Obsessive compulsive disorder symptoms

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. 

Mechanism of Action An antidepressant and antiobsessive agent that selectively inhibits neuronal reuptake of serotonin. Therapeutic Effect Relieves depression and symptoms of obsessive-compulsive disorder. 

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... 

Alsobrook, I.J., Leckman, J.F., Goodman, W.K., Rasmussen, S.A., and Pauls, D.L. (1999) Segregation analysis of obsessive-compulsive disorder using symptom-based factor scores. Am J Med Genet 88 669-675. 

Eapen, V., Robertson, M.M., Alsobrook, J.R, 2nd, and Pauls, D.L. (1997) Obsessive compulsive symptoms in Gilles de la Tourette syndrome and obsessive compulsive disorder differences by diagnosis and family history. Am Med Genet 74 432 38. 

Greenberg, B.D., Benjamin, J., Martin, J.D., Keuler, D., Huang, S.J., Altemus, M., and Murphy, D.L. (1998) Delayed obsessive-compulsive disorder symptom exacerbation after a single dose of a serotonin antagonist in fluoxetine-treated but not untreated patients. Psychopharmacology 140 434-444. 

Rauch, S.L., Jenike, M.A., Alpert, N.M., Baer, L., Breiter, H.C., Savage, C.R., and Fischman, A.J. (1994) Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry 51 62-70. 

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. 

TABLE 39.1 Symptoms of Obsessions and Compulsions in Children, Adolescents, and Adults with Obsessive-Compulsive Disorder... 

Fennig, S., Fennig, S., Pato, M., and Weitzman, A. (1994) Emergence of symptoms of Tourette s syndrome during fluvoxamine treatment of obsessive-compulsive disorder. Br J Psychiatry 164 839-841. 

Paroxetine. Paroxetine, also a serotonin reuptake inhibitor, has been the subject of a case report in two subjects. Ringold [1994] reported the effective treatment of two individuals who had not responded to prior therapy with fluoxetine and sertraline. Both individuals had comorbid psychiatric problems. Subject A demonstrated both social phobia and dysthymia. Although her symptoms of dysthymia were clinically responsive to fluoxetine therapy, her social phobia symptoms were resistant. Subject B had body dysmorphic disorder, obsessive-compulsive disorder, and social phobia. His obsessive-compulsive disorder symptoms benefited from fluoxetine therapy, but his social anxiety was resistant. Sertraline therapy was attempted in both subjects. Subject A required discontinuation because of adverse effects. Subject B experienced a worsening of both obsessive-compulsive disorder and social phobia symptoms. Both subjects demonstrated a positive response in their symptoms when switched to paroxetine [20 mg/day]. 

Phillipps was an individual with symptoms of classic obsessive-compulsive disorder. He never threw away a scrap of paper, hoarding household bills and copies of correspondences. Although he collected... 

Obsessive-compulsive symptoms. Clozapine has been reported to exacerbate symptoms of obsessive-compulsive disorder, probably because of 5-HT2 antagonism (Ghaemi et al. 1995). If this effect occurs, symptoms are usually controlled with the addition of an SSRI. 

Pato M, Zohar-Kadouch R, Zohar J, et al. Return of symptoms after discontinuation of clomipramine in patients with obsessive-compulsive disorder. Am J Psychiatry 1988 145 1521-1525. 

Patients with this disorder not only have a disturbed eating pattern but also problems with impulse control, often resulting in drug or alcohol abuse, self-mutilation, kleptomania, and sexual disinhibition. They also may have symptoms of obsessive-compulsive disorder or obsessive-compulsive personality disorder ( 498). In these individuals, manipulation of food is associated in varying degrees with alcohol and drug abuse. They are typically poor candidates for pharmacotherapy and, not surprisingly, have been unresponsive to a variety of psychotropics. 

There were two cases of hypertension from the United States, or possible serotonin syndrome reported with fluvoxamine while on St. John s wort concomitantly. A 44-year-old male with obsessive-compulsive disorder received fluvoxamine and experienced severe hypertensive crisis (160-170/ 120mmHg) after two tablets of St. John s wort. The physician stated that the reaction was probably due to the combination of fluvoxamine and St. John s wort, which has MAOI activity. A 38-year-old male was on fluvoxamine for approximately two months and hypericum 600 mg daily for approximately two weeks before reporting possible serotonin syndrome with severe bitemporal headache. He was hospitalized to rule out myocardial infarction. There were no electrocardiogram (EKG) changes or apparent causative pathology. Symptoms resolved on discontinuation of both drugs. 

Some of the growth in antidepressant use may be related to the broad application of these agents for conditions other than major depression. For example, antidepressants have received FDA approvals for the treatment of panic disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In addition, antidepressants are commonly used to treat pain disorders such as neuropathic pain and the pain associated with fibromyalgia. Some antidepressants are used for treating premenstrual dysphoric disorder (PMDD), mitigating the vasomotor symptoms of menopause, and treating stress urinary incontinence. Thus, antidepressants have a broad... 

Fluoxetine Highly selective blockade of serotonin transporter (SERT) little effect on norepinephrine transporter (NET) Acute increase of serotonergic synaptic activity slower changes in several signaling pathways and neurotrophic activity Major depression, anxiety disorders panic disorder obsessive-compulsive disorder post-traumatic stress disorder perimenopausal vasomotor symptoms eating disorder (bulimia) Half-lives from 15-75 h oral activity Toxicity Well tolerated but cause sexual dysfunction Interactions Some CYP inhibition (fluoxetine 2D6, 3A4 fluvoxamine 1A2 paroxetine 2D6)... 

---