(1) Genetic factors
Obsessive-compulsive disorder is closely related to heredity and has obvious family aggregation phenomenon. The prevalence rate of parents, siblings and children of patients with obsessive-compulsive disorder is four times that of the general population; The probability of identical twins getting sick at the same time is as high as 65%~85%, while that of fraternal twins is 15%~45%.
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(2)? Fundamentals of neurobiology
Obsessive-compulsive disorder patients have specific neuroanatomical basis, and their orbital frontal cortex-striatum-thalamus circuit lesions are characterized by obsessive-compulsive thinking. In addition, the occurrence of obsessive-compulsive disorder is also related to 5- hydroxytryptamine (5- HT), dopamine (DA) and glutamate.
(3)? personal traits
It is found that about 2/3 patients with obsessive-compulsive disorder have obsessive-compulsive personality before they get sick, which is usually manifested as: doing things perfectly, step by step, sticking to the rules and being orderly; Be very strict with yourself, hard to accommodate, stubborn and inflexible; Often feel insecure, afraid of negligence or mistakes when interacting with people, and often check or reflect on whether their actions are correct; Stick to details, even trivial things in life should be programmed.
2. Inducing factors
(1) negative emotions and life events
Negative emotions and life events are often the fuse of obsessive-compulsive disorder, such as changes in living environment, poor interpersonal relationships, increased responsibilities, family discord, death of relatives, sudden shock and so on.
(2) pressure
Stress makes people prone to fear and anxiety, forcing them to do certain fixed things, such as fixed thinking and behavior patterns to buffer stress.
Typical symptoms 1, the concept of obsessive-compulsive disorder
(1) Force memory
Patients should recall things and experiences that they have just done or have passed, even if they are irrelevant. Although they knew it was meaningless, there was nothing they could do.
(2) compulsory suspicion
After repeated consideration and examination, the patient is still uneasy about what he has done, such as wondering if he really locked the door after going out, worrying about not washing his hands after washing them, and so on.
(3) forced association
When such patients hear or see something, they will have associations with it. For example, students once ate a fly in vegetable soup, and then they thought of flies as soon as they saw the soup, which made them sick. They were afraid to drink soup for six years.
(4) Compulsive fatigue
Patients repeatedly think about the causes of natural phenomena or daily life events. Although patients themselves feel ridiculous, it is difficult to control, such as why people's eyebrows don't grow with their hair? How long is forever? What about humans when the earth explodes? Why do the leaves on the trees fall off? Why should people be divided into men and women? Wait a minute.
(5) compulsive thinking
There are always some opposing ideas in patients' minds. For example, when they see the word "happiness", the opposite word "sadness" appears; When it comes to "war", it immediately reflects the opposing concepts such as "peace".
2. Forced intention
Patients are often entangled in some desires and intentions that are contrary to their normal mental state, resulting in some impulses that may lead to terrible consequences. For example, when you walk to the river or the well, you will have the impulse to jump, and when you see a knife, you will have the intention to pick up the knife and cut people or yourself. It is worth noting that although many patients with obsessive-compulsive neurosis are extremely anxious by obsessive-compulsive ideas, they may even go crazy or commit worrying acts of violence, but few people really take these actions, they just can't control the emergence of these intentions. So surgeons who have this idea always want to avoid operating on the operating table, so as not to cause anxiety and fear. This kind of fear belongs to the emotional expression of obsessive-compulsive disorder, which is related to the strong chasing thinking of fear content, and is called obsessive-compulsive disorder.
3. Coercive behavior
Forced behavior, also known as forced action, refers to repeated and rigid behavior. It is subordinate to compulsive behavior or a desire, probably to eliminate disasters and nip in the bud. But this kind of action is neither practical nor obvious, but the patient must do it.
(1) Forced washing
Wash your hands or take a bath repeatedly for fear of being unclean or catching some infectious disease. Patients have to wash their hands many times a day, empty the dustbin, wipe the ashtray and wipe the dust on the table. A patient said, "Every time I go to the toilet, I always come out clean ... so I have to take a bath 8- 10 times every day." There is a girl who bathes more than three times a day, even in the cold winter, and is regarded as a neat freak by her classmates. It turned out that after she was raped by the bad guys, she always wanted to take a bath to reduce impurities, knowing that it was illogical, but she still couldn't control herself.
(2) Strong chase count
The uncontrollable counting of patients is related to forced association. In order to achieve the specified goal, patients can't help counting telephone poles, steps, household pillars, etc. They counted the numbers, the stakes on the fence, the cracks in the bricks on the sidewalk. Patients know that this kind of counting has no practical significance, but they still have to count when they see similar objects in the future. If you doubt the points, you will often go back and count them again. Otherwise, you will be nervous and anxious.
