obsessive compulsive disorder
Introduction
Introduction to Obsessive Disorder Obsessive-compulsive disorder (obsessive-compulsive disorder) is a type of neurological disorder characterized by repeated obsessions. The obsessive concept is a stereotype that repeatedly enters the mind, appearance or intention of the patient's consciousness field. These thoughts, representations or intentions are of no practical significance to the patient. They are unnecessary or redundant. The patient realizes that these are his own thoughts, he wants to get rid of it, but he cant do anything, so he feels very distressed and forced. It is a repetitive stereotype or ritual movement, which is the result of the patient's succumb to the obsessive attitude to reduce inner anxiety. The basic symptoms of the disease are obsession and compulsion. More than 90% of patients have both obsessive and compulsive behaviors; but according to Of et al. (1995), 28% of patients are mainly obsessive-compulsive. 20% of patients are mainly forced behavior, 50% of patients are very prominent, patients have a certain degree of self-awareness of obsessive-compulsive symptoms, knowing that such thinking or behavior is unreasonable or unnecessary, trying to control Successful, about 5% of patients do not think that their concept and behavior are unreasonable when they first get sick, and there is no treatment requirement, called obsessive-compulsive obsessive-compulsive disorder. basic knowledge The proportion of illness: 0.021% Susceptible people: no specific population Mode of infection: non-infectious Complications: depression
Cause
Cause of obsessive-compulsive disorder
(1) Causes of the disease
In the past, most of the disease was thought to stem from mental factors and personality defects. In the past 20 years, genetic and biochemical research, especially the widespread use of drugs, has shown a significant effect, suggesting that the disease has its biological basis.
1. Genetic factors family survey showed that the risk of anxiety disorder among the first-degree relatives of the obsessive-compulsive proband was significantly higher than that of the control group. If the person with obsessive-compulsive symptoms but did not meet the diagnostic criteria was included, the patient groups parents The risk of obsessive-compulsive symptoms (15.6%) was significantly higher than that of the control group (2.9%). The twins showed that the same rate of twins was higher than that of twins, suggesting that the occurrence of obsessive-compulsive disorder may have a certain genetic predisposition. .
2. Biochemical changes Some people think that 5-HT energy system may be related to the onset of obsessive-compulsive disorder. Drugs with 5-HT reuptake retardation, such as selective 5-HT reuptake inhibitor (SSRI), can be effective for obsessive-compulsive disorder. Some scholars have found that patients with obsessive-compulsive disorder have elevated serum prolactin or cortisol, and its role in the development of obsessive-compulsive disorder is still unclear.
3. Anatomical and physiological disconnection of the frontal lobe and striatum is effective for refractory obsessive-compulsive disorder, presumably related to dysfunction of basal ganglia.
Psychology
(1) The psychodynamic theory of the Freudian school: The psychological mechanisms of the formation of obsessive-compulsive symptoms include: fixation, regression, isolation, release, reaction formation, and replacement of impermissible sexual and aggression impulses. Unconscious, so it is not noticeable to the patient.
(2) Learning theory of the behaviorist school: The behaviorist school believes that first, the patient causes anxiety due to a special situation. In order to alleviate anxiety, the patient produces an avoidance response, which is manifested as forced ritual action, and some neutral thoughts such as thinking or imagination. (such as language, words, representations and thoughts) accompanied by initial stimuli, can further form a higher level of conditioning, generalization of anxiety, and ultimately lead to the formation of obsessive concepts.
(two) pathogenesis
1. The results of the family survey showed that the risk of anxiety disorder in the first-degree relatives of patients with obsessive-compulsive disorder was significantly higher than that of the first-degree relatives of the control group, but their risk of obsessive-compulsive disorder was not higher than that of the control group. Among the first-degree relatives who had obsessive-compulsive symptoms but did not meet the diagnostic criteria for obsessive-compulsive disorder, the risk of parental obsessive-compulsive symptoms in the patient group (15.6%) was significantly higher than that of the control group (2.9%) (Black et al. 1992), the coercive nature of this compulsive feature in monozygotic twins is higher than that of twin twins (Carey and Gottesman, 1981). These results suggest that certain qualities of compulsive behavior are heritable. Other reports indicate that obsessive-compulsive disorder can coexist with schizophrenia, depression, panic disorder, phobia, eating disorders, autism and hyperactive slang syndrome.
