Category Archives: OCD

Compulsions and Obsessions in OCD, – what comes first?

Now those of you who are suffering, or who knows of someone who is suffering with OCD or Obsessive Compulsive Disorder, will probably be under the impression that the compulsions associated with OCD are a result of an underlying anxiety and/or fear.

Now new evidence is challenging that view that it is the anxiety that comes first and is suggesting that the behaviours, such as obsessive hand washing, ritual cleaning routines, constant checking and rechecking doors and locks and any number of other repetitive behaviours are actually what come first and the obsessions, or anxiety and fears underpinning them, are just a way for the brain to justify those behaviours.

The study was carried out at the University of Cambridge along with the University of Amsterdam and involved 20 people with Obsessive Compulsive Disorder and 20 control subjects without the disorder.

As part of the research each person was asked to carry out a task which was designed to identify any tendency towards repetitive behaviours, or compulsions as they are often called.

Science Daily reports that they subjects were required to learn simple associations between stimuli, behaviours and outcomes to win points as part of the task.

Interestingly, the researchers found that people with OCD displayed a tendency to carry on with the behaviour regardless of whether the behaviour had a positive outcome or not. In other words they developed the “habit” of repeating the tasks just for the sake of it.

The researchers then made the assumption that the fact that the compulsions continued despite no associated fear or anxiety behind them suggested that the compulsions themselves are the main feature of OCD and not the anxiety or fears associated with them.

“It has long been established that humans have a tendency to ‘fill in the gaps’ when it comes to behaviour that cannot otherwise be logically explained” said Claire Gillan, a PhD student at the University of Cambridge.

“In the case of OCD, the overwhelming urge to senselessly repeat a behaviour might be enough to instil a very real obsessive fear in order to explain it” she said.

The research, which was funded by the Wellcome Trust, has been published in the American Journal of Psychiatry.

Hoarders May Soon Have Their Own Disorder

Whilst hoarding may not be an official psychiatric disorder this now looks set to change in 2013. Then a decision will be made about its new status with University of Pennsylvania therapists playing a major role in the decision. Seven different institutions have been selected as field trial sites for a new edition of a manual of mental disorders.

The manual is titled Statistical Manual of Mental Disorders (DSM-5.)

The manual itself has gotten it wrong in the past with homosexuality once included it in its folds.

Real World

It is all about seeing how the real world realities of the condition pertain to it being a psychological disorder of its own, with the therapists of the outpatient mental health clinic at Penn performing tests to determine if the manual is accurate in this real world. The manual will contain hoarding as a disorder of its own for the first time.

It will be determined if the therapists agree or not with the splitting up of binge eating, personality disorders, anxious depression, generalized anxiety disorder, OCD and also hoarding into their own definitive condition diagnosis.

Distinguish

The document itself is 943 pages long, and is a marker of how normal society distinguishes illness from eccentricity and normal behaviour. The Penn Psychaitrist who will lead the trials; Mahendra Bhati said, “The challenge is to more clearly define mental illnesses within the context of culture.”

It is only when significant problems are caused that behaviour of feelings is considered as an illness. Defining a hoarder is difficult when you take the example of a man who has a room devoted to sports memorabilia who may be known as a collector, against a person who has their home choc a block full of Beatles memorabilia to the point that it cant be used would be determined to be a hoarder.

Lumped In

To date hoarding has always been treated lumped in with OCD. Mahendra said, “What research is showing is that hoarders are probably different than people with classic obsessive-compulsive disorder. He continued stating that, “People with OCD often fear contamination and know they have a problem, whilst many hoarders think they’re fine and are not driven by anxiety.”

Background

Hoarding does not only occur within humans but is evident in the behaviour patterns of many animals also. Hoarding and caching occur where there is a natural requirement for the amassment of food and other substances, However when we look at magpies we can see that there is nothing necessary about the hoarding of items.

Magpies have been long known to b attracted towards the collection of items that are utterly useless to them. They hoard shiny items in particular such as coins and jewellery. In the human condition there is a need to amass a great deal of items, in particular during times of civil unrest, such as times of natural disaster or in preparation for this, anything from a rumour that a natural disaster is impending is enough to set it off.