(3) Forced ritual movement
Every time a patient receives a consultation, he must repeat certain actions according to certain procedures in order to calm down and do other things. For example, the patient preselects a specific number as a stimulus to complete some ritual actions, such as touching the heart twice every 6 steps, shaking his head every 12 steps and so on. For another example, when a patient enters the door, he takes two steps forward and one step backward, which means that his father's illness can be turned into luck. If this action is not completed, it must be repeated. Patients know there is no point in doing this, but if they don't, they will be anxious.
The treatment of obsessive-compulsive disorder includes medication, psychotherapy and physical therapy, among which psychotherapy and medication are the most important treatments.
In drug therapy, serotonin reuptake inhibitor (SSRIs) is the first choice for initial treatment. Cognitive behavioral therapy in psychotherapy is also the first-line treatment of obsessive-compulsive disorder, which has a good effect on improving the influence of obsessive-compulsive disorder.
The specific treatment varies from person to person. Doctors will make individualized treatment plans according to the symptoms and severity of patients, which requires regular observation and follow-up.
General treatment:
Obsessive-compulsive disorder is a chronic disease, and it is easy to recur, which needs long-term treatment like hypertension and diabetes. Generally speaking, the treatment of OCD should include three stages: acute treatment, consolidation treatment and remission treatment.
Acute treatment:
Acute treatment usually lasts 10~ 12 weeks, and SSRIs is the first choice, starting from the higher dose recommended by the prescription. Most patients will have obvious effect after 4~6 weeks of treatment. If the acute treatment effect is not good after 12 weeks, the drug dosage can be increased according to the doctor's advice, and those who still have no effect need to adjust the drug regimen, or choose other treatment methods such as psychotherapy and physical therapy.
Reinforcement and maintenance treatment:
After acute treatment, if the curative effect is remarkable, it can enter the domestic consolidation period and maintain its treatment. The general time is 1~2 years. Studies have shown that adherence to treatment can reduce the recurrence rate of patients. After completion of maintenance treatment, patients can gradually reduce the dosage after systematic evaluation by doctors, but they should go to the doctor for regular review to monitor the reaction and recurrence after reduction. If the symptoms are repeated, it is necessary to add back the original drug dose and extend the treatment maintenance period.
Drug therapy:
Drug therapy is one of the main treatments for obsessive-compulsive disorder. Commonly used drugs include SSRIs, such as fluoxetine, fluvoxamine, sertraline and paroxetine. In addition, there are tricyclic antidepressants (TCAs), such as clomipramine. Among them, SSRIs is the first-line treatment drug at present, and clomipramine has adverse reactions and is rarely used in clinic.
Although antipsychotics are not conventional drugs for the treatment of obsessive-compulsive disorder, they can increase the efficacy of SSRIs when used in combination with SSRIs. Commonly used drugs include atypical antipsychotics such as risperidone, aripiprazole, quetiapine and olanzapine.
Psychotherapy:
The etiology of obsessive-compulsive disorder is complex, and it is often difficult to achieve satisfactory results by drug treatment alone, which requires appropriate forms of psychotherapy to assist. At present, the main treatment methods of obsessive-compulsive disorder are cognitive behavioral therapy, psychoanalysis therapy, Morita therapy and supportive psychotherapy. Among them, cognitive behavioral therapy is considered to be the most effective psychotherapy for obsessive-compulsive disorder.
Behavioral cognitive therapy:
This method mainly improves patients' obsessive-compulsive symptoms by changing their correct views and attitudes towards themselves, others and things. It is necessary for both doctors and patients to fully cooperate with each other in order to achieve good therapeutic effect. This therapy mainly includes: thought blocking, exposure therapy, reaction prevention and system desensitization, among which exposure and reaction prevention therapy are the most effective.
Exposure therapy:
This method enables patients to learn to face objects or environments that cause anxiety.
Reaction prevention:
Ask patients to postpone, reduce or even give up behaviors that can relieve anxiety, such as shortening hand washing time and reducing hand washing frequency until giving up hand washing.
Morita therapy:
The therapy, founded by Japanese doctor Morita Shoma, emphasizes that patients should "accept symptoms objectively and do whatever they want". In the process of treatment, patients are required to take a natural attitude towards symptoms, first face the reality and learn to accept symptoms without resisting. On the other hand, gradually adapt to symptomatic work and study. At present, there have been many reports that Morita therapy is effective in treating obsessive-compulsive disorder, which is gradually recognized by Chinese people and applied to clinical treatment.
Other treatments:
When drugs and psychotherapy are ineffective, physical therapy can be considered, including modified electroconvulsive therapy, repetitive transcranial magnetic stimulation and vagus nerve stimulation.