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•    Recurrent & persistent thought intrudes
      into conscious awareness                        
•    Recognized as one’s own idea but is
      Ego -alien.(foreign to one’s personality)
•    Attempts to ignore or suppress
      but is unable (unpleasant)
•  Irresistible respective behaviour
•  Act are aimed at preventing or reducing distress
•  Failure to resist with marked distress

Neurotransmitter involved
  1. There is hyperactivity, increased glucose metabolism, and high caudate glutamate concentration in brain. The regions implicated are the orbitofrontal cortex, cingulate gyrus, basal ganglia (especially the caudate) and thalamus.
  2. Serotonergic system is involved in the pathogenesis SSRIs are effective for treatment of OCD.
  1. About 20-30% patients have significant improvement in their symptoms and 40-50% have moderate improvement. The remaining 20-40% of patients either remain ill or their symptoms worsen.             
  2. About one third of patient with OCD have major depressive disorder and suicide is a risk for all patients with OCD.
Defense mechanisms used in OCD = Isolation, Undoing & Reaction formation.
Types: Washers, (Most common) Checkers, Pure obsessions (no compulsions eg. Blasphemy, sexual obsessions, aggressive obsessions).
Primary Obsessive Slowness: obsessions with no anxiety; patient slow in all activities.

In clinical practice, one of the most useful scales is the Y-BOCS (Yale Brown Obsessive Compulsive Scale). It can be used to elicit the symptomatology and rate the severity of OCD. The Y-BOCS classifies the symptoms and signs of OCD as follows:
  1. Aggressive obsessions.                                 
  2. Contamination obsessions
  3. Sexual obsessions                                         
  4. Hoarding/Saving obsessions.
  5. Religious/Scrupulous obsessions.                
  6. Obsession with need for symmetry or exactness.
  7. Somatic obsessions.                                       
  8. Miscellaneous obsessions.
  9. Cleaning/washing compulsions.                   
  10. Checking compulsions.
  11. Repeating rituals.                                         
  12. Counting compulsions.
  13. Ordering/arranging compulsions.                             
  14. Hoarding/collecting compulsions.
  1. Treatment of choice of OCD - is Behavior therapyExposure and Response Prevention (ERP). In this the client is exposed to stimulus and response is prevented. Like some body suffering from repeated hand washing his hands are made dirty (Exposure) and he is not allowed to wash hands (Response prevention)
    - Among the two, Improvement occur because of Response prevention, (as by this patient is habituated to the Anxiety).
The therapy for pure obsession is :-
  1. Thought stopping - Wherever you get such thought say loudly “ STOP “ or in your mind say “STOP’.
  2. Thought flooding - Recording of all such thoughts and listening those for 4 hours/ day.
  1. Best group of drug for treatment of OCD is SSRI.
  2. Otherwise best drug of choice of OCD is clomipramine.
  3. Best SSRI for treatment of OCD is Fluvoxamine (Not fluoxetine) it is 10 times more potent & 50 times more specific than any other SSRI for treatment of OCD.
  4. Best treatment is combining behaviour therapy and drug therapy.
  5. Treatment of Resistant OCD is -IV ( intravenous ) Clomipramine.
    1. rTms- Repetitive Transcranial Magnetic stimulation.
    2. DBS- Deep Brain stimulation. In this electrode is placed directly on the Internal capsule through hole in skull.
    3. Psychosurgery- Cingulotomy.
  1. It is a thienodiazepine drug which is a benzodiazepine analog.
  2. The etizolam molecule differs from a benzodiazepine in that the benzene ring has been replaced by athiophene ring.
  3. It possesses amnesic, anxiolytic, anticonvulsant, hypnotic, sedative and skeletal muscle relaxant properties.
  1. Short-term treatment of insomnia
  2. Short-term treatment of anxiety or panic attacks, if a benzodiazepine is required
  1. For anxiety: 0.50–1 mg two or three times per day (maximum 3 mg per day)
  2. For insomnia: 1–2 mg before bedtime
1 mg dose of etizolam is approximately equivalent to that of 10 mg of diazepam, see List of benzodiazepines.
Side Effects
  1. Blepharospasms with long term use
  2. Very Rare, Erythema annulare centrifugum skin lesions

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