This may be down to the hoarding of particular foodstuff and water supplies. Hoarding is of course as this change in the manual suggests a mental illness. It is the repercussion of obsessive compulsive disorder, where there is far more value placed on items than is the case based on their real value. Many homes of hoarders need to be treated for vermin as a consequence of excessive hoarding.

Often the condition of hoarding is not fully realised by the loved ones of the persons until after the persons’ death. The person is likely to be embarrassed by their affliction and will avoid social contact or having people round to the house based on the state of disarray.

Radio-Surgery May Offer New OCD Treatment Option

Radio-surgery may now be an alternative treatment method for persons who have failed to get better after other forms of treatment for OCD, according to a new study.

The research has been undertaken by University of Pittsburgh scholars, who have used radio-surgery on three patients suffering from very severe (medically refractory) forms of the mental condition.

They have achieved very promising results.

Difficult Cases

There is of course further research necessitated, but it is believed by author of the study Dr Douglas Kondziolka that this is a means to provide a new treatment alternative in difficult cases.

A male and two females have been treated by them, in both cases the OCD was very severe with two of the patients scoring in the very high range (39 and 40) on the OCD scale. They had each taken numerous medications, but all three still had high symptom levels after this form of treatment. It was when none of the medication treatments on offer worked that the three moved to be treated via radio-surgery.

Gamma Knife

In radio-surgery a gamma knife is used delivering an intense beam containing radiation at the targeted area of the brain that is directly responsible for OCD symptoms. In this case the area is the anterior cingulated cortex.

Careful evaluation took place first before the procedure was enacted, the request for surgery of this nature had to be made by the individuals themselves, and it had to be the case that the individuals were at the higher end of the OCD scale in order to receive treatment. Also two psychiatrists had to recommend that this was the best means of treatment.

No Complications

On evaluation after the procedures it was determined that there were no complications evident. The scientists have only now published the report on the surgery types’ success, due to their determination to ensure there were no complications.

The surgery itself was performed more than four years ago. The patients having been reassessed over this period to ensure there were no long term complications.

Significant Improvement

It has been noted that of the three who underwent the surgery, all of them displayed significant functional improvements and a reduction in behaviours that OCD manifests. It was noted too that the improvements took some time to demonstrate themselves, the benefits of the surgery being realised only months after the surgery, with benefits peaking between two and four months after the conduction of the surgery.

Medication Still Needed

It was required that all of the patients needed to continue taking their medication in the wake of the surgery also, with one individual who stopped taking the medicine experiencing the symptoms worsen again.  Whilst this is all still in the preliminary stages, the results are suggesting that this is a credible treatment option for severe OCD cases.

Drawbacks

It may not all be beneficial however, it should be noted by anyone with OCD looking to take this treatment option that the effects of the surgery are irreversible, and there is no adjustment time to stimulation levels. This means that the individual goes straight into a position of being affected by the operation directly after the going for the operation. Other forms of treatment do allow for a certain amount of time to develop an understanding in the body for what is going on i.e. with medications there is a lead in time before the effects of the medication are realised.

The lead author is adamant that there still needs to be wide reaching research carried out in order for radio-surgery to be widely recommended to OCD patients.

Old Drug Takes on New Use in OCD Battle

New advances in the production of effective therapies for OCD in children are being made.

Paediatric-onset obsessive compulsive disorder has undergone a great deal of research of late.

It has been determined that there are many commonalities between the condition and Tourette’s disorder.

Many Similarities

They share a multitude of similarities, regarding their physical features, the way in which they can both be treated, and the genetic factors which play a part in determining their existence in the young patient are very similar also.

Not Enough

The authors of a new study into the domain of childhood OCD are still adamant however that not enough study has been conducted into this area, as yet there are very limited moderators, validated predictors and methods of treatment response.

Riluzole

Whilst the drug Riluzole has been used for the treatment of ALS, it is now also being looked at for the treatment of psychiatric conditions of this type.

Currently there is an ongoing clinical trial into its safety, and its effectiveness being used in this new way.

It is believed that it can work to stop many of the OCD symptoms, by blocking the glutamate release from the nerve cells. Of course side effects in particular with children are a concern and the drug is known to potentially cause pancreatitis.

