Obsessive Compulsive Spectrum Disorders

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    Obsessive CompulsiveSpectrum Disorders

    PRESENTER: DR. CAROLINE DIAS CHAIRPERSON: DR. KRISHNA!RTH"

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    Co#cept o$ spectrum

    • To i#dic%te &u%lit%tive disti#ctio# %risi#' $rom % &u%#tit%tive co#ti#uum • To ide#ti$( % 'roup o$ disorders ))*u%lit%tivel( disti#ct i# %ppe%r%#ce but believed to be rel%ted $rom p%t+o'e#etic poi#t o$ vie, • Di-ere#t me%#i#' ro%d %re%s o$ ps(c+i%tric p+e#ome#% rel%ti#' to % si#'le me#t%l disorder

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    Co#cept o$ spectrum

    •Not co#ti#uum •%#i$est%tio#s v%r( ,idel( i# t(pe %#d severit(

    •All /i#ds o$ combi#%tio#s %re possible

    • T+ese combi#%tio#s  s(#dromes

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    OC spectrum disorders

    model o$ medic%l cl%ssi0c%tio# ,+ere v%rious ps(c+i%tric1 #eurolo'ic%l %#d2or medic%l co#ditio#s %re described %s e3isti#' o# % spectrum o$ co#ditio#s rel%ted to

    obsessive4compulsive disorder 5OCD6

     T+e model su''ests t+%t m%#( co#ditio#s overl%p ,it+ OCD i# s(mptom%tic pro0le1 demo'r%p+ics1 $%mil( +istor(1 #eurobiolo'(1 comorbidit(1 cli#ic%l course %#d respo#se to v%rious p+%rm%cot+er%pies

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    OCD

    •DD •H(poc+o#dri%sis •A#ore3i% #ervos%

    Preoccupation with body

    Motor disorders

    • Tics • Tourette7s disorder •S(de#+%m7s c+ore% •PANDAS

    Impulse control

    disorder  Tric+otillom%#i% P%t+olo'ic%l '%mbli#' Compulsive se3u%l disorder Kleptom%#i%

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    OC spectrum disorders

    OTOR DISORDERS

    • Tourette7s disorder

    S(de#+%m7s c+ore% • Tics

    •PANDAS

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    OC spectrum disorders

    IP!LSE CONTROL DISORDERS •  Tric+otillom%#i%

    • Kleptom%#i%

    P%t+olo'ic%l '%mbli#' • P(rom%#i%

    • I#termitte#t e3plosive disorder

    Compulsive se3u%l disorder • Compulsive bu(i#'

    • S/i# pic/i#' 5derm%tillom%#i%6

    • N%il biti#' 5o#(c+op+%'i%6

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    OC spectrum disorders

    PREOCC!PATION 8ITH OD" •od( d(smorp+ic disorder

    •H(poc+o#dri%sis

    A#ore3i% #ervos% •ulimi% #ervos%

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    Co#troversi%l

    •Autism •Subst%#ce use disorder

    •Sel$ i#9urious be+%vior

    Deperso#%li%tio# •OCPD

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    COORIDIT"

    •P%tie#ts ,it+ OCSD +%ve +i'+ r%te o$ comorbidit( o$ OCD

    • Tourette s(#drome 4 ;?= •P%t+olo'ic%l '%mblers 4 @. times rel%tive ris/

    •DD 4 >

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    %mil( +istor(

    •Amo#' 0rst de'ree rel%tives o$ OCD 4 +i'+ prev%le#ce o$ DD1 +(poc+o#dri%sis

    Rel%tives o$ OCD pts. +%ve +i'+erprev%le#ce o$ tic disorder

    •Rel%tive o$ tic disorder p%tie#ts +%ve i#cre%sed r%te o$ OCD

    •Rel%tives o$ e%ti#' disorder p%tie#ts +%ve +i'+er prev%le#ce o$ OCD

    •OCD is more prev%le#t i# rel%tives o$

    %utism

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    A#im%l studies

    •Ho3b 'e#e mut%tio#s i# mice •E3cessive 'roomi#'

    •E3cessive +%ir remov%l

    Simil%r to tric+otillom%#i% •I$ tre%ted ,it+ SSRI t+ere is #o 'roomi#'

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    A#im%l studies

    •comp%#io# %#d domestic %#im%ls demo#str%te repetitive #o#$u#ctio#%l motoric be+%viors

    •%cr%l lic/ derm%titis 5p%, lic/i#'6

    •R%poport %#d colle%'ues demo#str%ted

    t+%t %cr%l lic/ derm%titis1 li/e OCD1 respo#ds more

    robustl( to clomipr%mi#e t+%# to desipr%mi#e

    •p+%rm%cot+er%peutic respo#se o$ t+is co#ditio# seems to mimic t+%t o$ OCD

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    Is it possible t+%t t+e OC spectrum o$ disorders c%# be de0#ed %lo#' #euro)

    evolutio#%r( co#sider%tio#s

    •Horses) stereot(pies i# locomotio#

    Co,s %#d pi's ) c+e,i#' stereot(pies •Prim%tes ) 'roomi#' %b#orm%lities

    •some p%tie#ts ,it+ OCD1 bod( d(smorp+ic disorder1 tric+otillom%#i%1 %#d #%il biti#' c%# be co#ceptu%lied %s su-eri#' $rom %b#orm%l 'roomi#'

