Obsessive-compulsive disorder (OCD. OCD is sort of the hand-washing, the checking, the counting. How many of you have some OCD traits? You don’t have to raise your hand because I know the answer. Probably all of us do. Probably 80-90% of college and professional athletes have some OCD stuff going on. The basketball player who has to bounce the ball three times before he makes a free-throw.
The etiology of OCD. There’s a few things going on. One, there may be some evolutionary components. You know, chimpanzees groom each other. It might be grooming rituals gone nuts.
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It’s one of the few things in psychiatry that is very similar in kids as it is in adults. You see a lot of kids with OCD and they think it may be related to strep infections now. Occasionally, one of the things about OCD by definition, is there has to be some un-comfort with it. People have to say, “I know this is stupid.” That’s what differentiates this from psychosis. The schizophrenic, why does he check all the food in the refrigerator before he eats it? Because he thinks the CIA is coming in and tampering with it. The OCD person says, “No, no. I know this is stupid but I feel like I have to check it because otherwise it’s going to be contaminated somehow by germs and if I don’t check it something bad is going to happen.”
Treatment of OCD. It changes all the time, but clomipramine was thought to be a bit more efficacious than the others, Anafranil. That’s the TCA that looks like a TCA but acts like an SSRI. Clomipramine or Anafranil. The trouble with that is no one wants to start a tricyclic antidepressant. It’s like Elavil. Elavil has a lot of side effects. Clomipramine is similar to Elavil online. So we like to use the SSRIs. Currently approved, I think, fluoxetine, sertraline, and paroxetine - Cheap Zoloft, Canadian Pharmacy Paxil, Prozac Online and Luvox. There’s five American SSRIs now and rour of them are approved for OCD. Luvox may be a little better than the others. The other thing is behavior therapy. What you do, just in a nutshell, if the person has a problem with washing their hands all the time you say to them, “Look, I want you to not wash your hands. Here’s your homework. You don’t wash your hands, and you’ve got to touch everything in the house. Go in the mud, not wash your hands, touch the toilet seats.” And if the person is very motivated - they’ve got to be very motivated - they’ll do it and they will have sky-high anxiety for about three or four days and then it will go down to nothing. That’s very good and they won’t relapse all that often. If they just go on Prozac they’ll feel better but you stop the Prozac and it all gets worse again. There is a schism. There’s people who say that the original studies that validated the efficacy of clomipramine were not that good and that in reality cognitive therapy is better.
Post-traumatic stress disorder. Response to a trauma, like assault, rape, or combat. Characterized by flashbacks, nightmares, avoidance. Easy to startle, insomnia, diminished interest in activities. Used to be in the old DSM, the psychiatry …acute stress disorder is just like PTSD but it resolves in four weeks.
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