Other Developments

New drugs may also come from the developments in the brain imaging technology used in assessing the functionality of an individual’s brain circuits. These modern brain imaging techniques such as PET and MRI have become instrumental in moving forwards in many fields of science and medicine.

MRI stands for Magnetic Resonance Imaging. It is used to determine change in the brain from any number of factors.  The beauty of the MRI scan is that there is no need to give the patient a radioactive substance into their bodies before the scan can take place, meaning that it is as safe as an XRAY, and far less intrusive than the PET system.

Functional MRI

The functional MRI can itself be used to measure brain activity without the need for radioactivity. To show a variation in the workings of the brain, it directs its attention towards blood flow within the brain, it can detect changes in this blood flow. This blood flow is a useful indicator, as when there is a sudden change in activity in one area of the brain, there is a consequent rush of blood to this area.

This is all done in real time, and its further use will have many positive outcomes for OCD patients in the future when it comes to seeing in real time the effect of the researched drug on the specific area of the brain being targeted. Advances in science on this end have been dramatic and it is

Visualisation

MRI allows for internal structures to be visualised in detail, and uses a powerful magnetic field that is generally seen as being harmless to the patient, as the MRI does not use ionizing radiation like used in X-rays or in CT scans.

It is the MRI ability to show through the sharp contrasts between muscle and bone that make it most useful in the medical profession. This ability makes it a superior means of imaging the heart and brain than any other method.

Its development is not brand new, but it has taken some decades for the mechanics of the MRI to become widely affordable, the first image produced by this means was in 1973.

It is in MRI’s contrast resolution that its larger benefits are noticed against other technologies in the sector, in that it has the ability to distinguish between very closely aligning structures as would be a norm in the human body.

Electrode Therapy Provides New OCD Combat Tool

Use of electrodes to stimulate areas deep in the brain has been uncovered as an alternative therapy for OCD sufferers who are resistant to other treatment types. It is a third means of treatment with pre-existing means being medication and cognitive behavioural therapy.

The two types of treatment mentioned are only effective for the bare majority of patients with 60% of sufferers experiencing a benefit by this means.

It is estimated that 10% of patients are severely affected by OCD despite using both of these treatment options. A reassessment of the safety of electrode use has been enacted by Damianna Denys of the University of Amsterdam. Also assessed was the effectiveness of the treatment type.

16 Study Participants

16 patients were taken who had symptoms of OCD, yet had not been cured after being in receipt of the other treatments for an extended time.

There were three treatment phases in the study, with the study taking place over an eight month period. Electrodes were implanted in the nucleus accumbens of the patients. This area of the brain is critical for our reward systems. Once implanted,

All participants received active stimulation to these electrodes. An assessment of their OCD symptoms was made every two weeks.

Blind Phase

After this eight month period (Open Phase) all of the participants were invited to partake in a double blind phase lasting one month. This double blind phase meant, that there was a random assignment made to have the electrodes turned on or off in blocks lasting two weeks.

Assessment occurred prior to the double blind phase, and at the end of each of these two week blocks. A 12 month maintenance phase followed.

In this maintenance phase, stimulation resumed with assessment only now occurring every three months.

Ranking

The ranking of OCD symptoms comes in the range of 0 to 40. If there was a score that showed a drop of more than 35% then these patients were classified as having responded to treatment. During the (open phase) of this study there was much improvement in symptoms noted, with the average score seeing a decrease of 46% of symptoms.

9 of the 16 participants showed a drop in symptom presentation of around 72%. It was found that depressive symptoms decreased by one half, with the stimulation being well received and tolerated by the participants.

Still Adverse Effects

There were however some permanent adverse effects of the OCD still present in these people, most notably word finding problems and mild forgetfulness.

It was uncovered during the double blind phase in which 14 of the patients were included, that there was a difference in the rate of response to the placebo stimulation and the real stimulation.

Lasting Improvement

Here there was a decrease in the presence of symptoms of between 8.3 and 25%. It was found that the improvements made were sustained during the maintenance phase of the study.

