Obsessive Compulsive Disorder (OCD)

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Denne hjemmeside informerer om OCD.

OCD er en forkortelse for Obsessive Compulsive Disorder, der typisk oversættes til Obsessiv Kompulsiv tilstand eller tvangstanker og tvangshandlinger.

Diagnosen OCD har F42 i WHO’s ICD-10 diagnosesystem, der anvendes i Danmark. Cirka 2,2% af en befolkning eller 100.000 til 150.000 danskere har OCD som hoveddiagnose. OCD optræder enten som en selvstændig diagnose eller (oftest) sammen med andre psykiatriske diagnoser. Man kan for eksempel have OCD som hoveddiagnose og panikangst eller depression som sekundær diagnose. Cirka halvdelen af dem, der har OCD som hoveddiagnose, vil typisk få en let eller moderat depression. Omvendt, hvis man har depression som hoveddiagnose vil 30 til 40 % få OCD som sekundær diagnose.
OCD optræder ofte i forbindelse med følgende psykiatriske lidelser: anoreksi, asperger syndrom, depression, panikangst, skizofreni, social angst osv..

Cirka 20% af de OCD-ramte responderer ikke på medicinsk behandling eller Kognitiv-adfærdsterapi (KAT) og cirka halvdelen af denne gruppe er alvorligt handikappede af deres sygdom. Nogle af dem er så handikappede af OCD’en at de bliver indlagt på institutioner. En del af de mest handikappede kan have gavn af neurokirurgi som for eksempel Gamma knife surgery (udføres ikke i Danmark) eller Deep-Brain stimulation (er pt. på forsøgniveau og udføres ikke i Danmark).

Mange OCD-ramte bliver fejlbehandlet pga. manglende viden om sygdommen hos den privatpraktiserende læge, privatpraktiserende psykiater, de psykiatriske afdelinger og psykologer, og fordi de sociale myndigheder obstruerer behandlingen.

WHOI følge World Health Organization (WHO), er OCD den 10 mest udbredte lidelse i verden i 1990, når man ser på det antal år man lever med OCD (”The leading causes of years lived with disability, worldwide, 1990″). Du kan læse mere på WHO’ hjemmeside: WHO

NIMH
National Institute of Mental Health (NIMH) i USA har sat OCD som den fjerde mest udbredte psykiatriske lidelse i den vestlige verden, når man ser på antal år, man lever med OCD. NIMH er en afdeling under USA’ Sundhedsministerium. Du kan læse mere på NIMH’ hjemmeside: The Impact of Mental Illness on Sociaty

Inderigs- og Sundhedsministeriet. Ministery of Interio and Health Det danske sundhedsministerium eller dets faglige rådgiver, Sundhedsstyrelsen, har desværre ingen information om OCD.

En af årsagerne til at Sundhedsministeriet og Sundhedsstyrelsen endnu ikke har ‘opdaget’ OCD, er måske, som Dr. Gerald Nestadt, professor of psychiatry at the Johns Hopkins School of Medicine, siger: “Without question people will tell you about their sex lives or criminal behavior before they’ll tell you about their OCD symptoms.” (Baltimore Sun, 9/9-2005).

De praktiserende læger i almen praksis er indgangen til sundhedsvæsenet. Hvis man skal i behandling hos for eksempel en psykiater, skal man først henvende sig hos en praktiserende læge, der vurderer om man har en psykisk lidelse, der skal behandles hos en psykiater. Det vil sige at den praktiserende læge skal kende til OCD. I en undersøgelse om OCD i Danmark, Quality of life with OCD, publiceret april 2004 i Nordic Journal of Psychiatry, fremgår det at det tager 8-9 år før OCD-ramte bliver henvist til rette behandling. Det vil derfor være logisk at efteruddanne de praktiserende læger, hvilket TV-Syd bl.a. spurgte praktiserende læge og formand for Praktiserende Lægers Organisation, Michael Dupont, hvortil han svarede:

“Vi er ret godt vant til, at folk der interesser sig lige for et bestemt område, syntes at lige akkurat deres lille område bliver tilgodeset i almen praksis.” (Kilde: TV-Syd den 21 juni 2004).

