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Obsessive-Compulsive Disorder

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Neurological and Psychiatric Disorders

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric illness that can be quite debilitating and historically has proven difficult to treat. Research conducted over the past decade has provided much insight into the underlying neuropathology, allowing significant advances in the treatment of these patients. Whereas psychotherapy was previously the only mode of treatment for OCD, pharmacological agents and psychosurgical procedures are proving to be effective in treating this disorder. The use of noninvasive or minimally invasive procedures to treat OCD also are currently being investigated. This chapter reviews the animal models and clinical features of OCD, as well as the neurochemicals and brain regions involved in this disorder, and the role of autoimmunity and familial inheritance. Treatment options including psychotherapy, medications, and invasive and noninvasive procedures are also discussed in detail.

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References

  1. Stein DJ, Stone MH. Essential papers on obsessive-compulsive disorders. New York, New York: New York University Press, 1997.

    Google Scholar 

  2. Bebbington PE. Epidemiology of obsessive-compulsive disorder. Br J Psychiatry 1998;35(Suppl):2–6.

    Google Scholar 

  3. Williams KE, Koran LM. Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum. J Clin Psychiatry 1997;58:330–334.

    PubMed  CAS  Google Scholar 

  4. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998;155:264–271.

    PubMed  CAS  Google Scholar 

  5. Hollander E. Obsessive-compulsive related disorders. Washington, D.C.: American Psychiatric Press; 1993.

    Google Scholar 

  6. Frost RO, Steketee GS. Hoarding: clinical aspects and treatment strategies. In: Jenicke MA, Baer L, Minichiello WE, eds. Obsessive-compulsive disorders: practical management, 3rd Ed. St Louis, Missouri: Mosby, 1998, Chapter 23.

    Google Scholar 

  7. Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown obsessive compulsive scale. I: development, use, and reliability. Arch Gen Psychiatry 1989;46:1006–1011.

    PubMed  CAS  Google Scholar 

  8. Scahill L, Riddle MA, McSwiggin-Hardin M, et al. Children’s Yale-Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997;36:844–852.

    Article  PubMed  CAS  Google Scholar 

  9. Rauch SL, Baxter LR Jr. Neuroimaging in obsessive-compulsive disorder and related disorders. In: Jenicke MA, Baer L, Minichiello WE, eds. Obsessive-compulsive disorders: practical management, 3rd Ed. St Louis, Missouri: Mosby;1998:289–317.

    Google Scholar 

  10. Hugo F, van Heerden BB, Zungu-Dirwayi N, Stein DJ. Functional brain imaging in obsessivecompulsive disorder secondary to neurological lesions. Depress Anxiety 1999;10:129–136.

    Article  PubMed  CAS  Google Scholar 

  11. Rauch SL, Savage CR, Alpert NM, et al. Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning. J Neuropsych Clin Neurosci 1997;9:568–573.

    CAS  Google Scholar 

  12. Szeszko PR, Robinson D, Alvir JMJ, et al. Orbital frontal and amygdala volume reductions in obsessive-compulsive disorder. Arch Gen Psychiatry 1999;56:913–919.

    Article  PubMed  CAS  Google Scholar 

  13. Baumgarten HG, Grozdanovic Z. Role of serotonin in obsessive-compulsive disorder. Br J Psychiatry 1998; 35 (Suppl):13–20.

    Google Scholar 

  14. Mundo E, Richter MA, Sam F, Macciardi F, Kennedy JL. Is the 5-HT(1Dbeta) receptor gene implicated in the pathogenesis of obsessive-compulsive disorder? Am J Psychiatry 2000;157: 1160–61.

    Article  PubMed  CAS  Google Scholar 

  15. Goodman WK, McDougle CJ, Lawrence LP. Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive-compulsive disorder. J Clin Psychiatry 1990;51(suppl):36–43.

    PubMed  Google Scholar 

  16. Nestadt G, Lan T, Samuels J, et al. Complex segregation analysis provides compelling evidence for a major gene underlying obsessive-compulsive disorder and for heterogeneity by sex. Am J Hum Genet 2000;67:1611–1616.

    Article  PubMed  CAS  Google Scholar 

  17. Stein DJ. Obsessive-compulsive disorder (seminar). Lancet 2002;360:397–405.

    Article  PubMed  Google Scholar 

  18. Enoch MA, Kaye WH, Rotondo A, Greenberg BD, Murphy DL, Goldman D. 5-HT2A promoter polymorphism-1438G/A, anorexia nervosa, and obsessive-compulsive disorder. Lancet 1998;351:1785–1786.

