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Obsessive-compulsive disorder

Perturbatio obsessivo-compulsiva · Obsedantně-kompulzivní porucha

What it is

A cortico-striatal loop stuck on 'not finished yet'.

Symptoms & signs

  • Intrusive thoughts
  • compulsive checking, washing, counting
  • hours lost daily
  • distress when resisting

🚩 Get help if…

  • call 112 / 911 now Thoughts of suicide
  • see a doctor soon Rituals taking over an hour a day or stopping daily life
  • see a doctor soon Raw, bleeding skin from washing
  • see a doctor soon Not eating or leaving home because of fears

Where it strikes

Medical treatment

  • Exposure and response prevention (the key treatment)
  • high-dose SSRIs
  • clomipramine
  • antipsychotic augmentation
  • deep TMS — FDA-cleared 2018 for OCD

Natural & lifestyle

  • ERP homework
  • exercise
  • sleep
  • reducing family accommodation of rituals

Emerging & experimental

  • Deep brain stimulation for severe cases
  • psilocybin trials

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • N-acetylcysteine — small trials disagree mixed evidence
  • Inositol — small trials early / small studies
  • Milk thistle — a small trial comparable to fluoxetine early / small studies

ICD codes