Instruct: Given a question, retrieve documents that answer the question.
Query: What types of medications treats OCD?
A form of psychotherapy called "cognitive behavioral therapy" (CBT) and psychotropic medications are first-line treatments for OCD.[1][77] Other forms of psychotherapy, such as psychodynamic and psychoanalysis may help in managing some aspects of the disorder, but in 2007 the American Psychiatric Association (APA) noted a lack of controlled studies showing their effectiveness "in dealing with the core symptoms of OCD".[78] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD.
Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.
OCD Action is a membership organisation with members electing a management body, the board of trustees, every year at the charity's Annual General Meeting. The trustee group is currently made up of three medical experts, two carers, four people with OCD and one charity management and fundraising professional.
Many different types of medication can create/induce pure OCD in patients that have never had symptoms before. A new chapter about OCD in the DSM-5 (2013) now specifically includes drug-induced OCD.
From the observation of the efficacy of antidepressants in OCD, a serotonin hypothesis of OCD has been formulated. Studies of peripheral markers of serotonin, as well as challenges with proserotonergic compounds have yielded inconsistent results, including evidence pointing towards basal hyperactivity of serotonergic systems.[65] Serotonin receptor and transporter binding studies have yielded conflicting results, including higher and lower serotonin receptor 5-HT2A and serotonin transporter binding potentials that were normalized by treatment with SSRIs. Despite inconsistencies in the types of abnormalities found, evidence points towards dysfunction of serotonergic systems in OCD.[66] Orbitofrontal cortex overactivity is attenuated in people who have successfully responded to SSRI medication, a result believed to be caused by increased stimulation of serotonin receptors 5-HT2A and 5-HT2C.[67] A complex relationship between dopamine and OCD has been observed. Although antipsychotics, which act by antagonizing dopamine receptors may improve some cases of OCD, they frequently exacerbate others. Antipsychotics, in the low doses used to treat OCD, may actually increased the release of dopamine in the prefrontal cortex, through inhibiting autoreceptors. Further complicating things is the efficacy of amphetamines, decreased dopamine transporter activity observed in OCD,[68] and low levels of D2 binding in the striatum.[69] Furthermore, increased dopamine release in the nucleus accumbens after deep brain stimulation correlates with improvement in symptoms, pointing to reduced dopamine release in the striatum playing a role in generating symptoms.[70]
The Office of Civilian Defense (OCD) was established by President Franklin D. Roosevelt in May 1941. It was responsible for planning community health programs and medical care of civilians in the event of a military attack on the United States. It was an independent agency and not associated with the United States Department of War. It coordinated with the Chemical Corps of the Department of the Army regarding protective measures against chemical weapons. United States Public Health Service officers were assigned as medical consultants with OCD local district offices. Later in 1941, Congress forbade OCD to support Fan dance.
Early onset OCD, manifesting in childhood or adolescence, is a subtype of OCD etiologically distinct from adult onset OCD. This early onset OCD is reported to be genetically related to tic disorders and Tourette’s syndrome, as one study has found that patients with early onset OCD have a higher rate of Tourette’s and other tic disorders. Family association studies have suggested that early onset OCD is correlated to increased familial and possibly genetic risk. The rate of OCD and subclinical OCD among relatives of probands whose OCD manifested in childhood or adolescence was at least twice as high as the rate among relatives of probands whose OCD manifested in adulthood. Other studies have also indicated that there is an inverse relationship between the age of onset of the proband and the risk of OCD in relatives. Consequently, it is possible that there are different genetic mechanisms behind the two types of OCD; therefore, it may be necessary to control for age of onset when examining candidate genes.
Obsessive-compulsive disorders are treated with various serotonergic antidepressants including the tricyclic antidepressant clomipramine and various SSRI medications. With existing drug therapy, OCD symptoms can be controlled, but not cured. Several of these compounds (including paroxetine, which has an FDA indication) have been tested successfully in conjunction with OCD hoarding.
