Obsessive Compulsive Disorder (OCD)

1. Referrals

1.1. Psychiatrist: for diagnosis, medication management, and monitoring of comorbidities

1.2. Psychologist or therapist trained in CBT/ERP

1.3. Neurologist: if structural abnormalities or tics are present

1.4. Support groups or social worker: for family support and community resources

2. Treatment Options

2.1. Pharmacologic Therapy

2.1.1. SSRIs (first-line): fluoxetine, sertraline, fluvoxamine, paroxetine, citalopram

2.1.2. Clomipramine: a tricyclic antidepressant with strong efficacy, though with more side effects

2.1.3. Augmentation strategies: antipsychotics like risperidone or aripiprazole for refractory cases

2.2. Psychotherapy

2.2.1. Cognitive Behavioral Therapy (CBT), especially Exposure and Response Prevention (ERP), is the most effective psychological treatment.

2.2.2. Family-based CBT for children or dependent individuals

2.3. Advanced Interventions

2.3.1. Deep Brain Stimulation (DBS): For severe, treatment-resistant OCD. Research indicates that level of insight may predict DBS outcomes (Acevedo et al., 2024)

2.3.2. Transcranial Magnetic Stimulation (TMS): Non-invasive and promising for some patients

2.3.3. Hospitalization: In cases of suicidal ideation, severe functional decline, or comorbid psychosis

3. Diagnostic Tests & Labs

3.1. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) – gold standard for assessing severity

3.2. Comprehensive psychiatric evaluation

3.3. Thyroid panel and metabolic labs – to rule out organic causes of anxiety

3.4. Neuroimaging (MRI or fMRI) – for research or complex cases (to assess CSTC circuit abnormalities)

3.5. ASO titers (Anti-streptolysin O) – in suspected pediatric autoimmune OCD (PANDAS)

4. References

4.1. Acevedo, N., Rossell, S., Castle, D., Groves, C., Cook, M., McNeill, P., Olver, J., Meyer, D., Perera, T., & Bosanac, P. (2024). Clinical outcomes of deep brain stimulation for obsessive‐compulsive disorder: Insight as a predictor of symptom changes. Psychiatry & Clinical Neurosciences, 78(2), 131–141. https://doi.org/10.1111/pcn.13619

4.2. Arslan, S. C., Altun, H., Islah, E. M., & Güneş, S. (2024). Clinical Features, Psychiatric Comorbidities and Treatments in Childhood Obsessive Compulsive Disorder in terms of Symptom Severity, Gender and Age. European Journal of Therapeutics, 30(4), 435–447. https://doi.org/10.58600/eurjther2200

4.3. Hudepohl, N., MacLean, J. V., & Osborne, L. M. (2022). Perinatal Obsessive-Compulsive Disorder: Epidemiology, Phenomenology, Etiology, and Treatment. Current Psychiatry Reports, 24(4), 229–237. https://doi.org/10.1007/s11920-022-01333-4

4.4. Jalal, B., Chamberlain, S. R., & Sahakian, B. J. (2023). Obsessive‐compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain & Behavior, 13(6), 1–18. https://doi.org/10.1002/brb3.3000

4.5. Pinciotti, C. M., & Fisher, E. K. (2022). Perceived traumatic and stressful etiology of obsessive-compulsive disorder. Psychiatry Research Communications, 2(2). https://doi.org/10.1016/j.psycom.2022.100044

5. Pathophysiology & Etiology

5.1. Chronic psychiaric condition

5.1.1. Intrusive thoughts

5.1.1.1. Obsessions

5.1.2. repetitiv behaviors

5.1.3. mental acts

5.1.3.1. compulsions

5.2. Dysregulation of the cortico-striato-thalamocortical (CSTC) circuitry

5.2.1. orbitofrontal cortex

5.2.2. anterior cingulate cortex

5.2.3. striatum

6. Risk Factors

6.1. GGenetic predisposition (family history of OCD or other anxiety disorders)

6.2. TTrauma or chronic stress, especially during early development

6.3. PPerinatal hormonal changes (particularly in women)

6.4. Neurodevelopmental disorders (e.g., Tourette’s syndrome, ADHD)

6.5. CChildhood infections (e.g., PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)

6.6. LLow levels of insight or poor awareness of symptoms, which predict more severe and treatment-resistant cases (Acevedo et al., 2024)

7. Signs & Symptoms

7.1. Obsessions: intrusive, unwanted thoughts, urges, or images that cause significant anxiety (e.g., fear of contamination, intrusive sexual or violent images, need for symmetry

7.2. Compulsions: repetitive behaviors or mental acts aimed at reducing the anxiety caused by obsessions (e.g., excessive handwashing, checking, repeating words silently)

7.3. Avoidance behaviors related to feared situations

7.4. Functional impairment in personal, occupational, or social domains

7.5. Distress or frustration due to the inability to control thoughts or behaviors

8. Impact on Body & Complications

8.1. Increased cortisol levels may contribute to hypertension, immune suppression, and metabolic dysfunction.

8.2. Poor sleep, fatigue, and gastrointestinal symptoms may result from chronic anxiety.

8.3. Comorbid conditions: depression, generalized anxiety disorder (GAD), panic disorder, tic disorders, and body dysmorphic disorder.

8.4. Complications include social isolation, academic/work impairment, suicidal ideation, or substance abuse.