1.1. CSTC loop dysfunction may affect executive functioning, increasing risk of comorbid depression and anxiety. Complications include social isolation, poor occupational functioning, and suicidal ideation (Hühne et al., 2023).
2. Diagnostics
2.1. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), structured clinical interview (SCID-5), neuroimaging (optional), and screening for comorbidities are standard diagnostic methods (Cervin, 2023).
3. Treatment Options
3.1. Cognitive Behavioral Therapy (CBT), especially Exposure and Response Prevention (ERP), and pharmacotherapy with SSRIs like fluoxetine or fluvoxamine are first-line treatments (Hühne et al., 2023).SSRIs (fluoxetine, sertraline), clomipramine (a TCA), antipsychotics (e.g., risperidone) as augmentation in refractory cases are the primary medications (Hühne et al., 2023).
4. Referrals
4.1. Psychiatrists (for medication management), clinical psychologists (for CBT), neurologists (in suspected neuroimmune cases), and support groups are commonly recommended referrals (Hühne et al., 2023).
5. References
5.1. Cervin, M. (2023). Obsessive-Compulsive Disorder: Diagnosis, Clinical Features, Nosology, and Epidemiology. *Psychiatric Clinics of North America, 46*(1), 1–16. https://doi.org/10.1016/j.psc.2022.10.006
5.2. Endres, D., Domschke, K., & Schiele, M. A. (2022). Neurobiology of obsessive‑compulsive disorder: from genetics to psychopharmacology. *Nervenarzt, 93*(7), 670–677. https://doi.org/10.1007/s00115-022-01331-0
5.3. Hühne, V., Chacur, C., de Oliveira, M. V. S., Fortes, P. P., Bezerra de Menezes, G. M., & Fontenelle, L. F. (2023). Considerations for the treatment of obsessive-compulsive disorder in patients who have comorbid major depression. *Expert Review of Neurotherapeutics, 23*(11), 955–967. https://doi.org/10.1080/14737175.2023.2265066
6. Pathophysiology
6.1. At the cellular level, OCD involves dysfunction in the cortico-striato-thalamo-cortical (CSTC) circuit. Imbalance in serotonin, dopamine, and glutamate neurotransmission, especially within the orbitofrontal cortex and basal ganglia, is central to OCD pathology (Endres et al., 2022).
7. Etiology
7.1. Etiology is multifactorial including genetic predisposition, neurobiological abnormalities, autoimmune factors (e.g., PANDAS), and environmental stressors (Cervin, 2023).
8. Diagnosis
8.1. Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition characterized by obsessions (recurrent intrusive thoughts) and compulsions (repetitive behaviors) (Cervin, 2023).
9. Signs & Symptoms
9.1. Obsessions (contamination fears, symmetry) and compulsions (hand washing, checking) are hallmark symptoms. Anxiety, guilt, and avoidance behaviors are also commonly observed (Cervin, 2023).
10. Risk Factors
10.1. Family history of OCD or anxiety, childhood trauma, streptococcal infections (PANDAS), neuroinflammation, and personality traits like perfectionism are major risk factors (Cervin, 2023).
