Case Study of Obsessive-Compulsive Disorder (OCD)
Yes, very good study. You helped and saved the family. Thank you so much sir. I came across many families, which are still suffering of OCD. Now I can guide them to take Ayurvedic help. Very informative case study sir. Many does not have an idea of this issue called OCD. I have closely come across a person with the same issue and has gone to a seveority now.
But it us equally important bring the confidence about the treatment And the doctor is the prime factor plays a role in controlling of this OCD. Thanks for letting me know the seriousness of this disease and the impact it leaves on rest of the family members. I myself have a obsession for washing hands often , thinking that the thing I touched could be dirty. But I should thank you for casually mentioning about it to me when I visited you.
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And you even asked me to do pranayam. But now I am fine as I gave a deep thought over what you told me and I follow that. I am very fortunate to have come acros a Dr , a mentor, a well wisher and a true friend like you. I thank you once again for all service you do so religiously. Your email address will not be published.
On the inside, however, Gail felt like a mess; she was distant from her family. She cleaned her house for hours every night after work and screamed at her husband and children when anything was out of place. She would become especially hysterical if she saw a piece of hair on the floor.
She was often at the sink washing her hands and made her husband and children wash their hands more than ten times a day. The children were often withdrawn and upset and her husband was ready to leave her. On the verge of divorce, Gail and her husband came to Amen Clinics. At first, her husband was very skeptical about the biological nature of her illness.
Within six weeks of treatment to calm this part of her brain, she became more relaxed, her ritualistic behavior diminished and her marriage got back on track. A year-old male attorney chased other drivers who cut him off, and on two occasions, he got out of his car and bashed in their windows with the baseball bat he kept in his car. After the second incident, he came to see us.
Adam came to Amen Clinics when his wife left him. His gambling had gotten out of control. During the past few years, he had been neglecting his business, spent more time at the racetrack, and was driving back and forth to the casinos in Reno and Lake Tahoe. The Structured Instrument for the Diagnosis of Personality Disorders 23 was employed for the assessment of personality disorders. The Revised NEO Personality Inventory 24 and Leyton Obsessional Inventory 25 were used as self-report measures of normal personality and obsessional features, respectively.
The interrater reliability of the examiners' diagnostic procedure was studied in a sample of 30 subjects. All available diagnostic materials evaluation by the clinical examiner, informant interview, clinical case summary, medical records, and audiotapes were reviewed independently by 2 expert psychiatrists G.
The diagnosticians were blind as to whether the subject was a proband or relative and whether they were from a case or control family. If any necessary criterion was absent, then the diagnosis was considered "not present. If the diagnosticians could not be sure of the presence or absence of a given diagnosis, then that diagnosis was recorded as "unknown. Subjects with unknown diagnoses for the phenotypes of main interest in this article OCD, obsessions, and compulsions were excluded from both the numerator and the denominator in the analyses.
Cases with probable diagnoses were treated in 2 ways: 1 when analyzing definite outcomes, these cases were considered as not present and excluded from the numerator but included in the denominator and 2 when analyzing definite and probable outcomes, these cases were considered as probable and included in the numerator and denominator. Although not reported here, we also reanalyzed the data considering the probable cases as "missing" and excluding them from both numerator and denominator; the magnitudes of the estimated odds ratios ORs were marginally stronger than the first method and considerably stronger than the second method described above.
The odds of OCD, obsessions, and compulsions in case vs control relatives were estimated using logistic regression by the method of generalized estimating equations, which accounts for within-family correlation among relatives. This method provides correct SE estimates using conventional methods while acknowledging that part of the model within-family correlation in this case may be misspecified. Potential confounding factors age of relative, sex of relative, and type of interview [direct or informant-only] were controlled by including terms for these variables in the regression models.
All but 1 proband in each group were white; 1 case and 1 control proband was Hispanic. Case and control probands were of similar ages.
In the case probands, the age range was 18 to 88 years median, 36 years; mean, 37 years ; in the control probands, the age range was 18 to 79 years median, 36 years; mean, 39 years. Both groups were highly educated. Despite these similarities, however, the case probands were significantly less likely to have ever married and, if married, to have children. The number of siblings in case-proband families examined and not examined mean [SD], 2.