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    NE!ROCIRC!ITR"

    DISR!PTION O CONTROL ECHANISS: •Cortico)stri%t%l #eurocircuitr( : medi%te t+e co#trol o$ procedur%l str%te'ies

    •D(s$u#ctio# i# t+e co#trol o$ procedur%l str%te'ies ,it+ i#%ppropri%te rele%se o$ s(mptoms r%#'i#' $rom simple motoric

    stereot(pies to more comple3 be+%vior%l pro'r%ms

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    •#eurolo'ic disorders c+%r%cteried b( stri%t%l lesio#s m%( be %ccomp%#ied b(

    obsessive)compulsive s(mptoms •$u#ctio#%l im%'i#' studies demo#str%te t+%t duri#' implicit le%r#i#' t+ere is stri%t%l %ctiv%tio# i# +e%lt+( co#trols but

    %b#orm%l e3tr%)stri%t%l %ctivit( i# OCD •success$ul tre%tme#t1 ,+et+er usi#' medic%tio#1 co'#itive)be+%vior%l t+er%p(1 or #eurosur'er(1 results i# decre%sed s(mptoms %#d %ltered %ctivit( i# cortico)stri%t%l circuitr(

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    DISR!PTION O RE8ARD ECHANISS

    •Cortico)stri%t%l circuitr( : medi%te re,%rd processes ) t+e ve#tr%l stri%tum

    •OCD : %bse#ce o$ % $eeli#' o$ 'o%l completio# %$ter %# %ctio# is per$ormed: people co#ti#ue ,it+ t+eir compulsio#s repetitivel( u#til t+ere is

    0#%ll( t+e se#se t+%t t+i#'s %re #o, FF9ust ri'+t.77

    Alt+ou'+ OCD %#d dru' %ddictio# +%ve

    si'#i0c%#t p+e#ome#olo'ic %#d ps(c+obiolo'ic di-ere#ces1 bot+ co#ditio#s m%( be c+%r%cteried b( disruptio# o$ re,%rd processes %#d co#se&ue#t compulsive be+%vior

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    NE!ROCHEISTR"

     T+e Seroto#i# H(pot+esis: OCD

    •Hi'+er levels o$ HIAA

    Reductio# i# ; HIAA %$ter tre%tme#t ,it+ clomipr%mi#e

    •et% 4 c+loro p+e#(l piper%i#e 5mCPP6 %dmi#ist%tio# 4 seroto#i# %'o#ist 4

    ,orse#i#' o$ OCD •SSRI %re e-ective i# tre%tme#t

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    R%poport %#d colle%'ues : clomipr%mi#e

    ,%s superior to desipr%mi#e i# % r%#'e o$ repetitive s(mptoms ot+er t+%# OCD

    E': +%ir pulli#' 1 #%il biti#' 1 stereot(pic be+%viors 1 obsessive4 compulsive

    s(mptoms i# %utistic disorder 1 s(mptoms o$ bod( d(smorp+ic disorder 1 sel$)i#9urious be+%vior i# me#t%l ret%rd%tio#

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    Autism : decre%sed c%p%cit( to s(#t+esie seroto#i# duri#' developme#t

    E%ti#' disorder: 4 lo,er ; HT 4 moder%te dieti#' c%uses +(perse#sitivit( o$ ;HTc

    4 e3%cerb%tio# o$ e%ti#' disorder

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    •de #ovo productio# or e3%cerb%tio# o$ tics ,it+ dop%mi#e %'o#ists1 %#d dop%mi#e bloc/ers +%ve lo#' bee# /#o,# to be e-ective

    i# TD

    •i#cre%sed stri%t%l dop%mi#e upt%/e sites i# TD

    •u#ctio#%l im%'i#' studies +%ve co#0rmed 're%ter t+%# #orm%l stri%t%l dop%mi#e tr%#sporter de#sities

    •o#o('otic t,i#s ,it+ TD)) i#cre%sed c%ud%te D receptor bi#di#' ,%s %ssoci%ted ,it+ i#cre%sed tic severit(

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    NE!ROANATOIC:

    S"DENHA7S CHOREA

    Alter%tio#s to b%s%l '%#'li%

    Si'#%l +(per i#te#sit( i# c%ud%te #ucleus

    PANDAS

    E#l%r'ed b%s%l '%#'li%

     TO!RETTE S"NDROE

    olume o$ c%ud%te #ucleus ,%s decre%sed

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    A!TIS

    E#l%r'eme#t o$ c%ud%te

    DD C%ud%te #ucle%r %s(mmetr( I#cre%sed ,+ite m%tter volume

     TRICHOTILLOANIA

    Decre%sed le$t put%me# %#d le#ticul%r #ucleus

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    %s%l %#'li% H(pot+esis:

    •b%sed o# d%t% t+%t OCD is medi%ted b( t+e stri%tum %#d le%ds to % co#cept o$ OC spectrum disorders comprisi#' t+ose

    co#ditio#s i# ,+ic+ ps(c+op%t+olo'( o$ t+e stri%tum le%ds to u#,%#ted repetitive be+%vior

    •Developmental basal ganglia syndrome (DBGS) - d(s$u#ctio#%l b%s%l '%#'li% developme#t ,+o prese#t ,it+ tics1 OCD1 %#d ot+er s(mptoms

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    I!NE ECHANISS:

    •p%tie#ts m%( develop OC s(mptoms i#