    Article  PubMed  CAS  Google Scholar 

  19. Enoch MA, Greenberg BD, Murphy DL, Goldman D. Sexually dimorphic relationship of a 5-HT2A promoter polymorphism with obsessive-compulsive disorder. Biol Psychiatry 2001; 49:385–388.

    Article  PubMed  CAS  Google Scholar 

  20. Hemmings SMJ, Kinnear CJ, Niehaus DJH, et al. Investigating the role of dopamine and serotonergic candidate genes in obsessive-compulsive disorder. Eur Neuropyschopharmacol 2003;13:93–98.

    Article  CAS  Google Scholar 

  21. Leonard HL, Swedo SE: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Int J Neuropsychopharmacol 2001;4:191–198.

    Article  PubMed  CAS  Google Scholar 

  22. Singer HS, Loiselle C. PANDAS: a commentary. J Psychosom Res 2003;55:31–39.

    Article  PubMed  Google Scholar 

  23. Perlmutter SJ, Leitman SF, Garvey MA, et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorder in childhood. Lancet 1999;354:1153–1158.

    Article  PubMed  CAS  Google Scholar 

  24. Overall KL. Natural animal models of human psychiatric conditions: assessment of mechanism and validity. Prog Neuropsychopharmacol Biol Psychiatry 2000;24:727–776.

    Article  PubMed  CAS  Google Scholar 

  25. Campbell KM, de Lecea L, Severynse DM, et al. OCD-like behaviors caused by a neuropotentiating transgene targeted to cortical and limbic D1+ neurons. J Neuroscience 1999;19:5044–5053.

    CAS  Google Scholar 

  26. Nordstrom EJ, Burton FH. A transgenic model of comorbid tourette’s syndrome and obsessivecompulsive disorder circuitry. Mol Psychiatry 2002;7:617–625.

    Article  PubMed  CAS  Google Scholar 

  27. Chou-Green JM, Holscher TD, Dallman MF, Akana SF. Compulsive behavior in the 5-HT2C receptor knockout mouse. Physiol Behav 2003;78:641–649.

    Article  PubMed  CAS  Google Scholar 

  28. Szechtman H, Sulis W, Eilam D. Quinpirole induces compulsive checking behavior in rats: a potential animal model of obsessive-compulsive disorder (OCD). Behav Neurosci 1998;112: 1475–1485.

    Article  PubMed  CAS  Google Scholar 

  29. Goodman WK, Ward HE, Kablinger AS, Murphy TK. Biological approaches to treatment-resistant obsessive-compulsive disorder. In: Goodman WK, Rudorfer MV, and Maser JD (eds). Obsessive-compulsive disorder: contemporary issues in management. London, UK: Lawrence Erlbaum Associates; 2000:333–369.

    Google Scholar 

  30. Dougherty DD, Rauch SL, Jenike MA. Pharmacological treatments for obsessive compulsive disorder. In: Nathan PE and Gorman JM (eds). A guide to treatments that work, 2nd Ed. London, UK: Oxford University Press; 2002:387–410.

    Google Scholar 

  31. Geller DA, Biederman J, Stewart SE, et al. Which SSRI? A meta-analysis of pharmacotherapy in pediatric obsessive-compulsive disorder. Am J Psychiatry 2003;160:1919–1928.

    Article  PubMed  Google Scholar 

  32. Albert U, Aguglia E, Maina G, Bogetto F. Venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder: a preliminary single-blind, 12-week, controlled study. J Clin Psychiatry 2002; 63:1004–1009.

    PubMed  CAS  Google Scholar 

  33. Denys D, Van Der Wee N, Van Megen HJ, Westenberg HG. A double-blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. J Clin Psychopharmacol 2003; 23:568–575.

    Article  PubMed  CAS  Google Scholar 

  34. Koran LM, Quirk T, Lorberbaum JP, Elliott M. Mirtazapine treatment of obsessive-compulsive disorder (letter). J Clin Psychopharmacol 2001;21:537–539.

    Article  PubMed  CAS  Google Scholar 

  35. Koran LM, Chuong HW. Mirtazapine treatment for adult OCD (poster). Presented at the 156th Annual Meeting of the American Psychiatric Association, May 17–22, 2003, San Francisco, CA.