Fluvoxamine, sold under the brand name Luvox among others, is a medication which is used primarily for the treatment of obsessive–compulsive disorder (OCD), and is also used to treat major depressive disorder and anxiety disorders such as panic disorder and post-traumatic stress disorder. Fluvoxamine CR (controlled release) is approved to treat social anxiety disorder in the United States. It is a selective serotonin reuptake inhibitor (SSRI) and σ receptor agonist.
When treating moderate to severe pain, the type of the pain, acute or chronic, needs to be considered. The type of pain can result in different medications being prescribed. Certain medications may work better for acute pain, others for chronic pain, and some may work equally well on both. Acute pain medication is for rapid onset of pain such as from an inflicted trauma or to treat post-operative pain. Chronic pain medication is for alleviating long-lasting, ongoing pain.
Drug treatment of OCD may be assumed to affect a proposed functional imbalance between the frontal lobes and other parts of the brain. Serotonin reuptake inhibitors, SRI, especially potent ones given at high doses over long periods of time, are often effective in the treatment of obsessive-compulsive disorder. However, a large percentage of patients do not respond to treatment with the SRI, and those who do respond often do not fully remit, which should be the standard goal of treatment in OCD. If a patient has been treated for several months and has not yet responded to treatment with several types of SRI medication, the physician should perform a careful assessment of resistant and/or residual clinical symptoms. Any comorbid conditions to determine which next-step treatment would be the most appropriate. One strategy for patients who have not responded to treatment with a SRI is to switch them to aserotonin-norepinephrine reuptake inhibitors.
Following clinical training, Insel joined the NIMH as a clinical fellow working with Dennis Murphy. In 1980 he began the first U.S. research project on the biology of adults with obsessive compulsive disorder (OCD), which was then largely treated with psychoanalysis. Following initial reports from Sweden, Insel was the first to demonstrate scientifically that a tricyclic antidepressant, clomipramine, was effective for treating OCD. This observation not only launched the neuropharmacological study of OCD, it suggested the importance of developing the SSRI class of antidepressants, which became a mainstay for treating both depression and OCD in the 1990s.
Tourette’s syndrome is a neurological disorder characterized by recurrent involuntary movements (motor tics) and involuntary noises (vocal tics). The reason Tourette’s syndrome and other tic disorders are being considered for placement in the obsessive compulsive spectrum is because of the phenomenology and co-morbidity of the disorders with obsessive compulsive disorder. Within the population of patients with OCD up to 40% have a history of a tic disorder and 60% of people with Tourette’s syndrome have obsessions and/or compulsions. Plus 30% of people with Tourette’s syndrome have clinically diagnosable OCD. Course of illness is another factor that suggests correlation because it has been found that tics displayed in childhood are a predictor of obsessive and compulsive symptoms in late adolescence and early adulthood. However, the association of Tourette’s and tic disorders with OCD is challenged by neuropsychology and pharmaceutical treatment. Whereas OCD is treated with SSRI, tics are treated with dopamine blockers and alpha-2 agonists.
The mission of the organization at its founding is much the same as today: education, awareness, training, accessing resources and research. In 2009, the IOCDF hired Teak Media to help promote awareness about OCD and effective treatments. The collaboration between Teak and the IOCDF resulted in almost 100 media hits in newspapers, online, in magazines, and has been featured on Nightline and CNN. Teak regularly accesses the IOCDF's Speakers Bureau. The Speakers Bureau members include people with OCD who understand firsthand the challenges of this disorder in addition to well-known clinical and research experts who have treated people with OCD.
Odlaug and Grant also argue that dermatillomania could have several different psychological causes, which would explain why some patients seem more likely to have symptoms of OCD, and others, of an addiction. They suggest that treating certain cases of excoriation as an addiction may yield more success than treating them as a form of OCD.
Social anxiety disorder can be treated with many different types of therapy and medication. Exposure therapy is an effective method of treating social anxiety. In exposure therapy a patient is presented with situations that they are afraid of, gradually building up to facing the situation that the patient fears most. This type of therapy helps the patient learn new techniques to cope with different situations that they fear. Role-playing has proven effective for the treatment or social anxiety. Role-playing therapy helps to boost individuals' confidence relating to other people and helps increase social skills. Medication is another effective method for treating social anxiety. Antidepressants, beta blockers, and anti-anxiety medications are the most commonly prescribed types of medication to treat social anxiety. Moreover, there are new approaches to treat phobias and enhance exposure therapy with glucocorticoids.