2. Clomipramine, fluoxetine, fluvoxamine, paroxetine, sertraline, etc., have drugs that inhibit 5-HT reuptake, and have obsessive-compulsive symptoms. Good results; and other tricyclic antidepressants that inhibit 5-HT reuptake, such as amitriptyline, imipramine, and imipramine, have poor therapeutic effects on obsessive-compulsive disorder, and alleviate obsessive-compulsive symptoms. Often accompanied by platelet 5-HT content and cerebrospinal fluid 5-hydroxyindole acetic acid (5-HIAA) content decreased, pre-treatment platelet 5-HT and cerebrospinal fluid 5-HIAA basal level is higher, the treatment with clomipramine is better Oral administration of the selective 5-HT agonist methyl-chlorophenyl-piperazine (mCPP) to patients with obsessive-compulsive disorder can temporarily increase the obsessive-compulsive symptoms, suggesting that the serotonin (5-HT) system function is associated with the onset of obsessive-compulsive disorder.
3. Some clinical evidence suggests that the onset of obsessive-compulsive disorder may be related to selective basal ganglia dysfunction, for example, hyperactive slang syndrome, which is closely related to basal ganglia dysfunction, 15% to 18% of patients have obsessive-compulsive symptoms, much higher than The prevalence of obsessive-compulsive disorder in general residents (2%); head trauma, rheumatic chorea, Economo encephalitis, and the presence of obsessive-compulsive symptoms in the basal ganglia; brain CT examination showed some patients with obsessive-compulsive disorder The lateral caudate nucleus is reduced in size (Luxenberg et al., 1988); positron emission tomography revealed increased obstruction of the lateral caudate nucleus and lateral cortex of the forehead cortex in patients with obsessive-compulsive disorder (Baxter et al., 1987); heavy weight with 5-HT In patients with good results of inhibitory drugs or behavioral therapy, the caudate nucleus, excessive activity of the frontal lobes and cingulate gyrus decreased (Baxter et al., 1992; Perani et al., 1995), and detours were observed in patients with effective behavioral therapy. Synergistic activity between the caudate nucleus and the caudate nucleus is significantly diminished, suggesting that the dysfunctional brain circuit is disconnected (Schwartz et al., 1996). It is believed that the severity of the obsessive-compulsive concept is related to the frontal and basal ganglia activities, with the accompanying anxiety. Counter Hippocampus and cingulate cortex activity (McGuire et al., 1994), Brita et al (1996) reported that functional magnetic resonance imaging (fMRI) showed that the symptoms of OCD patients in real-time showed caudate nucleus, cingulate cortex and The relative blood flow of the orbitocortex is significantly increased compared with the resting state. Based on this type of study, the hypothesis is that the obsessive-compulsive disorder is caused by the dysfunction of the valgus-edge-basal ganglia, and the relationship between the frontal lobe and the striatum is removed. Fibers are used to treat refractory obsessive-compulsive disorder and reduce symptoms (Kettle and Marks, 1986), supporting this theory.
4. The Freudian school regards obsessive-compulsive disorder as a further development of the obsessive-compulsive personality. Because the defense mechanism can not deal with the anxiety of compulsive personality formation, it produces obsessive-compulsive symptoms. The psychological mechanisms of obsessive-compulsive symptoms include: fixation, regression, isolation , release, reaction formation, and replacement of impermissible sexual and aggression impulses, this defense mechanism is unconscious and therefore not perceived by the patient.
The behaviorist school uses a two-stage learning theory to explain the mechanism of the onset and persistence of obsessive-compulsive symptoms. In the first stage, anxiety is caused by a special situation through classical conditioning, and in order to alleviate anxiety, the patient has escaped or evaded the response. For compulsive ritual movements, if anxiety is alleviated by means of ritual actions or avoidance reactions, in the second stage, such compulsive behaviors are repeated and continued through operational conditioned reflexes, neutral stimuli such as language, words When appearances and thoughts are accompanied by initial stimuli, a higher level of conditioning can be formed to generalize anxiety.
Prevention
Obsessive compulsive disorder prevention
At present, the causes of many mental illnesses are not detailed. Over the years, professional workers have continuously and carefully observed many mental diseases according to their living and working practices, and have formed some simple concepts, recognizing that many mental diseases are human individuals and The anomalous results of social or natural environment interactions, in quite a few cases, although the external conditions are similar, the disease can be completely different, suggesting that individual characteristics play an important role in the occurrence of disease, therefore, people prevent it from happening In this type of disease, it is advocated to improve people's mental health so that they can resist the invasion of external harmful factors. This is:
1Cultivate the whole body, including the development of brain function, and support it to be in a healthy state, so that the body is strong and full of spirit.
2 Cultivate the healthy development of personality and strengthen exercise so that it can be adapted to the social environment.
Because the disease usually occurs in adolescents, about one-third of the cases start from 10 to 15 years old for the first time. Therefore, the main characteristics of the physiological psychology of adolescents and the basic content of mental health are highlighted.
