Obsessive-Compulsive Disorder (OCD)
- A behavioral disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and/or compulsions (repetitive, ritualistic behaviors or mental acts) causing significant distress
- Not to be confused with obsessive-compulsive (anankastic) personality disorder
- Three subtypes: child/adolescent-onset (age <18 years), adult-onset (ages 18 to 39 years), and late-onset (age ≥40 years)
- Child/adolescent-onset in 50% of cases (usually by age 18 years) (1)
- Predominant gender: females > males
Consider pediatric autoimmune neuropsychiatric disorders associated with streptococcal (PANDAS) infections in acute presentation of OCD and tics in children (2).
Consider neurologic or neurodegenerative disorders in new-onset OCD.
Etiology and Pathophysiology
- Dysregulation of serotonergic, catecholaminergic, and glutamatergic pathways
- Dysfunction of cortico-striatal-thalamo-cortical (CSTC) circuit, involving the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC)
- Brain injury (physical trauma, stroke, etc.)
Prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD
- Family history of OCD
- Advanced paternal and maternal age
- Coexisting psychiatric disorders, most commonly anxiety disorders and schizophrenia
- Low serotonin levels (Antipsychotics with greater anti-serotoninergic mechanism, such as clozapine and olanzapine, have been associated with onset of OCD.)
- Brain insult (i.e., encephalitis, pediatric streptococcal infection, or head injury)
- History of childhood traumatic events, including social isolation and physical abuse
Early diagnosis and treatment can decrease patient’s distress and impairment.
Commonly Associated Conditions
- Major depressive disorder
- Panic disorder/phobia/social phobia
- Tourette syndrome/tic syndromes
- Substance abuse/eating disorder/body dysmorphic disorder
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