogenesis

The causes of obsessive-compulsive disorder are currently not fully understood. There are several hypotheses regarding the origin of this disease.

The provoking factors include biological, psychological and social.

Biological factors in the development of the syndrome:

• acute infectious diseases - meningitis, encephalitis,
• autoimmune diseases - group A hemolytic streptococcus causes inflammation of the basal ganglia,
• hereditary predisposition,
• alcohol and drug addiction,
• neurological diseases,
• metabolic disorders of neurotransmitters - serotonin, dopamine, norepinephrine.

Psychological or social factors of pathology:

1. special religious beliefs,
2. tensions in the family and at work,
3. excessive parental control in all areas of a child's life,
4. severe stress, psycho-emotional outburst, shock,
5. long-term use of psychostimulants,
6. experienced fear due to the loss of a loved one,
7. avoidant behavior and misinterpretation of their thoughts,
8. psychological trauma or depression after childbirth.

Panic and fear can be imposed by society. When the news reports of a robber attack on the street, it raises anxiety, which can be dealt with by special actions - constant looking around the street. These compulsions help patients only at the initial stage of mental disorders. In the absence of psychotherapeutic treatment, the syndrome suppresses the human psyche and turns into paranoia.

Pathogenetic links of the syndrome:

• the emergence of thoughts that frighten and torment the sick,
• concentration on this thought contrary to desire,
• mental stress and increasing anxiety,
• performing stereotyped actions that bring only short-term relief,
• return of obsessive thoughts.

These are the stages of one cyclical process leading to the development of neurosis. Patients become addicted to ritual activities that have a narcotic effect on them. The more patients think about the current situation, the more they become convinced of their inferiority. This leads to an increase in anxiety and a worsening of the general condition.

Obsessive-compulsive syndrome can be inherited through a generation. This disease is considered moderately hereditary. In this case, the gene that causes this condition has not been identified. In some cases, it is not the neurosis itself that is inherited, but a genetic predisposition to it. Clinical signs of pathology arise under the influence of negative conditions. Correct parenting and a supportive family atmosphere will help to avoid the development of the disease.

Symptoms

Clinical signs of pathology in adults:

1. Thoughts of sexual perversion, death, violence, haunting memories, fear of harming someone, getting sick or getting infected, anxiety about material loss, blasphemy and sacrilege, fixation on cleanliness, pedantry. In relation to moral and ethical principles, unbearable and irresistible drives are contradictory and unacceptable. Patients are aware of this, often resist and are very worried. A sense of fear gradually arises.
2. Anxiety following obsessive, repetitive thoughts. Such thoughts cause panic and horror in the patient. He realizes the groundlessness of his ideas, but is unable to control superstition or fear.
3. Stereotypical actions - counting steps on the stairs, frequent hand washing, “correct” arrangement of books, rechecking of switched off electrical appliances or closed taps, symmetrical order of objects on the table, repetition of words, counting. These actions are a ritual that supposedly gets rid of obsessive thoughts. For some patients, reading a prayer, clicking joints, biting lips helps to relieve stress. Compulsions are a complex and intricate system, when destroyed, the patient carries it out again. The ritual is slow. The patient seems to be wasting time, fearing that this system will not help, and internal fears will intensify.
4. Panic attacks and nervousness in the crowd are associated with the risk of contact with the "dirty" clothes of the people around, the presence of "strange" smells and sounds, "sidelong" glances, the possibility of losing your belongings. Patients avoid crowded places.
5. Obsessive-compulsive syndrome is accompanied by apathy, depression, tics, dermatitis or alopecia of unknown origin, excessive concern about one's own appearance... In the absence of treatment, patients develop alcoholism, isolation, rapid fatigue, thoughts of suicide, mood swings, quality of life decreases, conflicts increase, disorders of the gastrointestinal tract, irritability, concentration of attention decreases, hypnotics and sedatives are abused.

In children, signs of pathology are less pronounced and occur somewhat less frequently. Sick children are afraid of getting lost in the crowd and constantly hold the adults by the hand, clasping their fingers tightly. They often ask their parents if they are loved because they are afraid to end up in a shelter. Having lost a notebook once at school, they experience severe stress, forcing them to recount school supplies in their portfolio several times a day. The dismissive attitude of classmates leads to the formation of complexes in the child and skipping lessons. Sick children are usually gloomy, unsociable, suffer from frequent nightmares and complain of poor appetite. The child psychologist will help to suspend further development syndrome and rid the child of it.

