Obsessive-Compulsive Disorder
Treatment Options
Obsessive-compulsive
disorder has a slow onset and in most cases takes years
for the symptoms to reach the full-blown stage. However,
in some individuals there is a rapid onset of symptoms
associated with a traumatic event such as a loss or
pregnancy. Unfortunately, individuals with OCD often keep
their condition secret and it can take years until they
seek treatment. A poor prognosis is registered in
individuals that yield rather than resist to compulsions.
There are several treatment options available for individuals with obsessive-compulsive
disorder, such as: medication, psychotherapy, and neurosurgical treatment.
Medication:
Most individuals with OCD benefit from certain psychiatric medication.
This treatment approach is directed towards a specific receptor
deficit. The first-line medication prescribed in individuals with
OCD is serotonergic in nature (it targets the serotonin). Common
serotonin type medicines include:
- Selective serotonin
reuptake inhibitor (SSRI's) such as fluoxetine (Prozac),
fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil),
citalopram and escitalopram (the last two are not yet FDA approved).
- Tricyclic antidepressants
(Anafranil) was one of the first anti-obsession drugs prescribed
in the UK, but is less prescribed now due to their unpleasant
side effects. It is usually recommended when the treatment with
SSRI's have failed.
- Serotonin norepinephrine
reuptake inhibitor (SNRI) such as venlafaxine and duloxetine
are used only in clinical trials, because they are not FDA approved.
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The
benefit of antidepressant treatment is that it balances
the level of serotonin in the brain. However, this
treatment is not followed by a complete remission of the
symptoms, but rather a reduction (30 to 50 percent).
Also, the results tend to be noticed after several weeks
of treatment and the treatment has to be followed for at
least 10 to 12 weeks.
Psychotherapy: The
most effective psychological treatment that individuals
with OCD can benefit from are: behavioral therapy and
cognitive behavioral therapy.
- Behavioral therapy is not a traditional
psychotherapy but it focuses on modifying or
"unlearning" those maladaptive
behaviors that cause psychological discomfort. It
is usually the first-line therapy treatment for
individuals with OCD. Obsessive-compulsive
disorder can be treated with a behavioral therapy
approach called "exposure and response
prevention" which involves two major steps:
(1) graduate exposure to those stimuli that
create tension, and (2) prevents the engagement
into typical response that cause temporary
relief. The exposure step is conducted in safe,
comforting, and confidential settings where the
individuals face their anxiety or distress
causing stimuli, either direct or through
imagination. The "exposure and response
prevention" technique is based on the idea
that the therapeutic effect is achieved as the
individual confronts their fears and discontinue
their escape response. The goal of this technique
is habituations (getting used to something that
used to produce anxiety or distress).
Behavioral therapy has
proven to bring long lasting benefits for
individuals with OCD. However, this form of
therapy is beneficial when the individual with
OCD is fully motivated when they start the
therapy, and they have a cooperative family.
- Cognitive behavioral therapy is another
option for individuals with OCD. This form of
psychotherapy is based on learning principles and
experience. Cognitive behavioral therapy
considers that our thoughts and not the external
situations, people or events, trigger the
behavior and feelings. This form of therapy
combines methods from behavioral and cognitive
therapies for better outcomes.
Cognitive behavioral
therapy for individuals with OCD is focused
around two aspects (1) exposure and prevention,
and (2) cognitive restructuring, both supported
by laboratory research and clinical trials
conducted on adults and children. The exposure
and prevention technique is adopted from the
behavioral therapy and creates a safe setting for
the individuals with OCD to face the feared
stimuli and cope with the anxiety and stress by
not engaging in the compulsive rituals. The
cognitive restructuring technique helps the
individual to identify disruptive thoughts
associated with distress, and replace them with
realistic, functional thoughts.
Cognitive
behavioral therapy is an effective treatment
approach that works in 60 to 85 percent of the
individuals with OCD both adults and children.
In rare cases, when
individuals with OCD do not respond to medication or
psychotherapy, they can be exposed to electroconvulsive
therapy (ECT). This therapy involves delivering electric
shocks to the subject's brain through electrodes attached
to the head. The shock causes a seizure which alows the
neurotransmitters to released in the brain.
Neurosurgical treatment:
This is an option limited to a small number of
individuals with OCD when they don't respond to other
treatment options and their symptoms are severe and
refractory.
- Bilateral cingulotomy: This is a surgical
procedure where the pathway in the brain
responsible for OCD symptoms is being
interrupted.
- Stereotactic radiosurgery: This procedure
involves emitting hundreds of powerful, highly
focused gamma radiation beams into the brain area
involved in OCD symptoms through a non-surgical
machine (called Gamma knife).
Article by Alina Morrow
MS Psychology
Medical Writer
OmniMedicalSearch.com
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