Adolescence is a transitional period from childhood to adult, with sexual maturity as its physiological basis, often referred to as adolescence, but only physical maturity and reproductive ability do not make a person an adult, accompanied by physiology Mature, puberty also has a series of psychological changes, such as changes in sexual psychology, self-awareness and self-identity, cognitive change, socialization, etc. Therefore, the so-called transition period, and its understanding as the developmental stage of the body It is better to understand that the psychological developmental stage is a transitional process that is dependent, cared for, lives in accordance with the special norms determined by adults, and is independent and responsible for life.
The development of adolescent body and psychological development are generally accompanied by each other, and the development of the body may be slightly earlier, depending on the individual's quality, family social background, parenting style, life experience, etc., one looks A 17-year-old boy with the same appearance as an adult may still be in a period of full dependence on his parents, and an 11-year-old girl who is just beginning to develop may have taken care of her younger siblings independently and participate in dealing with the problems in her and her family's daily routine.
1. Physiological and psychological changes in adolescence
(1) Physical changes and psychological reactions: When adolescence arrives, young people undergo rapid growth and changes in their bodies. Muscles, bones and other tissues grow rapidly, their height and weight increase rapidly, and with the maturity of the reproductive system. The second sexuality gradually appeared. The boy had a beard, the throat became bigger, the voice became thicker, the girl's breasts changed, the body fat increased, the plump became full, the bust and hips increased, and both sexes grew pubic hair. The change took about two years to reach the peak of youth, and was marked by the presence of live sperm cells in the girl's menstruation and boy urine.
The age at which puberty arrives varies greatly from person to person. Some girls can go through as early as 11 years old, while others may go through 17 years old, with an average age of 12 years and 9 months. Boys are in the same age range. Sexual maturity is achieved, but on average the boy enters the developmental and maturity stages 2 years later than the girl. Until the age of 11 years, the average height and weight of the boy and the girl are the same; at 11 years old, the girl is both in height and weight. Suddenly over the boy, the girl keeps the gap for about 2 years, then the boy surpasses the girl and keeps leading in the future. This difference in body development speed is most noticeable in the junior high school stage, and the "young woman who is quite well developed is often found. "Sitting next to a group of undeveloped boys."
As the body develops, young people must adapt to the new self in development, and must also adapt to the reactions others have shown to his new image. For a developing teenager, neither is it like an adult nor a child. Their bodies may be slender, and the proportions of the parts may not match. This may make some young people feel uncomfortable, and some adverse reactions from people around them will aggravate their frustration. The young man is a "grass stalk", and the young boy with a thick beard is called "bearded", while the young man with fast body development and slow head development comments as "developed limbs, simple mind" or "small head" Children" and so on.
The speed of development, sooner or later, also puts pressure on young people. For example, boys with late development face a particularly difficult situation, because strength and bravery are very important in their peer activities. If they are shorter and thinner than their classmates, they may Losing in some competitions, may never catch up with the early development, boys who are dominant in physical activity, research indicates that boys with late development are generally not as good as their classmates, and their self-concepts are also poor, often engaged in some less mature, looking for attention Behavior, they feel that they have been abandoned by their peers and suppressed by their peers. On the other hand, children who develop early are often more confident and independent. These personality differences caused by early or late development may continue into adulthood, and the effect of developmental speed on personality. For girls, the precocious girls may be in a disadvantaged position because they are more like adults in the late primary school than their peers. However, in the early middle school, precocious children tend to be more prestigious among their classmates. In a leading position, this period of late-aged girls is like a late-matured boy Like, there may be less appropriate sense of self, and the relationship between parents and peers are not so close together.
Physical changes caused by sexual maturity are both a source of pride and a source of confusion. Whether young people feel comfortable with their new physique and the accompanying impulses depends to a large extent on the sexual development of their parents. Attitudes, parents' sexual privacy and taboo attitudes can cause anxiety among young people, and this anxiety may be gradually overcome due to the peers' more practical and realistic views.
(2) Achieving identity: With the rapid changes in the body, the previous trust in physical existence and physical function is seriously suspected. Only by re-evaluating the self can it be rebuilt. Young people strive to seek who am I? "And where do I go?"
In the process of physical change and sexual maturity, young people have some new experiences and feel the new reactions of people around them. They will try to find out what they are now and what they will become in the future. In the past, the emergence of new social relationships has also enabled them to expand their self-activity and self-exploration space. They also need to understand what the world looks like. What is society? How do I relate to them?
Young people's early consciousness of their own characteristics is developed from the various self-resident roles of children. The values and moral standards of young children mainly come from parents. Their self-esteem basically comes from the parents' views on them. When young people come After the broader world of middle school, the values of the peer group are increasingly important, as are the evaluations of teachers and adults. They have to re-evaluate the original ethical standards and their own values and abilities, and try to put these values and The evaluations are combined to form a stable system.
When parents' opinions and evaluations are clearly different from those of their peers and other important people, there is a high possibility of conflict. Young people try to play one role after another, and when they combine different roles into a single personality, they will encounter It is difficult, the so-called "role confusion."