As presented in Table 2 , case relatives were, on average, significantly older than control relatives; in case relatives, the age range was 9 to 94 years median, 49 years; mean, 48 years ; in control relatives, the age range was 8 to 91 years median, 43 years; mean, 45 years. There was a slight preponderance of females in the control relatives.
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The distribution of type of relative was significantly different between the 2 groups; children comprised a smaller proportion of case than control relatives. The mean SD number of first-degree relatives assessed in addition to the proband was 4. As presented in Table 3 , the prevalence of definite OCD was substantially higher in case than control relatives The prevalence of definite and probable OCD also was higher in case relatives The prevalence of definite obsessions was In addition, significant ORs were found for all definitions of the affected phenotype, indicating that first-degree relatives of cases met criteria for OCD-related phenotypes significantly more often than first-degree relatives of controls.
In general, using more stringent criteria for affected status ie, definite as opposed to definite and probable resulted in larger ORs. Although there is a lower frequency of obsessions than compulsions in both case and control relatives, the magnitude of the association for obsessions is larger than that for compulsions. As described earlier, case and control relatives were different with respect to age case relatives were older , sex of relatives interviewed a larger proportion of case relatives were male , and the type of interview conducted a greater proportion of case relatives had informant-only interviews.
Moreover, the prevalence of OCD was inversely related to current age and was greater in relatives who were directly interviewed than in those who had informant-only interviews data not shown. We therefore controlled for these potential confounding variables in the regression models. The age at onset of obsessive-compulsive symptoms in the 80 case probands ranged from 5 to 41 years.
The mean SD age at onset in males Age at onset in case probands was dichotomized into early onset years and late onset years groups. The prevalence of OCD in the relatives of probands with early vs late onset was 38 In addition, the association between age at onset of obsessive-compulsive symptoms in the case probands and the prevalence of definite OCD in their relatives was examined by including this characteristic as a quantitative variable in a generalized estimating equation model.
Tics single or multiple vocal or motor tics were diagnosed in 8 The prevalence of definite OCD was nonsignificantly lower in the relatives of probands with tics 6. This study reports 3 main findings. First, OCD is familial.
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This finding is more robust for a definite diagnosis of OCD ie, meeting all the DSM-IV criteria ; however, the results are significant if probable diagnoses are included. The difference in rates between case and control relatives should be considered from the vantage point of prevalence rates of OCD in the general population; the estimated lifetime prevalence rate in the control relatives was consistent with those in published epidemiological studies.
Second, obsessions are more specific to the familial aspect of the disorder than are compulsions. Relatives of case probands are at greater risk for both obsessions and compulsions than the relatives of controls; however, the magnitude of the association is substantially stronger for obsessions than compulsions. It should be noted that the frequency of compulsions in both case and control relatives is relatively high. This may indicate substantial heterogeneity for compulsions ie, they may be, in some instances, innocuous behaviors unrelated to an OCD diathesis, or they may be difficult to distinguish clinically from behaviors that are similar in form.
These latter behaviors may be associated with other medical conditions and ought not be classified in the same group as compulsions.
If there is heterogeneity, then compulsions alone perhaps should not be included in the phenotype for studies of OCD. Additionally, the specification for the definition of compulsions in the DSM-IV may benefit from refinement. Third, earlier age at onset of the symptoms of OCD indicates a more familial subgroup. The relationship between younger ages at onset and familiality of medical conditions is a well-recognized phenomenon.
This suggests that cases of OCD with early age at onset are more likely to yield information about the genetic origins of this disorder. Conversely, cases with older ages at onset, whose numbers are not inconsequential, may have different origins. However, the results do not substantiate this hypothesis: there was no difference in the familial risk of OCD based on the presence of OCPD in the case probands.
Previous studies have found that OCD occurs more frequently in the families of those with Tourette disorder, and it has been suggested that the presence of comorbid tics defines a familial subtype of OCD. Tics may be heterogeneous, with some related to OCD and some not.