Denne hjemmeside er mit bidrag til oplysning om OCD.

New treatment guidlines for OCD by NICE

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Today The National Institute for Health and Clinical Excellence (NICE) in England published a new guidelines set to improve identification,diagnosis and treatment of obsessive-compulsive disorder in children and adults. Continue reading ‘New treatment guidlines for OCD by NICE’

Cipralex Lexapro mod OCD

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Medicinalfirmaet Lundbeck, der fremstiller SSRI/anti-depressiva præparatet Cipramil , har gennemført to fase 3 forsøg, der viser at deres efterfølger til Cipramil, Cipralex, har vist sig effektiv i behandlingen af Obsessive Compulsive Disorder. Lundbeck vil søge det europæiske lægemiddelagentur om godkendelse til at anvende Cipralex mod OCD.

Danish pharmaceutical group Lundbeck said on Monday that two Phase III studies had shown its anti-depressant Cipralex to be effective in treatment of obsessive-compulsive disorder (OCD).

I Danmark er det kun Zoloft (Sertraline) og Seroxat/Paxil (Paroxetine), der er godkendt til OCD behandling.

I USA forhandles Cipralex under navnet Lexapro af Forest Laboratories

Kilder: Reuters, Pharmalive

Behandling af behandlingsresistent OCD

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Det Lundbeck udviklet Ebixa (Memantin) har ifølge et mindre forsøg beskrevet i American Journal of Psychiatry vist sig effektivt i behandling af behandlingsresistent OCD. Præparatet er oprindeligt udviklet til behandling af demens, men som så mange andre former for farmaka har det vist sin effektivitet på andre områder.
Er Ebixa en up-coming blockbuster for Lundbeck ?

Kilde: Memantine for Treatment-Resistant OCD, Am J Psychiatry 162:2191-a-2192, November 2005

Virtual Reality Therapy

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Psychologist Dr. Deborah Serani, specialized in trauma and depression has written an interessting article about the futur in therapy and what it will bring. The treatment involves exposing a patient to a virtual environment containing the feared situation rather than taking the patient into the actual environment or having the patient imagine the anxiety promoting situation.
Continue reading ‘Virtual Reality Therapy’

New layout

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OCDinfo is getting a rewamp so expect some erorrs……sry

OCDinfo er ved at få et nyt design…igen igen…denne gang anvender jeg Squible K2 . Der kan godt opstå et par tekniske problemer de næst par dage….beklager

OCD gene ?

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Is the SERT gene responsible for OCD? And what is SERT ?

The SERT gene is located on chromoson 17. The SERT codes for a serotonin transporter protein. Its a mutation in the SERT protein that might cause problems - its transportation of the serotonin that is affected. People suffering from OCD, autism, anorexia experience
a defective regulation of SERT resulting in proteins are “locked� into the activated state.

But it is importent to note, that this mutation is rare, and not responsible for these disorders in most individuals.

So you can not say that the OCD gene was found….

Read more:
Ozaki N, D Goldman, WH Kaye, et al.  2003.  Serotonin transporter missense mutation associated with a complex neuropsychiatric phenotype.  Molecular Psychiatry (8): 933-936.
“THE OCD GENE”, Popular Press v. Scientific Literature: Is SERT Responsible for Obsessive-Compulsive Disorder?
BBC Compulsion linked to faulty gene October 2003
BBC Gene for obsessive behaviour September 2002
MSNBC Gene found for obsessive disorder, Mutation affects how body uses serotonin, scientists say November 2003

According to UPI af teen girl from Illinois (USA) suffering from obsessive compulsive disorder, with a primary obsession of sex with obsessive and recurrent sexual urges, arousal and fantasies, has been declared a “sexually dangerous person” by the judicial system.