OCD in pregnant women has its own characteristics. It develops in the last trimester of pregnancy or 2-3 months after childbirth. The obsessive thoughts of the mother are the fear of harming her baby: it seems to her that she is dropping the baby; she is visited by thoughts of sexual attraction to him; she has difficulty making decisions about vaccinations and feeding choices. To get rid of obsessive and frightening thoughts, a woman hides objects with which she can harm the child; constantly washes bottles and washes diapers; guards the baby's sleep, fearing that he will stop breathing; examines him for certain symptoms of the disease. Relatives of women with similar symptoms should talk her into seeing a doctor for treatment.

Video: an analysis of the manifestations of OCD using the example of Sheldon Cooper

Diagnostic measures

The diagnosis and treatment of the syndrome is carried out by specialists in the field of psychiatry. Specific signs of pathology are obsessions - obsessive thoughts with persistent, regular and annoying repetitions. They cause anxiety, anxiety, fear and suffering in the patient, are practically not suppressed or ignored by other thoughts, are psychologically incompatible and irrational.

For physicians, compulsions are important, which cause overwork and suffering in patients. Patients understand that compulsions are not interconnected and excessive. For specialists, it is important that the manifestations of the syndrome last more than an hour a day, complicate the life of patients in society, interfere with work and study, and disrupt their physical and social activity.

Many people with the syndrome often do not understand or perceive their problem. Psychiatrists advise patients to undergo a complete diagnosis and then begin treatment. This is especially true when obsessive thoughts get in the way of life. After a psychodiagnostic conversation and differentiation of pathology from similar mental disorders, specialists prescribe a course of treatment.

Treatment

Treatment of obsessive-compulsive syndrome should be started as soon as symptoms appear. Complex therapy is carried out, which consists in psychiatric and medication.

Psychotherapy

Psychotherapeutic sessions for obsessive-compulsive syndrome are considered more effective than drug treatment. Psychotherapy gradually cures neurosis.

The following methods help to get rid of such ailment:

• Cognitive Behavioral Therapy is a resistance to a syndrome in which compulsions are minimized or eliminated altogether. During treatment, patients become aware of their disorder, which helps them to get rid of it forever.
• "Stop thought" is a psychotherapeutic technique, which consists in stopping memories of the most vivid situations, manifested by an obsessive state. Patients are asked a series of questions. To answer them, patients must view the situation from all angles, as in slow motion. This technique makes it easier to face and control fears.
• Exposure and warning method - conditions are created for the patient that provoke discomfort and cause obsessions. Before this, the patient is counseled on how to resist compulsive rituals. This form of therapy achieves sustained clinical improvement.

The effect of psychotherapy lasts much longer than medication. Patients are shown correction of behavior under stress, training in various relaxation techniques, healthy image life, proper nutrition, fight against tobacco smoking and alcoholism, hardening, water procedures, breathing exercises.

Currently, group, rational, psychoeducational, aversive, family and some other types of psychotherapy are used to treat the disease. Non-drug therapy is preferable to drug therapy, since the syndrome lends itself well to correction without drugs. Psychotherapy has no side effects on the body and has a more persistent healing effect.

Drug treatment

Treatment of a mild form of the syndrome is carried out on an outpatient basis. Patients are given a course of psychotherapy. Doctors find out the causes of the pathology and try to establish trusting relationships with patients. Complicated forms are treated with medications and psychological correction sessions.

Patients are prescribed the following groups of drugs:

1. antidepressants - "Amitriptyline", "Doxepin", "Amisol",
2. antipsychotics - "Aminazin", "Sonapax",
3. normotimic drugs - "Cyclodol", "Depakin Chrono",
4. tranquilizers - "Phenozepam", "Clonazepam".

It is impossible to cope with the syndrome on your own without the help of a specialist. Any attempts to control your mind and defeat the disease lead to a worsening of the condition. In this case, the patient's psyche is destroyed even more.

Obsessive-compulsive disorder is not a mental illness because it does not lead to personality change and disorder. It is a neurotic disorder that is reversible with proper treatment. Mild forms of the syndrome respond well to therapy, and after 6-12 months its main symptoms disappear. Residual phenomena of pathology are expressed in a mild form and do not interfere with the normal life of patients. Severe cases of the disease are treated for an average of 5 years. Approximately 70% of patients notice an improvement in their condition and are clinically cured. Since the disease is chronic, relapses and exacerbations occur after drug withdrawal or under the influence of new stresses. Cases of complete cure are very rare, but possible.

Preventive actions

Prevention of the syndrome consists in preventing stress, conflict situations, creating a favorable environment in the family, eliminating mental trauma at work. It is necessary to educate the child correctly, not to generate feelings of fear in him, not to instill in him thoughts of his inferiority.

Secondary psychoprophylaxis is aimed at preventing relapse. It consists in regular medical examination of patients, conversations with them, suggestions, timely therapy of the syndrome. For prophylactic purposes, phototherapy is carried out, since light promotes the production of serotonin; restorative treatment; vitamin therapy. Experts recommend that patients get adequate sleep, diet, rejection of bad habits, timely treatment of concomitant somatic diseases.

