OCD is the fourth most common neuropsychiatric disorder with lifetime prevalence estimates of 0.4-3.5%. Family and twin studies suggest a strong genetic component, and molecular genetic studies are being carried out to identify genes contributing risk to OCD. It is postulated as a frontal-striatal disorder and functional neuroimaging studies provide a strong support for the dysfunction of cortico-striatal-thalamic-cortical neurocircuit. OCD can be secondary to a variety of medical conditions that range from deteriorative neurological illness, to head injury, and to autoimmune disorders. Few reports and no controlled studies exist in the treatment of acquired/secondary OCD. Both CBT and pharmacotherapy are effective fi rst-line treatment modalities for OCD. Brain stimulation and/or psychosurgery have been tried with varying success in treatment of refractory OCD. Environmental, genetic, and clinical factors interact in a complex fashion in the individual patient. This chapter will examine OCD from the medical perspective.Keywords Obsessive compulsive disorder · Cortical-striatal-thalamo-cortical circuit · Genetics · Neuroimaging · Autoimmune · Treatment
IntroductionAs defi ned in DSM-5, obsessive compulsive disorder (OCD) is characterized by obsessions (recurrent, unwanted, and distressing thoughts, images, or impulses) and/or compulsions (complex, repetitive, rule-governed behaviors that the patient feels driven to perform). Patients usually try to actively dismiss obsessions or neutralize them by seeking reassurance, avoiding situational triggers, or engaging in compulsions. Obsessions and compulsions are maladaptive, and lead to impaired functioning. They typically center on four themes: contamination, sexual/aggressive/checking, and ordering and symmetry. Common compulsions include excessive cleaning, checking behaviors, ordering and arranging rituals, counting, and repeating routine activities. Compulsions usually involve observable behaviors (e.g., hand-washing) but may also consist of covert mental rituals (e.g., counting, or ritualized performance of mental math). Symptom themes can vary over the course of the illness but those without a personal or family history of tics are more likely to have more frequent contamination themes. In the DSM-5, hoarding has been categorized as a distinct disorder, and is no longer considered a specifi c form of OCD. The addition of a separate diagnosis is supported by extensive research suggesting that, although the two disorders can co-occur, patients with symptoms of hoarding have a number of signifi cant phenomenological differences than those with OCD, including distinct cognitive processes, reinforcement patterns, and response to treatments commonly used to address symptoms of OCD ( 1 ).The proposed lifetime prevalence of OCD in the pediatric and adult population ranges from 0.4 to 3.5% in national and international epidemiological samples ( 2 -7 ). Approximately half of all OCD patients fi rst present in childhood, before age 15 ( 8 ) with biphasic symptom p...