Obsessive compulsive neurosis is a relatively rare but potentially severe, deliberating disorder, characterized severe obsession and compulsion that interferes with normal daily activities, work and thinking.
Causes of Obsessive Compulsive Neurosis
1. Physical ailment involving Neuro-anatomic structures
Many individuals who have sleeping sickness during the encephalitis epidemic after world developed obsessive compulsive disorder(OCD)
individuals who experience head injury, neurological disorders and traumatic injury during birth have a higher risk of developing OCD
2. Genetic
OCD can be transmitted genetically
OCD occurs more often in persons who have 1st degree relatives with OCD than in general population
Some studies have also shown an increased prevalence of anxiety and mood disorders in relative of individuals who have OCD
3. Biochemical
Till date serotonin is the only neuro-transmitter that have been implicated in OCD
a convincing evidence for serotonin’s role in OCD comes from the fact that anti depressants that act more specifically on serotonin relieve the symptoms of OCD for most patients, whereas anti-depressants that are more specific for other neurotransmitters do not relieve OCD symptoms.
4. Parental or Guardian Attitude
in OCD patients, it is quite often to find out that their parents/guardian have been particularly concern over bowel training, and acquision of skills or feats beyond the children.s capabilities
parents of OCD patients are noted for excessive strictness, severe attack on failure in performance, setting of high standards with undue emphasis on excellence
5. Premorbid Personality
OCD commonly develop in people who have previously shown marked obsessional traits. For instance high standard of conduct, marked caution and need for preciseness, orderliness and cleanliness, leading to a rigid control over their feeling and behaviour. Obsessive personality is also called Ankastic Personality
6. Changing environmental Circumstances
obsessional personality is vulnerable when faced with demands arising out of changing circumstances such as changes at work involving new responsibilities, change in environment involving new relationships,
7. Comorbidity
OCD may be secondary to or associated with other psychiatric condition such as anxiety, depressive illness and early schizophrenia. Comorbidity personality disorder occurs in 80% of individuals with OCD
Clinical Features of Obsessive Compulsive Neurosis
1. the obsessive compulsive idea or impulses are recognized by the patient to be irrational and he may be depressed.
2. obsession must be irresistibly be accompanied by actions which usually relieve tension and distress
3. OCD symptoms and character arise from the implementation of three defence mechanism;
- isolation -separation of affect from a though
- Undoing – an act performed with the goal of prevnting consequences of a thought
- reaction formation – behaviour and consciously stated attitudes that are opposite to underlying impulse.
4. Manifestation of OCD include;
- Sexual obsession – intrusive sexual thought or mental images of obscenity or profanity that cannot be resisted
- agressive obsessions – repeated thought of hurting others that thy are unable to dismiss
- symmentrical obsessions – objects must be kept in certain order
- precisional obsessions – activities must be performed in a rigid fashion
- Somatic obsession – concerns about health, death associated with compulsive checking and request for reassurance
- Hoarding obsession – accumulation of objects in one’s house for no reason, even when needed to be discarded.
- Obsessional doubt – compulsion to check possesionsover and over again
- Religious Obsession – hyper morality that is associated with non-forgiveness of self even after divine pardon is assured
- Obsessional phobias – fear of contamination, fear of harm, fear of mistakes, leading to a pattern of being extremely cautious about dirt and making decisions.
5. Incidence of Obsessive Compulsive Neurosis
- Gender – rate of OCD are similar in women and men in the ration of 2:1
- Age – Onset is typically early twenties bit earlier for men than women
- Socio-cultural – higher rates found among the divorced or separated and unemployed.
Management of Obsessive Compulsive Neurosis
1. Assessment
- physical – lesions secondary to compulsive act e.g dermatologic lesions due to hand washing, excessive bathing. other symptoms through test may include lumber puncture for glucose level in CSF
- psychological – types and severity of obsession, mental status – concentration and attention, memory, speech
- Social – cultural and religious belief evaluated also ability to relate with others in marriage
- risk factors – history of hereditary and other casual factors taken.
2. Psychotherapy
- supportive – reassurance repeatedly and encouraging patient to learn and tolerate obsession without compulsive acts
- psycho-analysis – a procedure of relieving repressed ideas or concepts that may relate to diagnosis behaviour
3. Electro Convulsive Therapy
Helpful in treating obsessional symptoms that occur with depression
4. Physical Care
- attention to activities of daily living, nutrition and rest
- personal and environmental protective measure
5. Social Care
- Therapeutic mileu – an environment that divert though
- family and friends involvement/education
6. Chemotherapy
- Anxiolytics for anxiety
- seratonin re-uptake inhibitors, monoamine oxidase inhibitors for depressive symptoms and obsessional symptoms
- sedative
- anti-convulsants
- supportive drugs in case of side effects.
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