Obsessive-Compulsive Disorder (OCD)

Clinic

• OCD is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general function.
• Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort.
• Common obsessions include fear of contamination, obsession with symmetry, and intrusive thoughts about religion, sex, and harm.
• Compulsions are repeated actions or routines that occur in response to obsessions.
• Common compulsions include:
  • Excessive hand washing, cleaning in response to the fear of contamination.
  • Ordering is the preference for tasks to be completed a specific way
  • Hoarding is the collecting of unnecessary objects
  • Neutralizing is the act of engaging in a ritual to make up for supposedly "bad behavior".
  • Checking is the compulsion to check particular objects/places to ensure they are a certain way (e.g., checking to ensure the water is turned off).
• They tend to be overly cleanly, repeatedly count objects, and seek reassurance to avoid making a mistake.
• The cause of OCD is unknown. There appear to be some genetic components, and it is more likely for both identical twins to be affected than both fraternal twins.

Entities

Obsession

• DSM defines obsessions as “Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
• According to this this definition, I consider anxiety as the main eliminating entity of OCD.

Insight

• DSM-5 identifies a continuum for the level of insight in OCD, ranging from good insight (the least severe) to no insight (the most severe).
• They are aware that their compulsions do not make sense, but they perform them anyway to relieve the distress caused by obsessions.

Cognitive performance

A 2013 review reported that people with OCD may sometimes have mild but wide-ranging cognitive deficits, most significantly those affecting

• Spatial memory and to a lesser extent with verbal memory
• Fluency
• Executive function
• Processing speed
• Formulating an organizational strategy for coding information
• Set-shifting, and motor and cognitive inhibition.

Depression

• 60 -80% accompaniment suggest depression as a good but not eliminating entity.

Associated conditions

• Obsessive–compulsive personality disorder
• MDD (60 -80%)
• Bipolar disorder (9–35%)
• Generalized anxiety disorder (30%)
• Specific phobia (22% )
• Panic disorder (12%)
• Cyclothymic traits or hypomanic episodes (50%)
• Anorexia nervosa
• Social anxiety disorder (18%)
• Bulimia nervosa
• Tourette syndrome
• Transformation obsession
• ASD
• ADHD (51%)
• Dermatillomania
• Body dysmorphic disorder
• Trichotillomania.
• Suicidal tendencies (More than 50%), and 15% have attempted suicide.
• Eating disorder
• Sleep disturbance, Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset.
• Drug addiction
• Disorders in which perseveration is a possible feature (ADHD, PTSD, bodily disorders, or stereotyped behaviors).
• Some cases of OCD present symptoms typically associated with Tourette syndrome, such as compulsions that may appear to resemble motor tics; this has been termed tic-related OCD or Tourettic OCD.

• Epilepsy: While many forms of epilepsy carry an increased risk of OCD, temporal lobe epilepsy appears to have the strongest link

Autoimmune

• A controversial hypothesis is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections (GABHS), known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
• OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-streptococcal autoimmune process.
• A review of studies examining anti-basal ganglia antibodies in OCD found an increased risk of having anti-basal ganglia antibodies in those with OCD.

LBB

• Neuroinflammation occurs in both acute and persistent infection with Lyme borreliosis.
• Persistent infection with B. burgdorferi can induce chronic autoimmune disease,and anti-neuronal antibodies are present in many patients with persistent symptoms following treatment for Lyme borreliosis.
• As yet there are no reports of B. burgdorferi as a trigger for PANS. Neuropsychiatric symptoms associated with Lyme borreliosis are similar to those with PANS, including anxiety, depression, OCD and tics.

OCD Black Box

	STLE
Behavioral changes	+++
Altered Thought Pattern	+++
Anxiety	+++
Depression	+++
Cognitive impairement	+++
Ataxia	+++
Emotional lability	+++

Note

• There are two approaches in examining miasmatic obsessions. First, OCD has a miasmatic (infectious) root, so cycles of obsession - compulsions are the identity of the disease. Second, the identity of the disease is anxiety and the aforementioned cycles are a defense mechanisms.
• I prefer first approach, therefore try to find an infectious disease which could induce a similar picture of these cycles.
• PANDAS is a really similar disease.
• Regardless of the etiology of PANDAS , it can be considered a combination of infection and autoimmunity. Hence its symptoms will be very valuable. Especially the symptoms that are omitted / Subsided in the process of OCD, like dysgraphia, enuresis and emotional lability
• Dysgraphia is a sudden decreasing of fine motor ability, therefore its miasmatic rubric is Ataxia.
• In obsessive-compulsive disorder, we are dealing with a chronic and progressive condition that, despite the severe disruption it causes in his functioning and current life, does not go beyond its limits in terms of brain destruction. So obsession is not a destructive brain disease.

