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

Arg-n

Ars

Anac

Arg-n

ARS

aur

Calc

Carc

HYOS

Ign

Iod

Med

Nat-m

Nat-s

NUX-V

Plat

psor

PULS

Sil

Staph

sulph

syph

thuj

Verat.