OCD (Diana Aniceto Baptista)

Obsessive Compulsive Disorder as a familial disorder

                 

“Obsessive-compulsive disorder is a familial disorder. Obsessions are more specific to the phenotype than are compulsions. Age at onset of OCD is valuable in characterizing a familial subtype.”

Why did I choose this subject?

This year we’re learning about psychiatry, this subject seems very interesting to me because there are so many things about the brain and the human behaviour that we don’t know about.  

I find very curious to know that there are several mental disorders having genetic link.

What is Obsessive-compulsive disorder (OCD)?

This psychiatric condition was first described 100 years ago.

It is long-term disorder in which a person has uncontrollable, recurrent and obsessive thoughts and compulsive behaviours that he or she needs to repeat over and over. They may experience intrusive thought, images or urges that result in distressing feelings. This disorder affects people of all ages and lifestyles, although the period of highest risk is from childhood to early adulthood.

This cycle of obsessions and compulsions becomes so extreme that it takes a lot of time and prevents the carrying out of important activities for the patient.

People affected by the disorder recognize that their thoughts and behaviours are excessive and unreasonable, and they try to avoid them. The lifetime prevalence of OCD is estimated to be 1–3%.

 Clinical presentation:

The symptoms can influence all aspects of life, such as employment, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that trigger anxiety. Some of the common symptoms include fear of germ growth or contamination and taboo thoughts involving sex and religion. Some of them must have things symmetrical or in a perfect order and they may have aggressive behaviours towards others or self.

            Compulsions are repetitive behaviours that a person with OCD feels the urge to do in response to an obsessive thought. For example, excessive cleaning and washing and the habit of ordering things in a concrete way or repeatedly checking on things as if the door is actually locked.       

           

Unfortunately, a person with an obsessive-compulsive disorder generally can't control his or her thoughts or behaviours, even when those are recognized to be excessive.

Some individuals with OCD also have a tic disorder. Common vocal tics include sniffing, grunting sounds or repetitive throat clearing.

Symptoms may come and go, improve or get worse over time. These patients may try to help themselves by avoiding situations that promote their obsessions, or they may drink alcohol or take drugs to calm themselves

In the article they talk about diagnoses according to DSM-IV criteria, which is the criteria?

1. He or she is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. He or she shows perfectionism that interferes with task completion (e.g., the patient is unable to complete a project because his or her own overly strict standards are not met).
3. He or she is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. He or she is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. He or she is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. He or she is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. He or she adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. He or she shows rigidity and stubbornness.

Genetic linkage:

 “The lifetime prevalence of OCD was significantly higher in case compared with control relatives (11.7% vs 2.7%) (P<.001). Case relatives had higher rates of both obsessions and compulsions; however, this finding is more robust for obsessions. Age at onset of obsessive-compulsive symptoms in the case proband was strongly related to familiality (odds ratio, 0.92; confidence interval, 0.85-0.99) (P=.05); no case of OCD symptoms was detected in the relatives of probands whose age at onset of symptoms was 18 years or older. Probands with tics or obsessive-compulsive personality disorder were not more likely to have relatives with OCD than those without these features.” 

It has been proved that 35% of the first-degree relatives presenting ODC are also affected. In some way, obsessive-compulsive disorder can be considerate a familiar disorder. Age at onset of OCD is valuable in characterizing a familial subtype.

Other suspected obsessive-compulsive disorder causes:

Biological: Some research suggests that OCD may develop due to non-genetically related changes in the body chemical reactions and brain functions.

Environmental: One factor in OCD development may involve experiences and attitudes learned in a family circle what might cause the wrong thought patterns.

Insufficient serotonin: Low levels of the brain chemical messenger may play a role in OCD. These people do not have structural brain defects, but they have insufficient serotonin for an unknown reason.

Emotional trauma: Some researchers affirm that severe emotional disturbance, such as mourning or extreme suffering may contribute to the development of OCD, especially in predisposed individuals.

Infection: Some findings suggest that children and teenagers developed OCD after being infected from a Streptococcal bacteria. Scientists believe that the circulating autoantibodies react with the own brain, promoting, but not directly causing OCD in predisposed children.

Debate Topics:
·      Do you think that should exist more investigation in psychiatry area?
·      Which factor do you think that affects the most OCD?  Genetics, environment, biological…?

You can read more about that here:

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/205690

Diana Aniceto Baptista 

Lleida, 27 Febrero 2017