Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Synopsis

Obsessive-compulsive disorder is probably the psychiatric disorder for which most significant progress has been made on the last 20 years concerning pharmacologic and psychotherapeutic interventions. A number of studies have shown that OCD is much more prevalent than previously thought, occurring in an estimated 2% of the adult population around the world. A serious discrepancy still exists between research evidence and clinical practice and an update of this evidence and an international debate on it, as provided by this volume, is long overdue. This revised edition provides vital information on a considerably underdiagnosed condition. Provides accompanying commentaries by an outstanding line up of contributors Covers developments in diagnosis, therapy, prognosis, economic evaluation and quality improvement Provides an unbiased and reliable reference point

Excerpt

Until relatively recently, obsessive-compulsive disorder (OCD) was thought to be a rare disorder, with a prevalence of less than 5 per 1000 adults. Knowledge regarding the etiology was limited and no effective treatments were available. All of this has changed over the past two decades.

A number of studies have shown that OCD is much more frequent than was thought and, on the basis of these studies, it is estimated that its worldwide prevalence is about 2% of the adult population. Well-designed, double-blind, placebo controlled studies carried out in many countries have supported the notion that medium to high doses of serotonin reuptake inhibitors have a specific role in effectively treating OCD. Furthermore, there is increasing evidence that behavioural therapy, consisting of in-vivo exposure coupled with response prevention, is an effective treatment of the disorder.

Studies set up to investigate the pathophysiology of the disorder have produced intriguing findings, highlighting the role of serotonin and the frontal-basal-ganglia-thalamo-cortical (FBGTC) circuit in its pathogenesis. The use of new research tools, such as those stemming from molecular genetics, modern brain imaging techniques and advanced immunological procedures, has also resulted in findings contributing to our understanding of OCD. Some of these, used in combination with new approaches to the classification of the disorder (e.g. with or without tics, early vs late onset, etc.) may also soon lead to an improvement of the treatment strategies (e.g. by the addition of dopamine blockers for patients with tic disorders).

The work on OCD has also emerged as a bridge between psychiatry and neurology (e.g. in connection with Tourette's syndrome); between psychiatry and neuroimaging (through evidence of its distinctive neuronal circuitry); between psychiatry and immunology (through cases associated with streptococcal infection); and between psychiatry and neurosurgery (in view of the effectiveness of neurosurgical intervention in some forms of OCD).

On a different plane, interest in OCD has also contributed to the innovative conceptualization of links between OCD and impulse control disorders (e.g. trichotillomania, compulsive gambling) as part of the obsessive-compulsive spectrum which, in turn, has led to significant therapeutic advances resulting from the application of new therapeutic principles and strategies related to OCD in these disorders.

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