Treatment for children suspected of PANDAS is generally the same as the standard treatments for TS and OCD. These include cognitive behavioral therapy and medications to treat OCD such as selective serotonin reuptake inhibitors (SSRIs); and "conventional therapy for tics".
Behaviorally, there is some research demonstrating a link between drug addiction and the disorder as well. For example, there is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among people with OCD may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.[102]
Checking rituals, such as checking several times to determine if all of the doors to a house are locked, are also common safety behaviors. People with OCD often believe that if they do not perform their checking rituals, others will be in danger. Consequentially, people with OCD often perceive themselves as more responsible for the wellbeing of others than people without the disorder. Therefore, people with OCD use safety behaviors when they believe that other people will be in danger if these behaviors are not used. Continuous checking reduces the certainty and vividness of memories related to checking. Exposure and response prevention therapy is effective in treating OCD.
The English term obsessive-compulsive comes from the translated term used to describe the first conceptions of OCD by Carl Westphal, "zwangsvorstellung". Westphal's description went on to influence Pierre Janet who further documented features of OCD.[29] In the early 1910s, Sigmund Freud attributed obsessive–compulsive behavior to unconscious conflicts that manifest as symptoms.[112] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".[114] Freudian psychoanalysis remained the dominant treatment for OCD until the mid-1980s,[111]:210–211 even though medicinal and therapeutical treatments were known and available,[111]:210 because it was widely thought that these treatments would be detrimental to the effectiveness of the psychotherapy.[111]:210 In the mid-1980s, psychiatry made a sudden "about-face" on the subject[111]:210 and began treating OCD primarily through medicine and practical therapy rather than psychoanalysis.[111]:210
Sertraline is effective for the treatment of OCD in adults and children. It was better tolerated and, based on intention to treat analysis, performed better than the gold standard of OCD treatment clomipramine. It is generally accepted that the sertraline dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression. The onset of action is also slower for OCD than for depression.
Reduced dopamine D1 receptor (D1) and dopamine D2 receptor (D2) have been reported in the striatum in people with OCD, along with both increased and decreased reports of dopamine transporter (DAT) binding. While antipsychotics are sometimes used to treat refractory OCD, they frequently fail in treating or exacerbate OCD symptoms. Furthermore psychostimulants are sometimes used to treat OCD. Treatment with deep brain stimulation is effective in OCD, and response correlates with increased dopamine in the nucleus accumbens. Combined this evidence suggests that OCD may be associated with both increased and decreased dopamine signaling, or that a unidirectional model may not be adequate.
Prophylactic antibiotic treatments for tics and OCD are experimental and controversial; overdiagnosis of PANDAS may have led to overuse of antibiotics to treat tics or OCD in the absence of active infection.
Individuals with obsessive–compulsive disorder (OCD) may present with features typically associated with a tic disorder, such as compulsions that may resemble motor tics. "Tic-related OCD" is hypothesized to be a subgroup of OCD, distinguished from non-tic-related OCD by the content and type of obsessions and compulsions; individuals with tic-related OCD have more intrusive thoughts, and exhibit more hoarding and counting rituals than individuals with non-tic-related OCD.[29]
Dopaminergic systems are implicated in OCD by the efficacy of dopaminergic agents, the fact that PANDAS may be implicated, and by various neuroimaging studies. OCD may be treated with antipsychotic agents, however psychostimulants agents have also shown some promise in alleviating the symptoms of OCD. Although these need to be reconciled, they both implicate the dopaminergic systems. OCD also has a high comorbidity with ADHD, which is treated with psychostimulants and may result from increased phasic and decreased tonic signaling of dopaminergic neurons. PANDAS also affects the basal ganglia, where dopamine plays a large role as a neurotransmitter.