(3) Changes in attachment relationships: The emotional connection between parents and parents will be alleviated. They want independence and tend to associate with each other. They used to be family members. They are now becoming young people, both members of the family and members of the partner group. The time spent with the family is shortened and the means of transportation, the expansion of the scope of activities, the attachment and social relations are expanded, and their emotional connection with other adults may be close to the relationship with the parents, such as teachers, leaders, neighbors, etc. From primary school to high school, a large number of partnerships are formed. Gender attraction is also an important reason for peer relationships. Dating often begins with group activities. In partnerships, peers discussion of common problems and negative experiences can provide a large number of The technology to solve the problem.
Some young people are alienated by their families, in part because they have increased their time away from home. During adolescence, several communication patterns may occur in the family. There are two modes of alienation, one of which is expelling mode (expelling mode). ), which involves ignoring or rejecting young people, parents giving up their care roles, no longer looking after young people, encouraging children to go out, "release mode" is often used by some parents who are being asked about their own lives (such as marriage) The problem is exhausted, there is no energy to control the child, and the other is the "delegating mode". The teenager is implied to adopt a behavior that gives parents an alternative and enjoyable way to be their parents. Things that you want to do but fail to do include some bad habits that show your parents.
(4) Cognitive change: Adolescence is perfected by the appearance of formal computing. It has got rid of the single concrete operation and simple image thinking in childhood, and has entered the stage of abstract thinking. Among the 16 to 20-year-olds, 53 % can solve problems with abstract thinking. It is 65% between the ages of 21 and 30. Some people still lack life, but IQ is not based solely on abstract thinking. It is influenced by culture and experience. After abstract thinking, young people find them. You can make various assumptions arbitrarily, and learn to test hypotheses. They learn to criticize themselves. All aspects require themselves as adults. They also have the ability to listen to others. They can regard their internal subjective experience as real. In part, abstract thinking also enables young people to consider more possibilities when dealing with problems. The quantity and quality of thinking activities are greatly improved, but young people cannot distinguish what they think is different from what others think, because he mainly I care about myself. He believes that what others care about is also his appearance and behavior. The main interpreter of Piaget theory is D. Elrind. The phenomenon is adolescent egocentricity, and points out two consequences: an imaginary audience and a personal fable. The former refers to young people who project their own concerns and interests to others and think of their own behavior. Appearance and self-being are taken care of by others, so they pursue self-expression, chase after-time and rebellion against tradition. Because they think that they are the objects of concern to others, teenagers are prone to such a view that they and their emotions are unique, that is, individuals Deification, they are prone to some religious beliefs, they believe that they are guided and supported by God, expecting that they are not subject to the laws of nature, such as believing that they will not die, not taking contraceptive measures and dating their boyfriends will not be pregnant, etc. Share your opinions, experiences and experiences with your partners and your personal deification will diminish. They will find themselves as a single person, not unique.
2. Common psychosocial factors affecting adolescent mental health
(1) Cultural background: the traditional culture's totem for reading, the idea of "the scholar-official", the concept of "everything is the lowest, only the reading is high", the pursuit of high credits, the high admission rate, and the expectations of parents for their children are too high, requirements Too strict a phenomenon has caused adolescents to exert excessive psychological pressure. In addition, Confucianism promotes rationality, reason, and etiquette, and promotes the socialization of young people while causing the suppression of adolescents personality, or reversing and becoming a society. Rebellious.
(2) The problem of only child: The "Four Two One" family model naturally biases the family's center of gravity toward the child. On the one hand, it causes the parents to overprotect the child so that the child can not develop normally except for learning. On the other hand, parents pay too much attention to their children and rely too much on their own happy sources to make their children bear more mental burdens. It is easy to form teenagers who are tired of learning, truancy, and anxiety.
(3) The pressure of entering a higher school: the traditional "thinking of the child", the tendency of too much value in higher education makes the child suffer from excessive learning pressure. This situation is expected to be obtained in the reform of the education system and the wave of burden reduction. improve.
(4) Family factors: Children's problems are often part of family problems. Family function disorders play a vital role in children's mental health. Children growing up in unstable families are often prone to emotional and behavioral disorders. Parents The discord, divorce, and fostering all lead to the child's insecurity and mental health problems.
(5) Self-personal factors: perfectionist tendencies, a single happy source makes young people think that I must be stronger than others I can't have shortcomings Must be tested first To get everyones praise, therefore, they Can not withstand setbacks, swing back and forth between inferiority and arrogance, lack of socialization, self-centered, making it difficult for young people to get along with others.
Complication
Compulsive disorder complications Complications depression
Patients with severe obsessive-compulsive disorder may be associated with depression and even negative suicide thoughts.