Technorati Tags: declared sexually dangerous person

In what may be a major milestone in Tourette’s Syndrome (TS) research, scientists at Yale School of Medicine and their colleagues have identified a gene called SLITRK1 that appears to contribute to some cases of TS, according to a report in the October 14 issue of Science.

“We now have rare mutations, expression and functional data, all supporting a role for this gene in Tourette’s Syndrome,” said senior author Matthew State, M.D., Harris Assistant Professor in the Yale Child Study Center and in the Department of Genetics at Yale. “This finding could provide an important clue in understanding Tourette’s on a molecular and cellular level. Confirming this, in even a small number of additional TS patients, will pave the way for a deeper understanding of the disease process.”

TS is a relatively common neurological disorder characterized by tics–involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. It affects as many as one out of 100 school age children. The tics begin in mid-childhood and peak at the start of adolescence. TS is not life threatening, but affected children commonly have other neuropsychiatric disorders including ADHD, obsessive-compulsive disorder or depression. State said TS patients swearing uncontrollably is actually uncommon, with only a small percentage of TS patients ever having this symptom.

Source: EurekAlert 13th October 2005

PANDAS hypothesis supported

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Det anerkendte engelske tidsskrift The British Journal of Psychiatry har publiceret en artikel om PANDAS, der understøtter teorien.
I Danmark er behandlingen af OCD, herunder PANDAS desværre meget mangelfuld eller helt ikke-eksisterende. Sundhedsministerien mener dog det modsatte.

Background Obsessions and compulsions may occur in the post-streptococcal disorders Sydenham’s chorea and paediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). The proposed mediators are anti-basal ganglia antibodies (ABGA).

Aims We tested the hypothesis that post-streptococcal autoimmunity may have a role in‘idiopathic’obsessive–compulsive disorder (OCD).

Method We examined 50 children with OCD for ABGA using enzyme-linked immunosorbent assay (ELISA) and western immunoblotting. The findings were compared with paediatric autoimmune (n=50), neurological (n=100) and streptococcal (n=40) controls.

Results The mean ABGA binding on ABGA binding on ELISA was elevated in the patient cohort compared with all control groups (P<0.005 in all comparisons). Western immunoblotting revealed positive antibody binding (as seen in Sydenham’s chorea) in 42% of the patient cohort compared with 2–10% of control groups (P<0.001 in all comparisons).

Conclusions Our findings support the hypothesis that central nervous system autoimmunity may have a role in a significant subgroup of cases of OCD. Further studyis required to examine whether the antibodies concerned are pathogenic.

Source: The British Journal of Psychiatry (2005) 187: 314-319, Incidence of anti-brain antibodies in children with obsessive–compulsive disorder

Updated 1st october:
BBC News 30 september 2005, Anxiety disorder ‘infection link’

Some cases of obsessive compulsive disorder in children may be a result of an immune reaction following an infection, scientists believe.
Researchers found children with OCD were more likely to have antibodies associated with streptococcal infection than those without the disorder.
But the joint Institute of Psychiatry and Institute of Neurology team said more research was needed.
The findings were reported in the British Journal of Psychiatry.
About 3% of the population suffers from the anxiety disorder, which is generally treated by drugs or cognitive behaviour therapy counselling.

Obsessive Compulsive Podcasting

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I did a search to find some OCD information on podcasting. Well, not much but here is what I found:

The Australian Radio station Triple M has a OCD show: obsessive compulsive behaviour….what crazy things do you do?

and I found a comedy site Obsessive Compulsive Comedy Show, Obsessive Compulsive Comedy Show Podpage, Obsessive Compulsive Comedy Show at Idiotwox.

About podcasting:
Podcasting Sites: Podcasting News, Idiotvox, Odeo, The Podcast Directory
How to: Get Started with Podcasts in 3 Steps, DR’ vejledning om Podcasting (Danish)
Software: Ipodder, Itunes

A new Long-Term Follow-up study about treatment of Obsessive Compulsive Disorder has some promissing results.

Objective: The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome.

Method: Undertaken at a university-based clinic, this study involved 48 participants (8-19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome.

