Obsessive-Compulsive Disorder (OCD): A Comprehensive Review

Overview

• OCD is a neuropsychiatric disorder characterized by recurring obsessions and compulsions causing severe impairment internationally.
• It affects both adults and children, with significant comorbidities.
• Despite various therapies, many patients show treatment resistance.

Diagnosis and Challenges

• OCD symptoms include long-term obsessions and compulsions.
• Chronic and prevalent, often underdiagnosed and undertreated.
• Diagnostic challenges arise due to overlaps with other psychiatric disorders like bipolar disorder, schizophrenia, and ADHD.
• Misdiagnosis can lead to inappropriate care or treatment.

Comorbidities

• OCD frequently co-occurs with disorders such as bipolar disorder, schizophrenia, and GAD.
• Comorbidities complicate diagnosis and treatment.
• Pediatric OCD is often accompanied by other mental health issues, exacerbating severity and treatment difficulty.

Treatment Approaches

• Pharmacological:

  • First-line: Serotonin Reuptake Inhibitors (SRIs) and exposure and response prevention.
  • Some cases require antipsychotic augmentation.
  • SSRI monotherapy is effective but often needs augmentation.

• Psychological:

  • Cognitive Behavioral Therapy (CBT) is effective for OCD and common comorbid conditions like depression and anxiety.

• Alternative Treatments:

  • Memantine augmentation shows promise but is not yet recommended routinely.
  • Deep Brain Stimulation (DBS) is emerging for severe cases.

Complexities in Understanding OCD

• OCD is ranked by WHO among the most incapacitating conditions.
• Patients often aware of the irrationality of their compulsions (egodystonic aspect).
• Symptoms often misattributed to mood or anxiety disorders due to lack of nuanced understanding.

Special Considerations

• OCD and Schizophrenia:

  • Shared symptoms and circuits complicate diagnosis.
  • Pseudo-obsession concept helps in differential diagnosis.

• Childhood OCD Treatments:

  • Parental modeling and accommodation affect treatment outcomes.
  • High SSRI doses and CBT recommended where CBT alone is insufficient.

Research and Future Directions

• Need for continued research due to treatment-resistant cases.
• Investigation into cortico-striatal circuitry and pathogenic pathways.
• Developing novel treatments and understanding psychopathological overlaps.

Conclusion

• OCD’s complexity due to its comorbidities and treatment resistance needs a multi-faceted approach.
• Accurate diagnosis is crucial to avoid misclassification and inappropriate treatment.
• Ongoing research and new treatment developments are essential to address chronic symptoms.

Authors and Contributions

• Abhimanyu Singh, Vaibhav P. Anjankar, Bhagyesh Sapkale took part in concept design, data analysis, manuscript drafting, and supervision.