Symptom
Obsessive-compulsive disorder symptoms common symptoms forced behavior obsessive-conscious anxiety stressful obsessive-compulsive forced obsessive-compulsive obsessive-compulsive obsessive-compulsive obsessive-compulsive
Obsessive-compulsive disorder is characterized by persistent, imposed, unwanted thinking and uncontrollable thinking. Compulsive thinking is usually pollution, harming oneself or others, disaster, blasphemy, violence, sex or other Painful topic, these thoughts are the patient's own, not inserted by the outside world (such as the "thinking insertion" of schizophrenia), this kind of thinking also includes the imagination or scene in the brain, this thinking and imagination makes the patient very Pain and can lead to extreme uneasiness.
The basic symptoms of the disease are obsession and compulsion. More than 90% of patients have both obsessive and compulsive behaviors; but according to Of et al. (1995), 28% of patients are mainly obsessive-compulsive. 20% of patients are mainly forced behavior, 50% of patients are very prominent, patients have a certain degree of self-awareness of obsessive-compulsive symptoms, knowing that such thinking or behavior is unreasonable or unnecessary, trying to control Successful, about 5% of patients do not think that their concept and behavior are unreasonable when they first get sick, and there is no treatment requirement, called obsessive-compulsive obsessive-compulsive disorder.
1. Obsessive concept refers to the thought, appearance, emotion or intention of repeatedly entering the field of patient consciousness. These are of no practical significance to the patient. Unnecessary or redundant, the patient can clearly realize that this is wrong. And know that these are his own psychological activities, I really want to get rid of, but I can't do anything, so I feel very distressed.
(1) Obsessional thoughts: Some words, discourses, ideas or beliefs repeatedly enter the field of patient consciousness, interfere with the normal thinking process, knowing that it is not right and can not be controlled, can not get rid of, can have the following forms of expression.
1 Forced suspicion: The patient repeatedly doubts the correctness of his words and deeds; knowing that it is unnecessary, but he can't get rid of it. For example, when going out, he suspects that the gas is closed, even though it has been checked again, twice, three times... or not Rest assured, if you suspect that the document has signed your own name, whether you have written the wrong word, whether the number of pages is correct, etc., while being suspicious, often accompanied by anxiety, it prompts the patient to repeatedly check his behavior. Can not terminate, very painful.
2 Compulsive and exhaustive thinking: Patients have some questions about natural things in their daily lives or natural phenomena. They repeatedly think about it and know that they lack practical meaning. They are not necessary, but they cannot control themselves. For example, it is repeated: Why is rice white? Is millet yellow? And coal is black? Why are the leaves green, not other colors? Sometimes they cant stop, they cant be eaten, they cant sleep, they cant get rid of them, and some patients show up with their own minds. The arguing of restlessness is not clear.
3 Forced association: When a patient sees a sentence or a word, or a concept appears in his mind, he or she can't help but think of another concept or phrase. If the concept or statement of the association is contrary to the original meaning, such as "unity," Immediately associate with "split"; seeing "the sky...", immediately associates with "underground...", etc., calling the concept of compulsive opposition (or compulsive opposition), because the emergence of the concept of opposition violates the subjective will of the patient, often makes the patient Feeling distressed.
4 Forced representation: refers to the repeated visual experience (image) in the mind, often with a disgusting nature, can not get rid of.
5 Forced recall: The patient's experience of the incident has been repeatedly presented in his mind, unable to get rid of, and feel distressed.
(2) Forced emotions: manifested as unnecessarily worried or disgusting with certain things, knowing that they are unnecessary or unreasonable, and that they cannot get rid of themselves. For example, they worry that they will offend their colleagues or bosses, worry about the people around them, and worry about themselves. There will be irrational behaviors, fear of being contaminated by poisons or bacteria, and if you see a hospital, a mortuary or someone, immediately have a strong sense of disgust or fear, knowing it is unreasonable, but unable to restrain, so try to avoid it. Called obsessional phobia.
(3) Forced intention: The patient repeatedly experiences that he wants to do some kind of strong inner impulse to act or act contrary to his own wishes. It is absurd and impossible for the patient to know that it is impossible to control himself not to do it, but it cannot Get rid of this inner impulse, for example, there is an inner impulse to jump down the window of a tall building; look at his beloved wife, what kind of intentions would be like to kill her, even though this kind of inner impulse is very Strong, in fact, never put into action.
2. Forced behavior refers to recurring, rigid ritual movements, knowingly irrational, but having to do it, often to ease the anxiety caused by obsessive-compulsive attitudes, but these behaviors can not give people a pleasant feeling Forced examinations and forced cleansing (especially hand washing) are the most common, and patients often see that they can prevent certain objectively unlikely events and consider them to be harmful to the patient, often secondary to forced suspicion.
