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Obsessive-Compulsive Disorder (OCD): 

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Definition and Diagnostic Criteria:

Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric disorder characterized by:

• Obsessions: Recurrent, intrusive, and unwanted thoughts, urges, or images.
• Compulsions: Repetitive behaviors or mental acts performed to reduce distress.

DSM-5 Diagnostic Criteria:

• Presence of obsessions, compulsions, or both.
• Time-consuming or causing significant distress.
• Not attributable to substances or other medical conditions.
• Not better explained by another mental disorder.

Neurobiology of OCD:

CSTC Circuit dysfunction is central:

• Orbitofrontal Cortex (OFC): Error detection.
• Anterior Cingulate Cortex (ACC): Conflict monitoring.
• Caudate & Putamen: Filtering intrusive thoughts.
• Thalamus: Relay perpetuating loop.

Neurotransmitters:

• Serotonin: Low levels linked with OCD.
• Dopamine: Involved in compulsivity.
• Glutamate: Elevated in OFC and caudate.
• GABA: May be decreased in some brain regions.

Genetic and Environmental Factors:

• Heritability: 40–60%
• Genes: SLC1A1, HTR2A, COMT, SLITRK1.
• Environmental: Maternal stress, infections, trauma.
• PANDAS: Sudden onset OCD from immune response to strep.

Diagnostic Tools:

• Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
• Neuroimaging (fMRI, PET)
• Psychometric assessments: OBQ, DAS

Treatment Options:

Pharmacotherapy:

• SSRIs: Fluoxetine, Sertraline, etc.
• Clomipramine
• Augmentation: Antipsychotics, Glutamate modulators

Psychotherapy: CBT with Exposure and Response Prevention (ERP)

Neuromodulation: DBS, TMS, Ablative surgeries (rare)

Psychedelic and Novel Therapies:

Psilocybin: 5-HT2A receptor agonism; modulates CSTC circuitry; pilot studies show rapid symptom relief

Ketamine: Rapid anti-obsessional effects via glutamate pathways

Comorbidities:

• Anxiety disorders
• Major Depressive Disorder
• Tic disorders
• Body Dysmorphic Disorder
• Autism Spectrum Disorder

Prognosis and Course:

• Onset in adolescence or early adulthood
• Chronic but treatable
• 60–70% improve with treatment
• Early intervention yields best outcomes

References:

1. Saxena & Rauch, 2000, Psychiatric Clinics of NA
2. Pauls et al., 2014, Nat Rev Neurosci
3. Bloch et al., 2010, Mol Psychiatry
4. Moreno et al., 2006, J Clin Psychiatry
5. Pittenger et al., 2006, NeuroRx

Thanks for reading and sharing! Call or text anytime. 

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