The research authors have noted that in summary there is an indication as a result of the study that bilateral stimulation of the nucleus accumbens may be an effective and also a safe treatment in patients whose OCD is highly refractory.  Safe is the key detail in this instance and what the scientists are delving to unearth. With any degree of stimulation being emitted into the body there is the potential for harm and stimulating particular regions of the brain through direct contact with electrodes is dangerous for obvious reasons.

It was found also that there is a support mechanism here for patients and doctors, another means of treatment beyond the cognitive techniques and the medication. There is in other words therapeutic potential in patients with incapacitating chronic psychiatric disorders such as OCD.

New Biography Reports Dickens Had OCD

It seems that Charles Dickens himself suffered from a form of OCD according to research on his writings.

It has been determined that he used a routine that was in many ways ritualistic in his domestic life, as well as taking an obsessive approach to his work.

Both of these activities are consistent with OCD (Obsessive Compulsive Disorder.)

A new biography has provided the revelation, and in this biography many of the characters which he developed it is believed show that the OCD symptoms manifested themselves onto his written page.

Furniture Movement

It had been noted already that Dickens went through a process of rearranging the furniture in any hotel room he stayed in. He would also perform an inspection on his children’s bedrooms each morning. The evidence is in notes which he left remarking on their untidy state, a state which seemed to leave him deeply unsatisfied.

Genius

Emeritus professor of Victorian literature in Birbeck College London Michael Slater is the author of the new biography. It is entitled Charles Dickens the Genius.

It was found that this genius behaviour can indeed be traced back, right to his childhood. A childhood which frequently saw him and his family being forced to move due to the poverty they experienced.

In Control

This author has stated that the desire of Dickens to be in control may have been effected by these moves, a wanting to control his life a recurrent thought that forced his OCD tendencies to show their-selves in his life and in his work.

Slater also believes that one of Dickens’ chief characters Little Dorrit was a reflection of the character of Dickens himself. Little Dorrit was the main character in his book by the same name.

Quotation Evidence

He quotes from the book as evidence stating that the lines: There she is the epitome of neatness, in the squalid atmosphere of the Marshalsea prison, making order and making her father comfortable and sweeping and cleaning and tidying all the time.

The semi autobiographical David Copperfield written by Dickens he believes also contains irrefutable evidence of an underlying OCD condition.

Governed by Neatness

Slater has many reasons behind his belief, in particular Dickens’ attitude to women where all doings in relation to the opposite sex were controlled and governed by neatness.

OCD is an anxiety disorder that is experienced by many living and past famous people. It can in fact lead a person to perform above and beyond the abilities of regular individuals just like Charles Dickens did in his life.

Other Famous Sufferers

Other performers of note who rose to notoriety despite the disability are Charles Darwin, whose illness has been the subject of many studies. His affliction in this regards was very severe resulting in his incapacitation at the age of 28. It is speculated that is condition was in fact OCD.

American aviator Howard Hughes who became one of the worlds’ greatest industrialists, film directors and indeed one of the worlds’ richest persons, also suffered from the psychiatric condition. He showed in his life many of the symptoms in spite of his fame, and this included behaviour pertaining to an avoidance of the public.

Academy award winner Billy Bob Thornton is one of the most famous living sufferers of the condition. Whilst he admits that even he would have difficulty in explaining some of the worst effects of the condition on his life, it actually aided him in finding a solid friendship when he fell for fellow OCD sufferer Rocker Warren Zevon.

The condition is prevalent in women too and it can be seen that it can also affect the beautiful. Both Cameron Diaz and Jessica Alba have mild forms of OCD, and the pair actually look on the condition as helping them perform better. This is as the condition itself makes one more detail specific where perfection is a must.

Brain Clutter Filter Identified OCD

New hope has been brought to patients suffering from conditions ranging from obsessive compulsive disorder to ADHD and Tourettee Syndrome, thanks to new research.

The research suggests that an identification of the filters that can remove the feelings of brain clutter these persons complain of has been made. Whilst when damage to the prefrontal cortex of the brain is increasingly becoming associated with a loss of inhibition, inappropriate behaviour and impulsivity the reasons why have remained elusive to date.

This has made it very difficult for the treatment and diagnosis of patients.

Commenting on the new research is Julia Martinez-Trujillo who is a professor at McGill University Department of Physiology. She is also the Chair of Visual Neuroscience in Canada. With the research there is now a backed up belief that ‘brain clutter’ experienced by those where there is abnormal activity in the prefrontal cortex, is driven by a break-down of performance of specific types of brain cells.

Filters

Neurons have been identified contained in the dorsolateral sub region of this part of the brain, which act in filtering out based on a selection process, visual information that is not important.

We need to rid ourselves of the unimportant information to function normally, and these filters act in this manner, ‘the filter neurons’ strongly inhibiting unimportant information when there is a visual clutter, this then allows the brain access to only what is important.

Brain Limitations

Julia said,”Contrary to common beliefs, the brain has a limited processing capacity. It can only effectively process about one per cent of the visual information that it takes in.” This may surprise many persons given the belief that the brain is totally underutilised, but the reality is that where there is abnormal filtering the programming actions of the brain are in a constant state of competition with each. The competition is in other to gain access to the information that is important.

Info Suppressers

When the research scientist took to examining the behaviour of these neurons in the prefrontal cortex, it was discovered that the adequate performance of a single action when visual clutter was present was down to the suppression abilities of distracting information.

The Hope

It is now believed that these results will assist in the identification the underlying causes and indeed the diagnosis of many mental disorders including ADHD and schizophrenia. Therese Lennert a Vernier Scholarship student working towards her PhD conducted the research.

Clutter

Brain clutter is also experienced by persons who have autism, and it is normally seen examined in this regard. It is due to an over-stimulation of inputs on the senses.

This may be down to a sensory overload pertaining to the amount of verbal input in a conversation. It can be too much visual stimulation too. Either way, the result is that there is a sensory overload, and an inability to handle all of the input leading to a lack of performance or despair on the part of the individual.

Mind Power

It has been determined elsewhere, and you will read elsewhere on this site how through study the reasons behind bad driving by the elderly have been determined, and it is down to the function of the brain. How it can only process so much data at one time.

On the drivers behalf, the additional input of other vehicles or objects in the periphery of view proving too much information for the brain to handle.

It does surprise many people, even scientists that this is the case. It has long been believed that the brain is capable of processing far much more than the inputs we receive, and not as this study determines; less.

OCD – Hollywood star Megan Fox reveals her suffering

OCD or Obsessional Compulsive Disorder is a mental illness that involves obsessive thoughts that produce intense anxiety and which often results in ritualistic behaviour as a way of finding relief.

The severity of the disorder can range from mild, where it can cause only a slight inconvenience and suffering, to very severe which can severely impact and limit a person’s freedom to carry out their normal routines. Each person’s experience of OCD is different, which can make diagnosis and treatment problematic.

For some the disorder may be mild and involve things like checking they have their keys a few times or checking that the gas is off a number of times before they can actually leave the house and we can all relate to that on some level.

For others it may be more serious with repeated ritualistic hand washing and much higher than normal levels of cleanliness. A few people with severe OCD may find it impossible to work, sustain relationships, or live a normal life at all.

According to the Royal College of Psychiatrists, around one in 50 people suffer from OCD at some point in their lives. They list Charles Darwin, Florence Nightingale and John Bunyan as famous personalities who have suffered from the disorder.

Now 24 year old Hollywood beauty Megan Fox has revealed that she is suffering from OCD and she cannot use public toilets or go out for a meal in a restaurant because of her mental “sickness”.

Megan, who starred in the Transformers, was being interviewed by Allure Magazine and told them “This is a sickness, I have an illness – this is not OK anymore”.

“Every time someone uses a bathroom and they flush, all the bacteria is shot into the air” she said, which is why she cannot use public toilets.

“Putting my mouth where a million other mouths have been, just knowing all the bacteria that you carry in your mouth?” she said which is why she cannot use cutlery in a restaurant.

Megan reckons she would rather starve to death than try to make herself a meal and says she can go a week without food. She also said she prefers her own company to the company of others.

“I could go days, weeks, without talking to another human being,” she said. “I hate receiving compliments; I hate being told I’m talented or people think I’m going to be a movie star” and “I always feel that it’s forced and fake.”