    Google Scholar 

  36. Fux M, Levine J, Aviv A, Belmaker RH. Inositol treatment of obsessive-compulsive disorder. Am J Psychiatry 1996;153:1219–1221.

    PubMed  CAS  Google Scholar 

  37. Fux M, Benjamin J, Belmaker RH. Inositol versus placebo augmentation of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder: a double-blind cross-over study. Int J Neuropsychopharmacol 1999; 2:193–195.

    Article  PubMed  CAS  Google Scholar 

  38. Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous clomipramine for obsessive-compulsive disorder refractory to oral clomipramine: a placebo-controlled study. Arch Gen Psychiatry 1998;55:918–924.

    Article  PubMed  CAS  Google Scholar 

  39. Koran LM, Sallee FR, Pallanti S. Rapid benefit of intravenous pulse loading of clomipramine in obsessive-compulsive disorder. Am J Psychiatry 1997;154:396–401.

    PubMed  CAS  Google Scholar 

  40. Shapira NA, Keck PE, Goldsmith TD, McConville BJ, Eis M, McElroy SL. Open-label pilot study of tramadol hydrochloride in treatment-refractory obsessive-compulsive disorder. Depression and Anxiety 1997;6: 170–173.

    Article  PubMed  CAS  Google Scholar 

  41. Koran LM, Bullock KD, Franz BE, Elliot MA. Double-blind oral morphine in treatment-resistant OCD. Presented at the 156th Annual Meeting of the American Psychiatric Association, May 17–22, 2003, San Francisco, CA.

    Google Scholar 

  42. McDougle CJ, Goodman WK, Leckman JF, Lee NC, Heninger GR, Price LH. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 1994;51:302–308.

    PubMed  CAS  Google Scholar 

  43. Marek GJ, Carpenter LL, McDougle CJ, Price LH. Synergistic action of 5-HT2A antagonists and selective serotonin reuptake inhibitors in neuropsychiatric disorders. Neuropsychopharmacology 2003;28:402–412

    Article  PubMed  CAS  Google Scholar 

  44. McDougle CJ, Epperson CN, Pelton GH, Wasylink S, Price LH. A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2000;57:794–802.

    Article  PubMed  CAS  Google Scholar 

  45. Hollander E, Ross NB, Sood E, Pallanti S. Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo controlled study. Int J Neuropsychopharmacol 2003;6:397–401.

    Article  PubMed  CAS  Google Scholar 

  46. Arias F, Soto JA, Garcia MJ, Rodriguez-Calvin JL, Morales J, Salgado M. Efficacy and tolerance of risperidone addition in serotonin reuptake inhibitors (SRI) treatment for refractory obsessivecompulsive disorder. Eur Neuropsychopharmacol 2002;12:S341.

    Article  Google Scholar 

  47. Bystritsky A, Ackerman DL, Rosen RM, et al. Augmentation of SSRI response in refractory OCD using adjunct olanzapine: a placebo-controlled trial. APA Annual Meeting, New Research Abstracts; 2001;New Orleans, LA: 171,172.

    Google Scholar 

  48. Shapira NA, Ward HE, Mandoki M, et al. Placebo-controlled trial of fluoxetine versus fluoxetine plus olanzapine in obsessive-compulsive disorder. Paper presented at: New Clinical Drug Evaluation Unit (NCDEU) Annual Meeting; May 29, 2003; Boca Raton, Florida.

    Google Scholar 

  49. Atmaca M, Kuloglu M, Tezcan E, Gecici O. Quetiapine augmentation in patients with treatment resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study. Int Clin Psychopharmacol 2002;17: 115–119.

    Article  PubMed  CAS  Google Scholar 

  50. Foa EB, Kozak MJ. Psychological treatment for obsessive-compulsive disorder. In: Mavissakalian MR, Prien RF (eds). Long-term treatments of Anxiety Disorders. Washington, DC: American Psychiatric Press;1996: 285–309.

    Google Scholar 

  51. Cox BJ, Swinson RP, Morrison B, Lee PS. Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-compulsive disorder: a meta-analysis. J Behav Ther Exp Psychiatry 1993;24:149–153.

    Article  PubMed  CAS  Google Scholar 

  52. Albert U, Maina G, Forner F, Bogetto F. Cognitive-behavioral therapy in obsessive-compulsive disorder patients partially unresponsive to SRIs (abstract). J Eur Neuropsychopharm 2003;13: S357–S358.

