Psychiatric disorders obsessive compulsive disorde

Antidepressants are small heterocyclic molecules entering the circulation after oral administration and passing the blood-brain barrier to bind at numerous specific sites in the brain. They are used for treatment of depression, panic disorders, generalized anxiety disorder, social phobia, obsessive compulsive disorder, and other psychiatric disorders and nonpsychiatric states. 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

Otto, M., Normal and abnormal information processing A neuropsychological perspective on obsessive compulsive disorder. Psychiatric Clinics of North America 15(4), 825-848, 1992. 

Carlsson, M.L. On the role of cortical glutamate in obsessive-compulsive disorder and attention-deficit hyperactivity disorder, two phenomenologically antithetical conditions. Acta Psychiatr. Scand. 102 401, 2000. 

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. 

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. 

Appropriate management of AN also requires the early detection and treatment of any comorbid psychiatric disorders. The most common comorbid conditions associated with AN are major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and substance use disorders. At the time of presentation, over 50% of AN patients also fulfill criteria for MDD however, accurate diagnosis of depression in these patients is complicated by the fact that prolonged starvation often produces a mood disturbance and neurovegetative symptoms identical to MDD. If MDD appears to be comorbid with AN at the time of presentation, there is debate as to whether it is more prudent to withhold treatment of the depression until weight restoration has been initiated. If the depression persists despite refeeding, then treatment of the depression is likely warranted. 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

Billett EA, Richter MA, Sam F, Swinson RP, Dai XY, King N, Badri F, Sasaki T, Buchanan JA, Kennedy JL (1998) Investigation of dopamine system genes in obsessive-compulsive disorder. Psychiatr Genet 8 163-169... 

Camarena B, Cruz C, de la Puente JR, Nicolini H (1998) A higher frequency of a low activity-related allele of the M AO-A gene in females with obsessive-compulsive disorder. Psychiatr Genet 8 255-257... 

Kinnear C, Niehaus DJ, Seedat S, Moolman-Smook JC, Corfield VA, Malherbe G, Potgieter A, Lombard C, Stein DJ (2001) Obsessive-compulsive disorder and a novel polymorphism adjacent to the oestrogen response element (ERE 6) upstream from the COMT gene. Psychiatr Genet 11 85-87... 

Baxter, L.R., Jr. (1992) Neuroimaging studies of obsessive compulsive disorder. Psychiatr Clin North Am 15 871-884. 

Denckla, M. (1989) Neurological examination. In Rapoport, J., ed. Obsessive-Compulsive Disorder in Children and Adolescents. Washington, DC American Psychiatric Press, pp. 107-115. 

The past decade has seen a renewed emphasis on the range of neurological and psychiatric symptoms seen in TS patients. Symptoms associated with obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) have received the most attention. 

Cummings, J.L. and Cunningham, K. (1992) Obsessive-compulsive disorder in Huntington s disease. Biol Psychiatry 31 263-270. Denckla, M.B. (1989) Neurological examination. In Rapoport, J.L., ed. Obsessive-Compulsive Disorder in Children and Adolescents. Washington, DC American Psychiatric Press, pp. 107-118. Douglass, H.M., Moffit, T.E., Dar, R., McGee, R., and Silva, P. (1995) Obsessive-compulsive disorder in a birth cohort of 18 year olds prevalence and predictors. / Am Acad Child Adoles Psychiatry 34 1424-1431. 

Fitzgerald, K.D., MacMaster, F.P., Paulson, L.D., and Rosenberg, D.R. (1999) Neurobiology of childhood obsessive-compulsive disorder. Child Adolesc Psychiatr Clin North Am 8 533—575. 

Karno, M. and Golding, J. (1991) Obsessive compulsive disorder. In Robins L. and Regrer, D.A., eds. Psychiatric Disorders in America The Epidemiological Catchment Area Study. New York The... 

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Thomsen, P.H. and Mikkelsen, H.U. (1991) Children and adolescents with obsessive-compulsive disorder the demographic and diagnostic characteristics of 61 Danish patients. Acta Psychiatr Scand 83 262-266. 

Alderman, J., Wolkow, R., Chung, M., and Johnston, H.R (1998). Sertraline treatment of children and adolescents with obsessive-compulsive disorder or depression pharmacokinetics, tolerability, and efficacy./ Am Acad Child Adolesc Psychiatry 37 386—394. American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC American Psychiatric Association Press. 

Hewlett, W.A. (1993) The use of benzodiazepines in obsessive compulsive disorder and Tourette s syndrome. Psychiatr Ann 23 309-316. 

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