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Treatment for Obsessive compulsive disorder (OCD)

There are some treatments for OCD with the two principal ones being psychotherapy and medications. The treatment people choose depends on the personal situation and preferences. Research shows that combination of medications and psychotherapy is better.

The psychotherapy for obsessive-compulsive disorder is called cognitive behavioral therapy. This therapy works retraining thought patterns and routines so that compulsive behaviors are no longer necessary. One kind of CBT approach is called exposure and response prevention. This therapy is effective exposing the patient to a feared object or obsession, such as dirt, and teaching ways to calm the anxiety. It is important that with this technique patient learn to manage the obsessions and compulsions. Participation of family is essential; patient should feel the support of his family.

Antidepressants are the most commonly prescribed for OCD because they may help increase levels of serotonin, a monoamine neurotransmitter derived from tryptophan which may be lacking in people with OCD. There are some other medications like clomipramine, fluvoxamine, fluoxetine, sertraline and paroxetine. “The neurophysiological bases of cognitive-behavioral therapy (CBT) for obsessive–compulsive disorder (OCD) are not completely understood. Previous studies, though sparse, implicate metabolic changes in pregenual anterior cingulate cortex (pACC) and anterior middle cingulate cortex (aMCC) as neural correlates of response to CBT.” The objetive of one study was to determine the relationship between levels of the neurochemically interlinked metabolites glutamate + glutamine (Glx) and N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (tNAA) in pACC and aMCC to pretreatment OCD diagnostic status and OCD response to CBT. The results of the pilot study was that comorbid depressive symptoms in OCD patients may have contributed to metabolic effects, although baseline and post-CBT change in depression ratings varied with choline-compounds and myo-inositol rather than Glx or tNAA.

Psychosurgery can be a controversial treatment as it essentially involves destruction of a small part of the brain. Part of the controversy of course stems from the now discredited prefrontal lobotomy procedure and other surgical procedures that took place from the mid 1930s to the 1950s. These procedures were overzealously performed at the time on "disorders" such as schizophrenia, homosexuality, depression, developmental childhood disorders, criminals, etc. A prefrontal lobotomy is a surgical procedure in which the frontal lobes of the brain are irreversibly severed. This procedure was discredited because of limited effectiveness, and very common and severe side effects such as death, personality change, intellectual impairment, lack of emotional responsiveness, paralysis, etc. The doctor, named Moniz, who discovered prefrontal lobotomies — sadly received a Nobel Prize — making it a good case study for anyone who believes that modern medicine has all the answers. Modern medicine and psychiatry are much different today than in years past, with many more safeguards in place to prevent such travesties (although, perhaps the doctors who performed prefrontal lobotomies at the time believed such things too). The danger with extreme, and new treatments always remains though, no matter the level of prevention used.

One must remember that there are many options before psychosurgery, and most people do respond to medication or behavioral therapy. Nonetheless, some people have treatment-resistant OCD. In such cases, surgery should be considered.

The neuroanatomy of OCD is becoming increasingly better understood (there is however much more to learn). Through brain imaging studies doctors can see brain activity, lending evidence to which parts of the brain are affected in patients with OCD. The evidence seems towards the limbic system and its connection with the basal ganglia. The most commonly used psychosurgical treatments for OCD in the United States involve the use of radio-frequency waves to destroy a small amount of brain tissue, which disrupts a specific circuit in the brain that has been implicated in OCD. This area is the corticostriatal circuit, and it is comprised of the orbitofrontal cortex, the caudate nucleus, the pallidum, the thalamus, and the anterior cingulate cortex.

Surgical techniques for this purpose include anterior cingulotomy, capsulotomy limbic leukotomy These are generally safe procedures that do not usually effect a patient's memory or intellect. Cingulotomy, capsulotomy, and limbic leucotomy all appear to be equally effective, with cingulotomies believed to be the safest. Long-term outcomes of these procedures appear to be somewhere between 25 and 70 percent effective (depending on how strict the criteria) in alleviating the symptoms of treatment refractory OCD. Other less permanent brain-based techniques include vagus nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation.