Tag: OCD

OCD-Management & prognosis

OCD-Management & prognosis



  • First Line – SSRIs and Clomipramine [adverse side effect profile]
  • If first line fails then antipsychotics [Haloperidol, quetiapine, risperidone, olanzapine]
  • Other Drugs [Venlafaxine, Lithium, valproate and carbamazepine]


  • Cognitive Behavior therapy [Exposure & Response prevention]
  • Desensitization, thought stopping, flooding and aversive conditioning

Other T/T modalities – ECT, Psychosurgery [Cingulotomy, capsulotomy – Caudate tractotomy]


Acute Onset – 50%. 20-30% Significant improvement, 40-50% moderate, rest may so deterioration

OCD-Etiology & Symptoms

OCD-Etiology & Symptoms

The etiology of OCD is:

  • Serotonin dysregulation [Less evidence for Noradrenergic system]
  • Cortico-striatal-thalamic-cortical circulatory path
  • Prefrontal Cortex -> Striatum -> Thalamus -> Prefrontal Cortex

Symptom patterns:

  • Contamination-Washing behavior
  • Pathological doubt-Compulsion of checking
  • Intrusive thoughts-Intrusive Thoughts [sexual & aggressive] without an observable compulsion
  • Symmetry-Need for Symmetry and precision. Compulsion of slowness



OCD is characterized by recurrent obsessive thoughts followed by compulsive acts

  • Recurrent & Intrusive thoughts, images, impulses
  • Recognizes as the product of their own mind
  • Recognizes thoughts as Irrational & Senseless
  • Ego dystonic – UNWANTED and UNACCEPTABLE
  • Repetitive behaviors in response to obsession
  • Done to reduce stress and anxiety

Symptoms > 2 Weeks for diagnosis
Lifetime prevalence ~ 2-3%
Depression is the m/c co-morbid condition

Defense mechanisms in psychiatric diseases

Defense mechanisms in psychiatric diseases


  • Reaction formation
  • Displacement
  • Undoing
  • Inhibition

Phobia-Displacement & Inhibition

Dissociative disorder-Dissociation



Impulse Control Disorders-Acting out

Borderline Personality Ds-Projecting Identification

Substance Use Disorder-Rationalization

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