Forecast

Obsessive-compulsive syndrome is characterized by chronicity of the process. Complete recovery of pathology is quite rare. Relapses usually occur. In the course of treatment, symptoms gradually disappear, and social adaptation begins.

Without treatment, the symptoms of the syndrome progress, impair the patient's ability to work and the ability to be in society. Some patients commit suicide. But in most cases, OCD has a favorable course.

OCD is essentially a neurosis that does not lead to temporary disability. If necessary, patients are transferred to more easy work... The advanced cases of the syndrome are considered by VTEC specialists, who define the III group of disability. Patients are issued a certificate for facilitated work, excluding night shifts, business trips, irregular work time, direct impact of harmful factors on the body.

Adequate treatment guarantees patients stabilization of symptoms and relief of vivid manifestations of the syndrome. Timely diagnosis of the disease and treatment increase patients' chances of success.

Video: about obsessive-compulsive disorder

The obsessive-compulsive person should be distinguished from the person with OCD, i.e. which one obsessive compulsive disorder(obsessive-compulsive disorder).

Because in the first, somewhat obsessive and ritualistic thinking and behavior may look like an anxious and suspicious trait of character and temperament, and not particularly interfere with himself and those around him, close people.

In the second case, overly obsessive symptoms of OCD, for example, the fear of contracting and frequent hand washing, can significantly interfere with a person, both in personal and social life. Which, also, can negatively affect the immediate environment.

However, it should be remembered that the former can easily become the latter.

Obsessive-compulsive personality

The obsessive-compulsive personality type is characterized by the following features:

• Their keywords are: "Control" and "Should"
• Perfectionism (striving for excellence)
• Consider themselves responsible for themselves and others
• Others are frivolous, irresponsible and incompetent to them.
• Beliefs: “I have to manage the situation”, “I only have to do everything right”, “I know what is better….”, “You have to do it my way”, “People and yourself need to be criticized in order to prevent mistakes” ...
• Catastrophic thoughts that the situation will get out of control
• Control the behavior of others by excessive control, or by disapproval and punishment (up to the use of force and enslavement).
• They tend to regret, disappoint, punish themselves and others.
• Often anxious, may become depressed if they fail

Obsessive-compulsive disorder - symptoms

People with obsessive-compulsive personality disorder (OCD) have the following symptoms:

• Repetitive obsessive thoughts and forced actions that interfere with a normal life
• Repetitive obsessive, ritualistic behavior (or imagination) to relieve anxiety and distress caused by obsessive thoughts
• A person with OCD may or may not be aware of the meaninglessness of their thoughts and behavior.
• Thoughts and rituals take a lot of time and interfere with normal functioning, causing psychological discomfort, including in the immediate environment
• The impossibility of independent, volitional control and opposition to automatic thoughts and ritual behavior

Symptoms that accompany OCD:
Depressive disorder, anxiety and panic disorder, social phobias, eating disorders (anorexia, bulimia) ...

These accompanying symptoms may be similar to OCD, therefore, differential diagnosis is made to distinguish other personality disorders.

Obsessive disorder

Persistent (frequent) obsessive thoughts are ideas, images, beliefs and reflections that cause anxiety and distress, constituting an obsessive personality disorder.

The most common obsessive thoughts are fear of infection, pollution or poisoning, harm to others, doubts about closing the door, turning off household appliances ... and so on.

Compulsive disorder

Obsessive actions, or ritual behavior (ritual can also be mental) is a stereotyped behavior by which a person with compulsive disorder tries to reduce anxiety or distress.

The most common ritual behavior is washing hands and / or objects, counting aloud or silently, and checking the correctness of one's actions ... etc.

Obsessive Compulsive Disorder - Treatment

For the treatment of obsessive-compulsive disorder, drug therapy and psychotherapy are used, in particular, cognitive-behavioral therapy, exposure therapy and psychoanalysis.

Usually, with severe OCD and with little motivation for a person to get rid of it, drug treatment is used in the form of antidepressants and serotonin reuptake inhibitors, non-selective serotonergic drugs, and placebo pills. (the effect is usually short-lived, moreover, pharmacology is not harmless)

For OCD sufferers long time, and usually highly motivated to heal, the best option there will be psychotherapeutic intervention without medications (medications, in some difficult cases, can be used at the beginning of psychotherapy).

However, those wishing to get rid of obsessive-compulsive disorder and the accompanying emotional and psychological problems should be aware that psychotherapeutic intervention is laborious, not quick and expensive.

But those who have the desire, after a month of intensive psychotherapy, will be able to improve their condition to normal. Subsequently, supportive therapy meetings may be needed to avoid relapses and to consolidate the results.