Recent Developments on OCD
Obsessive Compulsive Disorder (OCD) is briefly defined by the repetitive disturbing thoughts and the repetitive behaviors made to get rid of them. There are two phases where it rises and becomes apparent during the lifetime: Late-childhood (6-11) or early adolescence (11-15) and early adulthood (20-29).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association in 2013, removed obsessive compulsive disorder from under the title “anxiety disorder” They offered a new category named “Obsessive Compulsive and Associated Disorders”. In this category, the condition of being aware of the fact that the obsessions are a “product of mind” was removed. Low insight, deliriums, current or past tics, hoarding disorder were added as new criteria of diagnosis.
The reason why OCD is presented as a different title is the fact that anxiety is not the building block of OCD, although it is similar to anxiety disorders in terms of brain imaging, genetics, and reaction to treatment. Not every OCD patient complains about anxiety; many of them complain about evasion, inhibition of their daily activities.
In the OCD treatment, SSRI-type drugs and cognitive behavioral therapy are jointly recommended. One of the most frequently implemented cognitive behavioral therapy practices is the “exposure” method. Through systemic exposure, it is aimed to manage disturbing thoughts, eliminate anxiety and decrease repetitive behaviors and evasion.
It was reported that the SSRI-type drugs used in the OCD treatment must be used for 6 to 12 months in order to determine their effectiveness on the patient. It was observed that decreasing the use of the drug before 6-12 months increase the risk of recurrence. The supplementary drugs taken to increase the effects of the main drug is recommended to be discontinued if there are no visible effects after a period of 6-10 weeks, as they cause side effects like weight gain and diabetes.
During the neuromodulation therapies, a method recommended to be administered solely for the patients who experience a very intense OCD and who are treatment-resistant, a surgical intervention is made on the brain parts where abnormalities are observed due to the disorder (front part of the internal capsule/reward center of the brain or thalamus/subthalamic nucleus); electrodes are placed, and an electrical stimulation is made in the target area. Electroconvulsive treatment (ECT) and transcranial magnetic stimulation (TMS) are neuromodulation methods, which do not include surgical intervention and are developed for mood disorders, and they are used in the treatment of OCD.