If you think you might be suffering from OCD then speak to your doctor as there is treatment and you can learn to deal with it.

What Causes Obsessive Compulsive Disorder OCD

Researchers from Weill Cornell Medical College in New York made an interesting discovery recently, in that they may have found a gene that is linked to Obsessive Compulsive Disorder or OCD as it is more commonly referred to.

Molecular Biologists Dr Shahin Rafii, Dr Francis Lee and Dr Sergey Shmelkov were not looking at OCD at all but were actually investigating genes for stem cell research and in particular the function of a gene called Slitrk5.

To discover more about its function they developed mice that had this gene “knocked out” or disabled to see what affect it would have on the blood stream. They didn’t find any noticeable effect on the bloodstream but what they did find was somewhat surprising in that the mice started to become anxious and indulge in obsessive grooming behaviour similar to the obsessive hand washing and other ritualistic behaviour observed in people suffering from OCD. The mice were also extremely jumpy (anxious) when touched, more so than normal.

So the researchers decided to see what would happen if they gave the mice an anti-depressant, which they did, and discovered that the obsessive behaviour stopped. Furthermore, they also found that the brains of the mice had similar neural wiring to that found in OCD patients.

Previous studies using functional magnetic resonance imaging in people with OCD have shown that part of the frontal cortex involved in decision making is active in people with OCD. What the researchers discovered was that this very same area in the brains of the mice that had the Slitrk5 gene removed was extremely active too.  The researchers still don’t know the exact function of Slitrk5 but believe it could play a role in somehow balancing neural activity.

Of course we have to remember that human beings are much more complex than mice and we can hardly make an assumption based on a single experiment but the implications are interesting nonetheless and may point researchers in the right direction towards a better understanding of the nature of OCD.

The researchers are now looking to se if human patients with OCD have a mutation of the Slitrk5 gene. If so, there’s a lot of hope on the horizon for finding an effective treatment in the future.

This new animal model of OCD has been published online in the April 25th 2010 issue of the journal Nature Medicine.

OCD – Depression Explained

OCD depression is depression that occurs with an OCD diagnosis.  The dual diagnosis complicates matters in terms of treatment.  The two do not necessarily respond to the same methods of treatment.  To understand their connection, you must first have a basic idea of what each entails independently.

OCD

OCD, or obsessive compulsive disorder, is marked by obsessions and compulsions.  Obsessions are repetitive thoughts that happen involuntarily.  Some typical examples are a fear of dirt, the need to have things in perfect order or perfect arrangements, and persistent doubts.  As a result you may avoid shaking hands for fear of being contaminated or repeatedly check to make sure doors have been locked.

Compulsions are actions that the individual feels driven to do.  They are meant to reduce the stress that is related to obsessions.  Typical examples involve cleaning, counting, checking, and other repetitive actions.  Symptoms may be severe enough that the individual does not have time for anything but these actions.

Depression

Depression is a condition marked by persistent feelings of sadness, worthlessness, hopelessness, and guilt.  It includes a loss of energy, changes in sleep patterns, and changes in appetite.

The individual loses interest in usual activities of living and may become irritable or even aggressive.  This can impact every area of a depressed person’s life.

Performance at work may decline (if the individual manages to go to work).  Relationships are harmed because of withdrawal from life in general as well as because of other symptoms.  Depression, too, can be a disabling condition that robs a person of a full life.

The Connection

Depression may result from OCD.  The biological indicators of the two conditions have some similarities.  Oddly enough, the depressed state can cause an improvement in OCD symptoms in some cases.

Their treatment methods are different.  Certain antidepressants that are proven to be effective in treating symptoms of depression have no effect on the symptoms of OCD.  This implies differing underlying causes.

Another difference is that another treatment for depression known as electroconvulsive therapy also has no effect on OCD symptoms.  If they were closely related then one would expect that a treatment that had proven effective in treating one condition would treat the other with similar efficacy.  This is not the case.

This form of depression is a complicated combination of conditions.  This confounding diagnosis can make treating the individual more difficult as a professional decides how to treat both conditions simultaneously.  Until a connection is found, this dual diagnosis must be treated very carefully.