    Article  Google Scholar 

  53. Cosgrove GR, Rauch SL. Psychosurgery. Neurosurg Clin N Am 1995;6:167–176.

    PubMed  CAS  Google Scholar 

  54. Rauch SL, Markris N, Cosgrove GR, et al. A magnetic resonance imaging study of regional cortical volumes following stereotactic anterior cingulotomy. CNS Spectrums 2001;6:214–216,221,222.

    PubMed  CAS  Google Scholar 

  55. Sachdev P, Trollor J, Walker A, et al. Bilateral orbitomedial leuocotomy for obsessive-compulsive: a single-case study using positron emission tomography. Aust N Z J Psychiatry 2001;35: 684–690.

    Article  PubMed  CAS  Google Scholar 

  56. Kim CH, Chang JW, Koo MS, et al. Anterior cingulotomy for refractory obsessive-compulsive disorder. Acta Psychiatr Scand 2003;107:283–290.

    Article  PubMed  Google Scholar 

  57. Dougherty DD, Baer L, Cosgrove GR, et al. Update on cingulotomy for intractable obsessivecompulsive disorder: prospective long-term follow-up of 44 patients. Am J Psychiatry 2002; 159:269–275.

    Article  PubMed  Google Scholar 

  58. Montoya A, Weiss AP, Price BH, et al. Magnetic resonance imaging-guided stereotactic limbic leucotomy for treatment of intractable psychiatric disease. Neurosurgery 2002;50:1043–1052.

    Article  PubMed  Google Scholar 

  59. Hay P, Sachdev P, Cumming S, Smith JS, Lee T, Kitchener P, Matheson J. Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand 1993;87:197–207.

    Article  PubMed  CAS  Google Scholar 

  60. Kim MC, Lee TK, Choi CR. Review of long-term results of stereotactic psychosurgery. Neurol Med Chir (Tokyo) 2002;42:365–371.

    Article  Google Scholar 

  61. Van Bockstaele EJ, Peoples J, Valentino RJ. Anatomic basis for differential regulation of the rostrolateral peri-locus coeruleus region by limbic afferents. Biol Psychiatry 1999;46:1352–1363.

    Article  PubMed  Google Scholar 

  62. Malhi GS, Sachdev P. Novel physical treatments for the management of neuropsychiatric disorders. J Psychosom Res 2002;53:709–719.

    Article  PubMed  Google Scholar 

  63. Ward H, Ninan PT, Pollack M, et al. Treatment-refractory obsessive-compulsive disorder: potential benefit of VNS therapy. Poster presented at 23rd Annual Conference of the Anxiety Disorders Association of America, Toronto, Canada; March 27-30, 2003.

    Google Scholar 

  64. Nuttin BJ, Gabriels LA, Cosyns PR, et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 2003;52:1263–1274.

    Article  PubMed  Google Scholar 

  65. Greenberg BD, George MS, Martin JD, et al. Effect of prefrontal repetitive transcranial magnetic stimulation (rTMS) in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry 1997;154:867–869.

    PubMed  CAS  Google Scholar 

  66. Alonso P, Pujol J, Cardoner N, et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: A double-blind, placebo-controlled study. Am J Psychiatry 2001;158: 1143–1145.

    Article  PubMed  CAS  Google Scholar 

  67. Martin JLR, Barbanoj MJ, Clos S. Transcranial magnetic stimulation (TMS) for the treatment of obsessive-compulsive disorder (OCD). Cochrane Database Syst Rev 2003;3:CD003387.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL

    David S. Husted MD, Nathan A. Shapira MD, PhD & Wayne K. Goodman MD

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  1. David S. Husted MD
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  2. Nathan A. Shapira MD, PhD
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  3. Wayne K. Goodman MD
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Editor information

Editors and Affiliations

  1. Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA

    Frank I. Tarazi PhD, MSc

  2. Laboratory of Psychiatric Neuroscience, McLean Hospital, Belmont, MA

    Frank I. Tarazi PhD, MSc

  3. Department of Pharmacology and Neuroscience, Univesity of North Texas Health Science Center, Fort Worth, TX

    John A. Schetz PhD

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© 2005 Humana Press Inc., Totowa, NJ

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Husted, D.S., Shapira, N.A., Goodman, W.K. (2005). Obsessive-Compulsive Disorder. In: Tarazi, F.I., Schetz, J.A. (eds) Neurological and Psychiatric Disorders. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-856-0:171

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  • DOI: https://doi.org/10.1385/1-59259-856-0:171

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-369-5

  • Online ISBN: 978-1-59259-856-4

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