(1) Forced examination: It is the measures taken by the patient to alleviate the anxiety caused by compulsive suspicion. For example, when checking out the doors and windows, the gas and water pipes are closed, and the contents of the documents are checked repeatedly to see if they are wrong. Words and so on.
(2) Forced cleaning: The patient always has dirty clothes in the hands or clothes. In order to eliminate the fear of contamination by dirt, odor or bacteria, he often washes his hands, bathes or washes clothes. Some patients not only wash themselves repeatedly, but also require People who live with him, such as spouses, children, parents, etc., must also be thoroughly cleaned according to his requirements.
(3) Forced inquiry: patients with obsessive-compulsive disorder often do not believe in themselves. In order to eliminate doubts or worry about the anxiety caused by patients, they often repeatedly ask others to give explanations or guarantees in an unreasonable manner. Some patients can express themselves in themselves. In the mind, ask questions and repeat, to enhance confidence.
(4) Compulsive ritual movements: When a patient produces a strong, persistent, uncontrollable impulse or desire to perform certain behaviors, often leading to anxiety and extreme uneasiness, it can be temporarily relieved by performing specific ritual actions. This kind of uneasiness, this ritual action is usually related to forced thinking. For example, the patient thinks that my hand is dirty, which stimulates repeated hand washing. Other patients repeatedly imagine electricity, gas can cause fire, so it is inspiring. Repeated inspection of power supply, electrical appliances, sockets, and gas switches. Most common forced ritual actions are cleaning or inspection. Other ritual actions, including going out, must go forward two steps, then step back, and then go out; otherwise patients I feel a strong nervousness. Before I take a seat, I must first touch the seat with my finger to sit down. This action may be symbolic for eliminating the concept of obsession, compulsive counting, counting steps, counting panes or doing things specific. And stereotypes, these movements are repeated, others seem unreasonable or ridiculous, there is no reality Righteousness, but the patient completed the ritual movement, just to reduce or prevent the tension caused by the obsessive concept or to avoid the emergence of anxiety. Some patients only count in their own mind, or repeat certain sentences to relieve anxiety, is a kind of spirit. Mental compulsion, a symptom that is not uncommon and often overlooked.
Although ritual movements are intended to alleviate anxiety or anxiety, the relief of this anxiety is usually short-lived, and some patients may consider it necessary to repeat this ritual many times because many obsessive-compulsive patients have more than one forced thinking and related ritual movements. So many times of the day will be occupied by these ritual actions.
In addition, obsessive-compulsive disorder can lead to avoidance of some things or situations (such as dirt, leaving home to avoid locking the door), thus affecting life. The symptoms of obsessive-compulsive disorder are at the disposal of patients, families, friends and colleagues. And annoying.
(5) Compulsive slowness can be slow due to ritual movements; for example, repeated inspections of electrical appliances and gas at the time of going out, so that patients can not go out, or even go back to their homes to check, causing frequent punctuality Going to work, but it may also be the original. For example, whenever a patient reads a book, his eyes often stop at a certain line of a certain line, and the following contents cannot be read smoothly. This phenomenon may be caused by the patient not sure whether he has seen it clearly. Or understand this line of words, and thus stagnant, such patients often do not feel anxious.
The above-mentioned obsessive-compulsive symptoms often make the patient entangled in some unrealistic concepts and behaviors, hindering normal work and life, and making patients feel distressed.
The pre-existing personality of patients with obsessive-compulsive disorder is often characterized by compulsion, and this personality trait will be described in the chapter on personality disorder.
There are two main manifestations of this disease: First, forced thinking is the main clinical symptoms, including compulsive concepts, forced recall, forced appearance, forced suspicion, compulsive opposition, forced obsessive thinking, compulsive fear, etc. Second, forced movements are the main clinical symptoms, such as forced washing, forced checkup, forced inquiry, and forced ritualization.
Characteristics of obsessive-compulsive symptoms: their thoughts and actions belong to themselves; at least one of their forced thinking and movements is still vainly resisted by the patient, and at the same time, because of the unsuccessful resistance, there are more obvious anxiety; repeated thoughts, appearances or impulses make the patient very Unpleasant, these symptoms will make the patient entangled in some meaningless behaviors and behaviors all the time, hinder normal work and life, and make the patients feel distressed. The obsessive-compulsive patients have compulsive characteristics of pre-personal personality.
Examine
Examination of obsessive-compulsive disorder
Mainly for psychiatric examination, skull ct, exclude brain organic psychosis.
