The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.
Symptoms may include some, all or perhaps none of the following:
Repeated hand-washing
Specific counting systems - i.e. counting in groups of four, arranging objects in groups of three, having objects grouped in odd/even numbered groups, etc.
One serious symptom which stems from this is "counting" your steps, e.g. you must take twelve steps to the car in the morning, etc.
Perfectly aligning objects at complete, absolute right angles, etc. This symptom is shared with OCPD and can be confused with this condition unless it is realised that with OCPD it is not stress-related.
Having to "cancel-out" bad thoughts with a good thought. Examples are:
Imagining harming a child, and having to imagine (for example) a child playing happily to "cancel" it out.
Unwanted sexual thoughts. Two classic examples are fear of being gay or fear of being a pedophile. In both cases, the sufferer will obsess over whether or not they are genuinely aroused by the thoughts.
A fear of contamination; some sufferers may fear the presence of human body secretion such as saliva, sweat, tears or mucus, or excretions such as urine or feces. Some OCD sufferers even fear the soap they're using is contaminatedA need for both sides of the body to feel even. As in, a person with OCD might walk down a sidewalk and step on a crack with the ball of their left foot. They might then feel the need to step on another crack with the ball of their right foot. Also, if one hand gets wet, the sufferer may feel very uncomfortable if the other is not.
There are many other symptoms. It is important to remember that one must be diagnosed by a doctor to officially suffer from OCD in medical terms; furthermore possessing the symptoms above is not an absolute sign of OCD and vice-versa.
Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. People with OCD who obsess about hurting themselves or others are actually less likely to do so than the average person.
Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.
Most OCD sufferers are aware that such thoughts and behavior are not rational, but feel bound to comply with them to fend off fears of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, untreated OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.
In an attempt to further relate the immense distress that those afflicted with this condition must bear, Barlow and Durand (2006) utilize an odd example. Strangely enough, they implore readers not to think of pink elephants. Their point lies in the assumption that many people will immediately create an image of a pink elephant in their mind even if told not to do so. The more one attempts to stop thinking of these colorful animals, the more they will succeed in generating these mental images. This phenomenon is termed: the “Thought Avoidance Paradox”, and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of his/her mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers. (K. Carter, PSYC 210 lecture, February 14, 2006).
People who suffer from the separate and unrelated condition obsessive compulsive personality disorder are not aware of anything abnormal with them; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People who suffer with OCPD tend to derive pleasure from their obsessions or compulsions. Those with OCD do not derive pleasure but are ridden with anxiety. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic--marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress (K. Carter, PSYC 210 lecture, April 11, 2006). This is a significant difference between these disorders.
Equally frequent, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Not all OCD sufferers engage in compulsive behavior. Recent years have seen increased diagnoses of Pure Obsessional OCD, or "Pure O." This form of OCD is manifested entirely within the mind, and involves obsessive ruminations triggered by certain thoughts. These mental "snags" can be debilitating, often tying up a sufferer for hours at a time. As of 2004, headway continues to be made by specialists. It is believed by many that Pure O OCD is in fact more prevalent than other types of OCD, although it is likely the most underreported as it is not visibly apparent, and sufferers tend to suffer in silence. In this disorder, the sufferer tries to "disprove" the anxious thoughts through logic and reasoning, yet in doing so becomes further entrapped by the obsessions. "Pure O" OCD is thought to be the most difficult form of OCD to treat.
Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to do their compulsions are irrational or not. After some (possibly long) discussion, it is possible to convince the individual that their fears may be unfounded. It may be extra difficult to do ERP therapy on such a patient, because they may be, at least initially, unwilling to do it.
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no tangible pleasure in doing so.
OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships.
The illness ranges widely in severity. The illness affects many people and it is not cureable but can be treated with anti-depressants. This illness affects millions of people worldwide, and the number keeps growing.
SSRIs are used to treat this disorders.
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. Studies have also found that SSRIs, as a side effect of their action, may cause in many people either a delay of sexual climax or anorgasmia, so they can be used to develop drugs specifically targeted to treat premature ejaculation.
SSRI drugs are designed to allow the available neurotransmitter serotonin to be utilized more efficiently. A low level of utilization of serotonin is currently seen as one among several neurochemical symptoms of depression. Low levels of serotonin in turn can be caused by an anxiety disorder, because serotonin is needed to metabolize stress hormones [citation needed].
These medications evolve their effects at the serotonin transporter. They increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell. They have no or only weak effects on other monoamine transporters, thus having little direct influence on the level of other neurotransmitters. That distinguishes them from the older tricyclic antidepressants (TCAs), thus they are named selective. SSRIs are considered to be considerably safer than TCAs, since the toxic dose is much higher and they are said to have fewer and weaker side effects and drug interactions.
