Obsessive-compulsive behavior

Beginning in the 1960s, ben2odia2epiae anxiolytics and hypnotics rapidly became the standard prescription dmg treatment. In the 1980s, buspkone [36505-84-7] (3), which acts as a partial agonist at the serotonin [50-67-9] (5-hydroxytryptamine, 5-HT) type lA receptor, was approved as treatment for generali2ed anxiety. More recently, selective serotonin reuptake inhibitors (SSRIs) have been approved for therapy of panic disorder and obsessive—compulsive behavior. 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

Brett PM, Curtis D, Robertson MM, Curling HM (1995) Exclusion of the 5-HTlA serotonin neuroreceptor and tryptophan oxygenase genes in a large British kindred multiply affected with Tourette s syndrome, chronic motor tics, and obsessive-compulsive behavior. Am J Psychiatry 152 437-440... 

Mechanism of Action A tricyclic antidepressant that blocks the reuptake of neurotransmitters, such as norepinephrine and serotonin, at CNS presynaptic membranes, increasing their availability at postsynaptic receptor sites. Therapeutic Effect Reduces obsessive-compulsive behavior. 

Mectianism of Action An antidepressant, anxiolytic, and antiobsessional agent that selectively blocks uptake of the neurotransmitter serotonin at neuronal presynaptic membranes, thereby increasing its availability at postsynaptic receptor sites. Therapeutic Effect Relieves depression, reduces obsessive-compulsive behavior, decreases anxiety. 

Swoboda, K.J. and Jenike, M.A. (1995) Frontal abnormalities in a patient with obsessive-compulsive disorder the role of structural lesions in obsessive-compulsive behavior. Neurology 45 2130-2134. 

Conditions in the immune system also seem to play a role in OCD. This connection arose because the development of a movement disorder called Sydenham s chorea, which occurs in children following a particular type of bacterial infection that causes rheumatic fever, also often produces obsessive-compulsive behaviors. 

Comings DE, Comings BG. Hereditary agoraphobia and obsessive-compulsive behavior in relatives of patients with Giles de la Tourette s syndrome. Br J Psychiatry 1987 15 195-199. 

Fluvoxamine Similar to above but approved only for obsessive-compulsive behavior ... 

Tourette s syndrome (TS) is a chronic neurological disorder characterized by motor tics, involuntary verbalizations, and obsessive-compulsive behaviors. The current treatment lends itself to the use of antipsychotic agents. However, these treatments are only effective in about 70% of the treated population.84-85 Nicotine potentiates the behavioral effects of antipsychotics in a number of animal models.86 Clinical trials are under way involving patients receiving both nicotine and antipsychotic agents and appear to be promising.87 To date, there have been no studies mentioning the use of lobeline in TS. 

Several lines of evidence show that dopamine (DA) is implicated in the mediation of some obsessive-compulsive behavior. Animal studies demonstrate that high doses of various dopaminergic agents, such as amphetamine, bromocriptine, apomorphine, and L-DOPA, induce stereotyped movements in animals, which resemble compulsive behaviors in OCD patients. Increased dopaminergic neurotransmission may be responsible for this. Human studies consistently report that abuse of stimulants such... 

Obsessive-compulsive behavior after oral cortisone has been described (106). 

A 75-year-old white man, without a history of psychiatric disorders, took cortisone 50 mg/day for 6 weeks for pulmonary fibrosis and developed severe obsessive-compulsive behavior without affective or psychotic symptoms. He was given risperidone without any beneficial effect. The dose of cortisone was tapered over 18 days. An MRI scan showed no signs of organic brain disease and an electroencephalogram was normal. His symptoms improved 16 days after withdrawal and resolved completely after 24 days. Risperidone was withdrawn without recurrence. 

Zombielike (robotic) behavior with loss of emotional spontaneity Obsessive-compulsive behavior Convulsions... 

Meanwhile, the stimulants have no proven therapeutic effect beyond the first few weeks of behavioral suppression with enforced docility and compulsivity. Furthermore, they have no positive impact on learning, academic progress, or socialization. Instead, they disrupt learning by causing abnormal overfocusing, and they often induce obsessive-compulsive behavior, depression, and social withdrawal. 

Reduction of tics and obsessive-compulsive behaviors (reviewed by Muller-Vahl 2003)... 

Impulse control problems Obsessive-compulsive behaviors Panic attacks... 

Undoing Action to symbolically reverse the unacceptable Fixing or repairing, obsessive-compulsive behaviors... 

Sertraline, which was introduced in 1992, has a similar mechanism, yet it may offer some advantage over fluoxetine by exhibiting little CNS action (i.e., it has less sedation and anxiety and is shorter acting). Both drugs show promise in the treatment of obesity and obsessive-compulsive behavior. 

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