Neuroanatomy

• Cortical areas which maintain the main projections to the ventral striatum areas (Nucleus accumbens, Caudate nucleus and Putamen) are:
  • Anterior cingulate gyrus (ACC)
  • Dorsolateral prefrontal cortex (dlPFC)
  • Orbitofrontal cortex (OFC)

• Cortico-striato-thalamo-cortical circuitry (CSTC) is altered in the brain of OCD individuals, which includes three relevant loopings of indirect pathways with the respective cortical connection:
  1. Affective (ACC, NAC and thalamus)
  2. Dorsal cognitive (dlPFC, CN and thalamus)
  3. Ventral cognitive (OFC, PT and thalamus)
• These circuits are related to the affective and reward processing, the working memory and executive function, and the motor and inhibitory response.
  

Remedies

• Ars , Anac , Arg-n, Carc, Hyos, Ign, Iod,, Med , Nat-m, Nat-s, Nux-v, Plat, Psor, Puls, Sil, Staph, Sul, Verat, Thuj, Syph, Aur Calc

2) Cann-i

3) Lachesis:

• Timidity of character, with variableness and indecision.
• Great apathy and extraordinary weakness of memory, everything that is heard is, as it were, effaced, even orthography is no longer remembered, and there is forgetfulness even of things on the point of utterance.
• Mistakes are made in speaking and writing, as well as in the hours of the day and the days of the week.
• Imbecility and loss of every mental faculty.
• Over-excitement and excessive nervous irritability, with a tendency to be frightened.
• Perfect happiness and cheerfulness followed by gradual fading of spirituality, want of self-control and lasciviousness, felt as if she was somebody else and in the hands of a stronger power. Amativeness. Affections of the intellect in general.
• State of ecstasy and exaltation which even induces tears, desire to meditate, and to compose intellectual works, with a sort of pride.
• Frantic loquacity with elevated language, nicely chosen words, rapid and continual change of subject-matter.
• Loquaciousness, with mocking jealousy.

4) Medorrhinum:

• Homeopathic medicine for OCD in which patient makes wrong statements, because she does not know what to say next, begins all right but does not know how to finish,
• weight on vertex, which seems to affect the mind.
• Difficulty in cncentrating his thoughts on abstract subjects.
• Could not read or use mind at all from pain in head.
• Thinks some one is behind her, hears whispering, sees faces that peer at her from behind bed and furniture.
• Is sure she is going to die. Sensation as if all life were unreal, like a dream.
• Wild and desperate feeling, as of incipient insanity.
• Cannot speak without crying.
• Is in a great hurry, when doing anything is in such a hurry that she gets fatigued.
• Better by torrents of tears.
• Is always anticipating, feels most matters sensitively before they occur and generally correctly. Dread of saying the wrong thing when she has headache.
• Fear of the dark. Feeling as if he had ommitted the unpardonable sin and was going to hell. Irritated at little things.
• Very impatient. Great selfishness.

5) Nat.mur:

• Unpleasant recollections & much weeping.
• Hypochondriacal, tired of life. Joyless, taciturn.
• Hurriedness, with anxiety and fluttering of heart.
• Prefers to be alone. Anthropophobia. Anxiety respecting the future.
• Indifference, laconic speech, moroseness, and unfitness for labour.
• Hatred to persons who have formerly given offence.
• Laughs immoderately and cannot be quieted.
• Difficulty of thinking, absence of mind.
• Weakness of memory and excessive forgetfulness. Heedlessness and distraction.
• Tendency to make mistakes in speaking and writing.
• Brain-fag, with sleeplessness, gloomy forebodings.
• Exhaustion after talking, embarrassment of rain.
• Incapacity for reflection, and fatigue from intellectual labour. Distraction, does not know what he ought to say. Awkwardness.

6) Pulsatilla:

• Homeopathic medicine for OCD that has impulse to hide or to run away, mistrust and suspicion.
• Taciturn madness, with sullen, cold, and wandering air, sighs, often seated with the hands joined, but without uttering any complaint.
• Despair of eternal happiness, with continual praying.
• Discouragement, indecision, dread of occupation, and obstructed respiration.
• Disposition envious, discontented, and covetous, exhibiting itself in a wish to appropriate everything.
• Caprice, with desire at one time for one thing, at another time for something else, either being rejected as soon as obtained.
• Hypochondriacal humour and moroseness, worse evening, often with repugnance to conversation, great sensitiveness, cries, and weeping.
• Ill-humour, sometimes with a dread of labour, and disgust or contempt for everything.
• Difficulty in expressing thoughts correctly when speaking, and tendency to omit letters when writing.iddiness, patient neither knows where he is nor what he does.
• Great flow of very changeful ideas.
• Weakness of memory. Fixed ideas. Stupidity.

7) Rhus-tox:

• Anxious sadness and excessive anguish, especially (at twilight) in evening and at night, with wish for solitude and inclination to weep.
• Restlessness which does not allow the patient to remain seated, and compels him to throw himself about in bed.
• Homeopathic medicine for OCD that has anxiety with fear of death and sighs. Fear of being poisoned.
• Suicidal mania (desire to throw himself into the water).
• Moral dejection with anthropophobia.
• Helplessness and profound despondency.
• Weakness of memory and forgetfulness (cannot remember the most recent events).
• Want of ideas and of mental energy.
• Difficult comprehension. Slowness of conception and mental dullness. Delusions of the imagination and visions.