How best to treat OCD?

23 June 2014


What is the ideal treatment for obsessive compulsive disorder (OCD)? What happens in the brain when someone has OCD?


We next return to our panel with your questions. Pushkar Nareshta got in touch asking, "What's the ideal treatment for OCD or obsessive compulsive disorder?" First up, Roger.

Roger - OCD, obsessive compulsive disorder can be a very difficult and debilitating issue. Some estimates suggests that 3% of the population have OCD at some point in their lives. Often, it can be recurrent as well. It tends to occur when we have full images or repetitive ideas that come into mind intrusively and are quite distressing. In order to try and deal with them, often, we feel compelled - it's where the compulsions comes in - to do certain things, perhaps engage in a ritual whether that's internal psychological, whether that's something external in the environment.

Hannah - So, the typical stereotype of OCD if you like might be someone that has a fear of contamination with bugs in the environment. And so, they might compulsively wash their hands and wash light switches for example and everything around them in order to take control of those bugs and make sure that they're wiped out and therefore, they're safe.

Roger - That's often the kind of way it work. although of course, it's not restricted to it, while it's very common to have concerns about contamination and dirt and so forth. There are many other areas that it can affect in life. At worse, people can be spending a lot of their waking hours concerned with a form of ritual. So, it can be a real problem. But the good news is, is that there are treatments of OCD. So, part of the treatment is going to be, exposing one's self to the feared stimulus. So, you might be the contaminations around like a dirty door handle and then resisting the urge to perform the rituals to it and overtime, very often, the level of anxiety drops down and some progress can be made. Typically, what we'll try and do is clinically, is take a particular line of work around a ritual and get the number of rituals down and achieve some symptomatic reduction that way. And at least 50% of the people respond well. There's also evidence that SSRIs can be held for either as a standalone treatment or combined with psychotherapy.

Hannah - So, that's a type of anti-depressants given with the cognitive behavioural therapy where you expose the thing that you're frightened or obsessive about. Martin, do we know much about what's going on in the brain of people that are affected by obsessive compulsive disorder?

Martin - Yes, so those are basic circuit in a brain that's involved in normal behaviour and it involves an interaction between deep brain structures and prefrontal cortex. This is called prefrontal basal ganglia loop system that's involved in normal behavioural control. We're all engaging in that system at the moment. I think the general idea is that there is disruption to the system, the information process and capabilities of the system and patients with obsessive compulsive disorder. I think most research nowadays is trying to really focus in on which part of that system or which part, constituent parts have aberrant physiological behaviour and conditions like obsessive compulsive disorder. Essentially, that's all as it's a shift in normal behaviour and so, it's a shift in a normal circuit in the brain and I think a lot of treatment is trying to re-establish the balance in these circuits.

Katie - In fact, the idea of putting an electrical impulse through the skull and into a very specific part of the brain and there's actually this being looked at in OCD currently in an area called the ventral striatum which is involved in the loops that Martin was just talking about to alter the connectivity and to alter the activity going on in the brain there. But I think again, it's important to know that obsessive compulsive disorder has many different symptoms. For each individual, it can present very differently. Some people, it really is about obsessive thoughts that can keep re-entering the brain and for other people, it comes with those rituals and those behaviours. Any idea of a best treatment, it's never a 'one size fits all'. There's multiple different treatments available and it's about working with the clinician to find the one that works for that individual.

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