Many drugs in this class are familiar in the USA through advertising, including the following:
(Trade names in parentheses)
citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram)
escitalopram oxalate (Lexapro, Cipralex, Esertia)
fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR))
fluvoxamine maleate (Luvox, Faverin)
paroxetine (Paxil, Seroxat, Aropax, Deroxat, Paroxat)
sertraline (Zoloft, Lustral, Serlain)
dapoxetine (no known trade name)
Escitalopram is simply the left-handed s-enantiomer of the racemic citalopram. It had been introduced to the market just before the patent protection for citalopram had expired.
It is commonly thought that that the primary action of St. John's wort is as an SSRI.
Note that trazodone is not a typical member of the SSRIs - while it is a serotonin reuptake inhibitor, it is believed that its anti-depressant properties may be due to some of its other pharmacokinetic properties rather than its effect on serotonin reuptake inhibition. That said, it does still share many properties of the typical SSRIs, especially the possibility of the so-called 'discontinuation syndrome'
The main indication for SSRIs is major depression. Apart from this, SSRIs are frequently prescribed for anxiety disorders, panic disorders, obsessive-compulsive disorder (OCD), social phobia and eating disorders. Though not specifically indicated by the manufacturers, they are also sometimes prescribed to treat irritable bowel syndrome (IBS). Additionally, SSRIs have been found to be effective in treating premature ejaculation in up to 60% of men.
Basic understanding
In the brain, messages are passed between two nerve cells via a synapse, a small gap between the cells. The cell that sends the information releases neurotransmitters (of which serotonin is one) into that gap. The neurotransmitters are then recognized by receptors on the surface of the recipient (postsynaptic) cell, which upon this stimulation, in turn, relays the signal. About 10% of the neurotransmitters are lost in this process, the other 90% are released from the receptors and taken up again by monoamine transporters into the sending (presynaptic) cell (a process called reuptake).
Some theories link depression to a lack of stimulation of the recipient neuron at a synapse. To stimulate the recipient cell, SSRIs inhibit the reuptake of serotonin. As a result, the serotonin stays in the synaptic gap longer than it normally would, and has the chance to be recognized again (and again) by the receptors of the recipient cell, which can finally be stimulated fully.
Pharmacodynamics
SSRIs inhibit the reuptake of the neurotransmitter serotonin (5-hydroxytryptamine or 5-HT) into the presynaptic cell, increasing levels of 5-HT within the synaptic cleft.
But there is one counteracting effect: high serotonin levels will not only activate the postsynaptic receptors, but also flood presynaptic autoreceptors, that serve as a feedback sensor for the cell. Activation of the autoreceptors (by agonists like serotonin) triggers a throttling of serotonin production. The resulting serotonin deficiency persists for some time, as the transporter inhibition occurs downstream to the cause of the deficiency, and is therefore not able to counterbalance it. The body adapts gradually to this situation by lowering (downregulating) the sensitivity of the autoreceptors.
Of greater importance is another adaptive process: the downregulation of postsynaptic serotonin 5-HT2A receptors.
These (slowly proceeding) neurophysiological adaptions of the brain tissue are the reason why usually several weeks of continuous SSRI use are necessary for the antidepressant effect to become fully manifested.
Interaction with carbohydrate metabolism
Serotonin is also involved in regulation of carbohydrate metabolism. Few analyses of the role of SSRI's in treating depression cover the effects on carbohydrate metabolism from intervening in serotonin handling by the body.
Neuroprotection
Studies have suggested that SSRIs may promote the growth of new neural pathways.[1] Also, SSRIs may protect against neurotoxicity caused by other compounds (for instance MDMA and Fenfluramine) as well as from depression itself.
SSRIs versus TCAs
SSRIs are described as 'selective' because they affect only the reuptake pumps responsible for serotonin, as opposed to earlier antidepressants, which affect other monoamine neurotransmitters as well. Because of this, SSRIs lack some of the side effects of the more general drugs.
There appears to be no significant difference in effectiveness between SSRIs and tricyclic antidepressants, which were the most commonly used class of antidepressants before the development of SSRIs.[2] However, SSRIs have the important advantage that their toxic dose is high, and, therefore, they are much more difficult to use as a means to commit suicide. Further, they were initially claimed to have fewer and milder side effects.
SSRIs versus 5-HT-Prodrugs
Serotonin cannot be administered directly because when ingested orally, it will not cross the blood-brain barrier, and therefore won't have an effect on brain functions. Also, serotonin would activate every synapse it reaches, whereas SSRIs only enhance a signal that is already present, but too weak to come through.
Biosynthetically serotonin is made from tryptophan, an amino acid. If depression is caused by lack of serotonin, rather than insensitivity to it, SSRIs alone will not work well, whereas supplementing with tryptophan will. In 1989, the Food and Drug Administration made tryptophan available by prescription only, in response to an outbreak of eosinophilia-myalgia syndrome caused by impure L-tryptophan supplements sold over-the-counter. With current standards, L-tryptophan is again available over the counter in the US as well as supplement 5-HTP which is a direct precursor to serotonin.
2006-11-25 00:52:15
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answer #6
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answered by Ajeesh Kumar 4
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