1. Structural image
Neuroanatomical studies have found that patients with obsessive-compulsive disorder have abnormal cortico-striatum-thalamic pathways, which are treated by the drug treatment by affecting the 5-HT system, which is projected back to the frontal lobe through the striatum and anterior cingulate ligament. The cortex, indirectly confirmed the above findings, other studies found that the caudate nucleus of patients with obsessive-compulsive disorder, the white matter volume decreased, the volume of cortex and island cover increased, the T1 value study of MRI showed that the patient's abnormal T1 value involved The temporal cortex, the frontal white matter, the cingulate gyrus, and the lenticular nucleus indicate structural changes and abnormal blood flow or dysfunction in these areas. Whether they are related to the anxiety that is often present in patients with obsessive-compulsive disorder needs further confirmation.
2. Functional imagery
The current results of functional imaging techniques support the presence of basal ganglia dysfunction in obsessive-compulsive disorder. In addition, the frontal sacral cortex, caudate nucleus, thalamus and anterior cingulate gyrus function are enhanced, and it is speculated that the striatum-white globule The tension of the road causes high function of the frontal lobe and the subcortical loop. The neuropsychological test is an auxiliary method to evaluate the function of the cortical striatum system. Both the patient and the control group are tested for certain learning abilities and the test is found. During the course, the performance of the two groups was basically similar, but the control group showed that the bilateral striatum was activated in the lower part of the striatum. The patient group did not have this phenomenon and replaced it with activation of the bilateral middle sacral area. The study showed that patients with obsessive-compulsive disorder were receiving the mobilized cortex. Stimulation of the function of the striatum system, due to the abnormal function of the part, can only be compensated by increasing the function of other parts, another neuropsychological test - Wisconsin card classification test, OCD patients The number of invalid classifications was significantly higher than that of the control group and was associated with perfusion of the left lower frontal cortex and left caudate nucleus.
Although theoretically considered that the caudate nucleus function of patients with obsessive-compulsive disorder is abnormal, the findings of imaging are quite inconsistent, some support the increase of caudate nucleus function, and some believe that it is reduced, or that the function of the caudate nucleus is abnormal, which may be related to The heterogeneity of the disease, such as the presence of neurological signs in patients, will affect the results of observation, relatively speaking, the frontal lobe, especially the frontal lobe cortex function abnormality is more certain, has been confirmed by many studies, For example, in older men with no history of mental illness, obsessive-compulsive symptoms occurred after infarction in the right lower parietal lobe. SPECT showed inferior inferior parietal infarction, low perfusion of right basal and temporal lobes, and right frontal temporal lobe function was significantly higher. On the left side, after treatment, the function of the part tends to be normal with the relief of obsessive-compulsive symptoms. In addition, the metabolism of the frontal lobe can be used as a predictor of the efficacy of the drug or behavioral therapy, such as the site before treatment. Lower metabolic values, good response to drug treatment, such as higher metabolic values, better response to behavioral therapy, indicating that patients with obsessive-compulsive disorder with different metabolic patterns can use different treatments Law.
Although the comparison of imaging data before and after drug treatment can reflect the pathophysiology of obsessive-compulsive disorder, the results are not the same. Some think that before treatment, patients with upper frontal lobe, right frontal lobe, left Lateral temporal lobe and parietal lobe, right caudate nucleus and thalamus perfusion were lower, and right lower frontal lobe perfusion was associated with the severity of the disease, obsessive compulsive behavior, depressive behavior and depression and left lower frontal lobe, middle frontal lobe and The perfusion of the right parietal lobe was negatively correlated, and the anxiety was positively correlated with the perfusion of the upper frontal, lower right, bilateral caudate nucleus and thalamus. It was also considered that the bilateral frontal lobe, posterior frontal lobe and back were treated before treatment. The lateral parietal lobe has high function and the caudate nucleus has low function. After treatment, the caudate nucleus function has not increased, and the functions of other parts have decreased to normal. The results of PET study are: anterior cingulate gyrus, thalamus, globus pallidus or putamen High metabolism, bilateral cingulate gyrus function decreased to normal level after treatment, so it was suggested that obsessive-compulsive disorder is a high-function of the specific site of the neuronal reticular structure, and some effective treatments have selective regulation and cingulate cortex The role of neurons.
Functional imaging techniques can also be used to identify obsessive-compulsive disorder and other diseases with similar clinical symptoms. For example, depression is similar to obsessive-compulsive disorder in clinical manifestations, psychopathology, neurochemistry, and response to 5-HT antidepressants. However, the double basal ganglia function of obsessive-compulsive disorder is lower than depression, and obsessive-compulsive disorder compared with patients with anxiety and depressive symptoms, although their anxiety and depression levels are associated with whole cerebral blood flow and double caudate nucleus Perfusion-related, but bilateral peritoneal upper cortex and right caudate nucleus perfusion were significantly different from each other. Tourette syndrome is a type of unexplained neuropsychiatric disorder characterized by tics and compulsive behavior, familial Tourette syndrome The patient presented with striatum, low-perfusion of the frontal and temporal lobes, and obsessive-compulsive disorder was highly perfused in these areas. The members of the Tourette syndrome family, if forced, also had imaging findings similar to other Tourettes in the family. Patients are similar, but different from patients with primary obsessive-compulsive disorder.
