Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a mental health disorder characterised by the presence of persistent obsessions and/or compulsions. These are time consuming (e.g., take more than 1 hour per day) and/or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Differential diagnosis from other psychiatric disorders with recurrent thoughts and repetitive behaviours is nuanced and requires specialist guidance.

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is useful in grading severity initially and following trials of therapy. The results obtained from the Y-BOCS should be complemented by assessment of the patient’s impairment, level of family accommodation, and insight.

Patients tend to seek treatment from three to four doctors and spend on average around 9 years in treatment before a correct diagnosis is made. The average amount of time that lapses between onset of symptoms and appropriate treatment is 17 years.

Cognitive behavioural therapy (CBT), in the form of exposure and response prevention alone or in combination with a selective serotonin-reuptake inhibitor (SSRI) or clomipramine, is a first-line therapy.

Although controlled trials with SSRIs have demonstrated a selective efficacy in OCD, up to 40% to 60% of patients do not have a satisfactory outcome.

Interest in neuromodulation devices and procedures (e.g., transcranial magnetic stimulation and deep brain stimulation) is steadily growing, driven by their potential to effectively treat various neurological and psychiatric conditions.

OCD is a frequently debilitating and often severe mental health disorder that affects 1% to 4% of the population.[1]Nazeer A, Latif F, Mondal A, et al. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr. 2020 Feb;9(suppl 1):S76-93. https://pmc.ncbi.nlm.nih.gov/articles/PMC7082239 http://www.ncbi.nlm.nih.gov/pubmed/32206586?tool=bestpractice.com ​ OCD is characterised by the following thoughts and behaviours: (a) obsessions, defined as recurrent or persistent thoughts, urges or images that are experienced as intrusive and unwanted and which usually result in marked anxiety or distress that the person tries to ignore, suppress or neutralise with some other thought or action; and (b) compulsions, defined as repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly and which are aimed at preventing or reducing anxiety or distress, or preventing a dreaded event or situation; however, compulsions are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.[2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.​ OCD causes significant distress and impairment in daily functioning and can have a substantial effect on the sufferer's quality of life.[3]Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47:270-275. http://www.ncbi.nlm.nih.gov/pubmed/16769301?tool=bestpractice.com