Results: Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome.

Conclusions: The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis.

Source:
Cognitive-Behavioral Family Treatment of Childhood Obsessive-Compulsive Disorder: Long-Term Follow-up and Predictors of Outcome in American Academy of Child and Adolescent Psychiatry, October 2005.

OCD is not an anxiety disorder?

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New informations about the up-coming DSM-V diagnostic system has been published on different mental health news sites.

According to Pscyhiatric Times and Medscape Obsessive Compulsive Disorder is going to be removed from the ‘anxiety disorders’ and instead in DSM-V they create a new category: Obsessive-Compulsive Behaviors Spectrum !!! So bye bye to the anxiety for those who suffers from Obsessive Compulsive Disorder. I think not. They will still suffer from anxiety too, like people with depression and schizofreniac but the new category will perhaps be better?

New disorders will be OCBS Obsessive Compulsive Behaviors Spectrum or OCBD Obsessive Compulsive Behaviors Disorder.

The obsessive-compulsive behaviors disorders would include various disorders that share clinical features (obsessive thoughts or compulsive behaviors), course of illness, comorbidity, family/genetic transmission, neurocircuitry and treatment-response profile with OCD. These disorders may fall within three groupings: 1) repetitive behaviors to reduce anxiety focused on body image or sensations (i.e., body dysmorphic disorder, hypochondriasis); 2) repetitive behaviors to regulate arousal (i.e., pathological gambling, trichotillomania, compulsive-impulsive sexual behavior, compulsive-impulsive Internet usage); and 3) neurological disorders with basal ganglia impairment (i.e., Tourette’s syndrome, autism spectrum disorders).

Sources: New Developments in an Evolving Field By Eric Hollander, M.D., and Bernardo Dell’Osso, M.D., Psychiatric Times July 2005 Vol. XXII Issue 8; DSM-V Prelude Project: Research and Outreach and
Developing Guidelines for Treatment-Resistant OCD: An Expert Interview With Eric Hollander, MD.

OCD Scrupulosity

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Baltimore Times has published an article about Scrupulosity - an OCD basic type:

Most people with OCD exhibit symptoms such as continual hand-washing, hoarding and constant checking of doors, locks and appliances. These behaviors have been given popular exposure in the TV show Monk, about a detective with OCD, and movies like The Aviator, based on the life and compulsions of billionaire Howard Hughes.

For a smaller minority, however, OCD manifests itself as scrupulosity, “body dysmorphic disorder” (the preoccupation with one’s physical appearance), “olfactory reference syndrome” (body odor paranoia) or other less common phobias.

“Like all OCD behaviors there’s a spectrum of severity,” says Bruce Hyman, a psychotherapist in Hollywood, Fla., and co-author of The OCD Workbook: Your Guide to Breaking Free From Obsessive-Compulsive Disorder.

Hyman considers scrupulosity to be one of six basic OCD types, but adds that it’s comparatively rare. “I may get two cases a year,” he says. “For a guy who sees almost exclusively patients with OCD, that’s a very small number.”

Source: OCD suffers consumed by religion, Baltimore Sun, 9th september 2005

APA to publish OCD treatment guideline

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American Psychiatric Association (APA) is going to publish a guideline for treatment of
Obsessive-Compulsive Disorder. The guideline is expected 2006.

About APA guidlines:

APA practice guidelines are intended to assist psychiatrists in clinical decision-making and to improve patient care. They also document evidence available to determine appropriate care. A practice guideline is not a “standard of care.” The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available.

Guidelines available
Acute Stress Disorder and Posttraumatic Stress Disorder
Alzheimer’s Disease and Other Dementias of Late Life
Bipolar Disorder
Borderline Personality Disorder
Delirium
Eating Disorders
HIV/AIDS
Major Depressive Disorder
Panic Disorder
Psychiatric Evaluation of Adults
Schizophrenia
Suicidal Behaviors

Expected 2006
Substance Use Disorders
Obsessive-Compulsive Disorder




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