QUESTION OF THE DAY

In Nigeria, I’ve noticed people hate going to hospitals and would rather wait till their ailment gets worse before they visit the hospital.

What do you think is the reason for this?

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Obsessive Compulsive Disorder

Obsessive-compulsive disorder is an anxiety disorder that affects children and adolescents as well as adults in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviours that make them feel driven to do something (compulsion).

These intrusive thoughts often produce uneasiness, apprehension, fear or worry; by repetitive behaviours aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions.

Often the person carries out the behaviours to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety.

Obsessive-compulsive disorder (OCD) is more common than was once thought. It affects both the young and the old – children, adolescents and adults.

There are several theories about the cause(s) of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD. OCD has also been linked to above average intelligence because its sufferers often give high attention to detail, avoid risk, plan carefully, take time in making decisions and have a exaggerated sense of responsibility.

OCD has also been linked to Tourette syndrome due to the fact that about 20% of OCD patients have tics, however, this link is yet to be confirmed.

Obsessions and compulsions that are not due to medical illness or drug use, that cause major distress or interfere with everyday life have been pencilled down as the symptoms of OCD.

Some of these obsessions/compulsions include checking and rechecking actions (such as turning out the lights and locking the door), excessive counting, excessive fear of germs,the compulsion to repeatedly wash the hands to ward off infection.

Other symptoms of OCD include extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room.

These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress.

The person usually recognizes that the behaviour is excessive or unreasonable and may become further distressed by this realization.

Your own description of the behaviour can help diagnose the disorder. A physical exam can rule out physical causes, and a psychiatric evaluation can rule out other mental disorders.

Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale (YBOCS), can help diagnose OCD and track the progress of treatment.

OCD is treated using medications and therapy. The first medication usually considered is a type of anti-depressant called a selective serotonin reuptake inhibitor (SSRI). These drugs include: Citalopram (Celexa), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft)

If an SSRI does not work, the doctor may prescribe an older type of antidepressant called a tricyclic antidepressant. Clomipramine is a TCA, and is the oldest medication for OCD. It usually works better than SSRI antidepressants in treating the condition, but it can have unpleasant side effects, such as difficulty starting urination, drop in blood pressure when rising from a seated position, dry mouth, sleepiness.

In some cases, an SSRI and clomipramine may be combined. Other medications, such as low-dose atypical antipsychotics (including risperidone, quetiapine, olanzapine, or ziprasidone) have been shown to be helpful. Benzodiazepines may offer some relief from anxiety, but they are generally used only with the more reliable treatments.

Cognitive behavioral therapy (CBT) has been shown to be the most effective type of psychotherapy for this disorder. The patient is exposed many times to a situation that triggers the obsessive thoughts, and learns gradually to tolerate the anxiety and resist the urge to perform the compulsion. Medication and CBT together are considered to be better than either treatment alone at reducing symptoms.

Psychotherapy can also be used to provide effective ways of reducing stress, reduce anxiety, resolve inner conflicts.

OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment.

Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not usually progress into another disease.

There is no known prevention for this disorder.

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