In Perspective: Obsessive Compulsive Disorder
Amir is an A-Level student living in Lahore with his parents. He just turned 18 on 18th of this month. He is obsessed with even numbers. He loves the number 18 also. That’s why he celebrated his birthday with full joy and happiness this year. He loves his mobile number also because the digits add up to form an even number. Also, his class roll number is an even number.
Moreover, he is fond of cleanliness. He keeps his room tidy and clean. Also, he likes to keep everything organized and in perfect manner. Whenever he locks the door of his room, he checks it several times to ensure that it is properly locked. When someone enters his room and touches anything, he becomes angry and does not like it.
Once, his brother entered his room and used his washroom. It made Amir so upset that he went inside, scrubbed the toilet and washed the basin several times until he was satisfied that the whole washroom was clean. Also, he visits the kitchen several times during night to check the stove.
The above mentioned weird rituals are part of Amir’s life. He has recently been diagnosed with Obsessive-compulsive disorder (OCD). It is a psychiatric illness in which individuals experience debilitating recurrent and persistent thoughts, or obsessions, which they try to eliminate with rituals, known as compulsions.
 Names have been changed to protect privacy.
OCD is among the 10 most disabling medical and psychiatric conditions. At present, researchers and scientists know very little about this behavioural disorder due to which there is no proper cure for eliminating this disorder. However, certain antidepressant drugs and behavioral therapies help in reducing the obsessive thoughts in few people only. Generally, it is believed that people with OCD show increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.
Also, glutamate, an excitatory neurotransmitter, is dysregulated in OCD, and that this dysregulation may contribute to the pathophysiology of the disorder. By the mid 20th century, psychiatrists classified OCD as an anxiety disorder based on the persistent nervousness of individuals with OCD. But thinking began to change and according to an international survey of 2007, most of the authors of OCD publications challenged this particular belief. They believe that anxiety is more of a sidelight than a defining feature of OCD and that treating anxiety may not be the best way forward.
Psychiatrists also know that serotonin signalling could be malfunctioning in OCD. So in order to treat that, Serotonin reuptake inhibitors (SRIs), drugs that increase the amount of serotonin neurotransmitter, are among the most effective medications for OCD. Researchers believe that a protein which acts as a serotonin transporter is produced too much in people with OCD and as a result of that overproduction of protein, little serotonin is left in the spaces between neurons, thereby, suppressing signalling.
Several family genetic studies, including one published in 2002 by psychiatrist Edwin Cook, Jr., and his colleagues at the University of Chicago and the University of Michigan at Ann Arbor, USA, have associated OCD with variations in the gene for a protein that removes glutamate from outside neurons. Glutamate, generally fuels a brain circuit involved in making decisions that will lead to positive outcomes. Mutations in the glutamate transporter gene might impair the protein’s ability to regulate activity in this circuit, leading to senseless decisions and behaviours.
Also, a study in mice published few years back reported that mice missing a gene involved in immune functions demonstrated OCD like symptoms. Moreover, in 1998, paediatrician Susan Swedo of the National Institutes of Mental Health (NIMH) identified a group of children who had acquired OCD or related disorders immediately after suffering from Group A Streptococcus infections, the cause of strep throat. According to her, sometimes, the brain can accidently develop antibodies against basal ganglia neurons. And so these antibodies begin attacking these cells which are mistaken for the bacteria. Disruption in circuits occurs which finally leads to OCD symptoms in an affected child.
At present, the most effective treatment for OCD is exposure and response prevention (ERP). Therapists expose patients to objects and stimuli that trigger their repetitive behaviours. Eventually, the patients realize that nothing bad happens when they fail to perform their rituals.
Another most effective treatment includes the use of SRIs. Individuals who do not respond well to SRIs might one day benefit from medications that calm glutamate activity in the brain. Several case reports have shown that drugs which block specific glutamate receptors can improve symptoms when taken with SRIs. Scientists are now conducting placebo-controlled trials of these drugs to see how well they perform on their own.
- Recent Advances in the Genetics of Obsessive-Compulsive Disorder. Jack F. Samuels in Current Psychiatry Reports, vol. 11, no. 4, pages 277–282; August 2009.
- Obsessive-Compulsive Disorder and Its Related Disorders: A Reappraisal of Obsessive-Compulsive Spectrum Concepts. D. L. Murphy et al. in Dialogues in Clinical Neuroscience, vol. 12, no. 2, pages 131–148; 2010.
- OCD? Your Immune System Could Be to Blame. Mitch Leslie in ScienceNow; May 27, 2010. Available at http://news.sciencemag.org/sciencenow
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