Obsessive-compulsive disorder behavioral

Obsessive-Compulsive Disorder Behaviors from on Evolutionary Perspective... 

Obsessive-Compulsive Disorder (OCD). In theory, distingnishing the obsessions and compnlsive ritnals of OCD from the delusions and behavioral peculiarities of schizophrenia shonld be straightforward. Usually, the OCD patient is aware of the excessive natnre of his/her obsessions and wishes to be rid of them. The delusional patient with schizophrenia is nnaware that these false beliefs are not based in reality and clings to them tenacionsly. However, a few OCD patients lose the insight that their obsessions are excessive. At this point, the distinction between obsession and delnsion often becomes blnrred. 

Panic disorder is characterized by the occurrence of panic attacks that occur spontaneously and lead to persistent worry about subsequent attacks and/or behavioral changes intended to minimize the likelihood of further attacks. Sporadic panic attacks are not limited, however, to those with syndromal panic disorder as they do occur occasionally in normal individuals and in those with other syndromal psychiatric disorders. The hallmark of panic disorder is that the panic attacks occur without warning in an unpredictable variety of settings, whereas panic attacks associated with other disorders typically occur in response to a predictable stimulus. For example, a person with acrophobia might experience a panic attack when on a glass elevator. A patient with obsessive-compulsive disorder (OCD) with contamination fears may have a panic attack when confronted with the sight of refuse, and a combat veteran with post-traumatic stress disorder (PTSD) may experience a panic attack when a helicopter flies overhead or an automobile backfires. 

Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ (1998) Behavioral versus pharmacological treatments of obsessive compulsive disorder a meta-analysis. Psychopharmacology (Berl) 136 205-216... 

Mechanism of Action An antidepressant, anxiolytic, and obsessive-compulsive disorder adjunct that blocks the reuptake of the neurotransmitter serotonin at CNS neuronal presynaptic membranes, Increasing its availability at postsynaptic receptor sites. Therapeutic Effect Relieves depression, reduces obsessive-compulsive behavior, decreases anxiety... 

Although genetic influences on the dynamics of drug response have been studied in a wide range of disorders, most of the studies have been carried out in only the past few years. Disorders and behaviors studied include Alzheimer s disease, schizophrenia, depression, suicide, anxiety, obsessive-compulsive disorder (OCD), substance abuse, smoking, and alcoholism. Across these disorders, however, there has been a focus on only a handful of neuroeffector systems. These include apolipoprotein and the cholinergic system (in Alzhei-... 

Obsessive-compulsive disorder is a disorder of the frontal-subcortical system. A characteristic of this group of disorders is a complex interaction between the exogenous and endogenous stimuli and the neural systems that link stimuli to cognitive and behavioral responses. Although cortical dysfunction cannot be excluded as a basis for OCD symptoms, there is evidence that basal... 

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. 

Geller, D.A., Biederman, J., Griffin, S., Jones, J., and Lefkowitz, T.R. (1996) Comorbidity of juvenile obsessive-compulsive disorder with disruptive behavior disorders. / Am Acad Child Adoles Psychiatry 35 1637-1646. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

McDougle, C.J., Kresch, I.E., Goodman, W.K., Naylor, S.T, Volk-mar, F.R., Cohen, D.J., and Price L.H. (1995) A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry 152 772-777. 

Rosenberg, D.R., Benazon, N.R., Gilbert, A., Sullivan, A., and Moore, G.J. (2000) Thalamic volume in pediatric obsessive-compulsive disorder patients before and after cognitive behavioral therapy. Biol Psychiatry 48 294-300. 

Franklin, M.E., Kozak, M.J., Cashman, L.A., Coles, M.E., Rhein-gold, A.A., and Foa, E.B. (1998) Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder an open clinical trial. / Am Acad Child Adolesc Psychiatry 37 412—419. 

March, J. (1998a) Cognitive behavioral psychotherapy for pediatric OCD. In Jenike, M., Baer, L., and Minichello, , eds. Obsessive-Compulsive Disorders 3rd ed. Philadelphia Mosby, pp. 400 20. 

March, J., Mulle, K., and Herbel, B. (1994) Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder an open trial of a new protocol driven treatment package. J Am Acad Child Adoles Psychiatry 33 333—341. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

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