Diagnosis
Diagnosis of obsessive-compulsive disorder
diagnosis
According to the typical obsessive-compulsive symptoms, the patient realizes that the obsessive-compulsive symptoms originate from oneself, rather than being imposed or influenced by others, recurring, meaningless, knowing is wrong, and can not get rid of, interfere with their daily life, learning And work, very anxious, distressed, trying to eliminate or confront, or urgently require treatment, general diagnosis is not difficult, but in chronic cases, patients try to get rid of obsessive-compulsive symptoms, form a behavior that adapts to their pathological psychology No longer feel distressed about his obsessive-compulsive symptoms, but insist on retaining his morbid behavior and no longer require treatment. About 5% of patients do not think that their concepts and behaviors are unreasonable and there is no treatment requirement, called self-knowledge. Poor force obstruction.
According to ICD-10, forced thinking or behavior (or both) makes the patient feel painful, life is affected, is the patient's own thinking or impulse, and at the same time, at least one kind of thinking or action must not be resisted, think or do these The ritual movement is unpleasant, reluctantly repeating forced thinking or ritual movements, and most of the time, the symptoms exist for more than 3 months, at least for 2 consecutive weeks, can be diagnosed as obsessive-compulsive disorder.
Differential diagnosis
Symptoms typical of obsessive-compulsive disorder, depending on the obsessive-compulsive symptoms, interfere with or damage the individual's life, study and work, accompanied by anxiety and distress, try to resist and can not get rid of, seek medical advice, etc., general diagnosis is not difficult, but need to Identification of the following diseases:
Schizophrenia
Forced thinking of obsessive-compulsive disorder is sometimes mistaken for the illusion of schizophrenia. However, patients with obsessive-compulsive disorder often have self-knowledge and believe that this forced thinking is unrealistic, often suffering from anxiety and anxiety. Patients with schizophrenia may have obsessive-compulsive symptoms in the early stage, and their obsessive-compulsive symptoms lack obvious psychological incentives. They are characterized by bizarre content, variable form and incomprehensible characteristics, and patients often do not feel distressed, without obvious anxiety. There is no strong self-control intention and desire to seek treatment, self-knowledge is incomplete, and the occurrence of obsessive-compulsive symptoms in patients with schizophrenia is only a part of the symptoms of schizophrenia, and may also be accompanied by other symptoms of schizophrenia. As a basis for the identification of both, patients with chronic obsessive-compulsive disorder may develop transient psychiatric symptoms, but they will recover soon. It is not considered that schizophrenia has developed at this time. In a few cases, schizophrenia can be simultaneously with obsessive-compulsive disorder. Exist, there should be two diagnoses at this time.
2. Depression
Depressive patients may have obsessive-compulsive symptoms, often expressed as excessive rethinking or thinking about specific thoughts. However, these thoughts of depressive disorder are not as meaningless as obsessive-compulsive disorder, and depression is usually accompanied by obsessive-compulsive symptoms. Mainly with emotional disorders with low mood, patients with obsessive-compulsive disorder are often associated with depression. It should be analyzed from the pathogenesis process to analyze whether the main clinical symptoms are obsessive-compulsive symptoms or depression, and whether the obsessive-compulsive symptoms are primary or secondary to depression. The obsessive-compulsive symptoms of depression patients can be eliminated with the disappearance of depression; and the depression of patients with obsessive-compulsive disorder can also be improved by the reduction of obsessive-compulsive symptoms. If the two types of symptoms exist independently, the next two diagnoses should be made.
3. Phobia
The core symptom of phobia is the fear of a special environment or object. The object of fear comes from objective reality, with obvious avoidance behavior, without obsessive attitude; while forced thinking and behavior are derived from the subjective experience of patients; Forced suspicion is related to forced fear, and both diseases can coexist.
4. Brain organic diseases
The central nervous system organic lesions, especially the basal ganglia lesions can also have obsessive-compulsive symptoms, based on medical history and physical signs.
5. Excessive repetitive behaviors with intrinsic pleasure, such as gambling, drinking or smoking, cannot be considered forced behaviors, and the behaviors performed by compulsive behaviors are unpleasant repetitions.
6. Obsessive-compulsive disorder, in addition to comorbidity with schizophrenia and depression, can also be associated with hyperactive slang syndrome, tic disorder, panic disorder, simple phobia and social phobia, eating disorders, autism, etc. Exist, should be diagnosed according to the diagnostic criteria.
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is useful for understanding the characteristics of the symptoms, establishing a good doctor-patient relationship, and designing a behavioral treatment plan.
