CASE STUDY ON OBSESSIVE COMPULSIVE DISORDER
Discussion on Neurotransmitters
Obsessive-compulsive disorder also referred to as OCD is a psychiatric mental disorder in which an individual is characterized by compulsive behaviors or obsessive thoughts that interferes with ones normal life significantly. Obsession refers to primarily negative ever present fears such as those of germs while compulsions refers to repetitive rituals aimed at lessening the anxiety caused by the disorder such as repeated hand washings (NIMH, 2010). Obsessions experienced in this order are recurrent, unwanted, disturbing and the individual finds it hard to suppress them and as a result they cause overwhelming anxiety on the individual. The compulsions experienced in this disorder are ritualized repetitive behaviors which the individual feels compelled to undertake as a measure of alleviating the anxiety caused by the obsessions. These compulsive and obsessive rituals can occur irregularly and occupy a substantial amount of time within a day. In the case under study, Marias compulsions lead her to utilize several hours per day trying to ensure that her religious and personal cleanliness rituals are well observed. Although not all OCD patients suffer from both compulsions and obsessions, approximately 80 exhibit both while only 20 exhibits either obsession or compulsion. The disease affects roughly 140 adults in the United States (CAMH, 2009).
Researchers are in general agreement that OCD is both a biological and a physical disease. Brain imaging studies have shown that there are specific areas of the brain that may be directly linked to the disorder. These include the orbit frontal cortex, striatum and the cingulated gyrus. For people with this disorder, these parts have been linked with over activity. The actual cause of the disorder involves brain chemicals known as neurotransmitters that are responsible for transmitting impulses from one nerve cell to other cells. For individuals with this disorder, these neurotransmitters behave abnormally in the parts mentioned above. The common neurotransmitters that are believed to cause the disorder are serotonin, dopamine and glutamine. OCD can have severe effects on an individual depending on its severity although there are positive research developments that show that OCD patients may benefit from behavioral therapy, medication or a combination of both.
Genetic Contribution to the disorder
By applying intensive comparison of normal brains and OCD brains, researchers have gained considerable insight into the cause of the disorder. Considerable debate has rotated around the whether environmental influences or neurobiological factors cause the disorder. Parts of research have so far proved that normal brains differ considerably from brains of those having the OCD disorder. Studies conducted using magnetic resonance imaging (MRI) have recently shown that victims with OCD disorder had significantly less white matter in their brains as compared to those of normal subjects. In efforts to establish the genetic contribution in the disorder, scientists from the University of Cambridge undertook a study in 2007 to evaluate the possibility of a link between genetics and the disorder. Although no conclusive results have been found to link the disorder with genetic make up, there are several genetic factors that may suggest a link in the disorder (Fox News, 2009). First, individuals with OCD share distinctive brain pattern structures with close family members. One suggestion is that genes may influence the structure of the brain. For instance, in the study conducted by these researchers, a study group of 31 individuals was studied alongside two control groups. One group consisted of 31 individuals drawn from close family members and another group of 31 individuals from families with no OCD history. A significant observation was that individuals with OCD and their close family members exhibited less grey matter in the brain which is linked with suppressing responses common in OCD individuals. Based on this, the researchers concluded that there was significant evidence to back assumptions that OCD has a genetic link (Fox News, 2009).
Brain Abnormalities Indicated in the Disorder
The brains of individual with the disorder have a significant difference with those of normal persons. MRI studies have shown that OCD sufferers have less white matter compared to their normal counterparts. This white matter is located at the cerebral cortex and it connects neurons in that portion of the brain to other parts of the brain. Lowered population of the white matter suggests that there is a significantly reduced intracranial activity in the nervous system of OCD Patients. There have also been research findings that suggest that OCD patients exhibits significantly abnormal metabolic activity rates in the orbital cortex (Basal ganglia) and the frontal lobe of the brain. Excessive metabolism in the orbital cortex of these patients is responsible for initiating a worry circuit which consists of the caudate nucleus, a part within the basal ganglia responsible for intermittent switching of gears from one thought to the other. It also consist of cingulated gyrus, another part within the basal ganglia that wrenches the gut with dread as well as the thalamus responsible for regulating the bodys sensory inputs. As such, the brains of OCD patients may portray some significant differences from normal subjects based on these three brain areas that continually trigger a worry circuit that is responsible for the repetitive obsessions and compulsions on the individuals.
Medical treatment
Medical treatments aimed at correcting this disorder are aimed at increasing the level of serotonin in the brain. Since research has shown that the disorder is associated with an imbalance in the level of serotonin, a neurotransmitter, pharmaceuticals which increase the level of serotonin in the body are preferred in the treatment. Drugs which increase the level of serotonin in the body have been shown to reduce the effect of the disorder on the patients. The classes of drugs used to increase the level of serotonin are referred to as SRIS (serotonin reuptake inhibitors) and they are part of the wider class of antidepressants. According to CAMH (2009), some of the drugs that are used in the treatment are a tricyclic antidepressant, Anafranil and two selective serotonin reuptake inhibitors, prozac and Luvox. Others include sertraline and paroxetine. When applied in the body, the drugs produce a healthy balance of serotonin in the brain and therefore reduce hyperactivity in the three regions of the brain associated with the worry circuit prevalent among these patients (CAMH, 2009). Though all these drugs have shown effectiveness, different drugs may work differently for different patients.
In addition to medication, behavioral therapy is also applied in these patients. This is a psychotherapy aimed at exposing and developing response prevention techniques that helps then patients to deal and respond to the compulsions and obsessions without necessary performing the rituals (Penzel, 2000, p. 21). For instance, a patient who has an obsession with germs may be asked to touch a can full of garbage and be restrained not to wash his hands. Initially, the patients anxiety would rise but with time, it would subside gradually in a process referred to as extinction. When extinction is allowed for a continuous period, the overall anxiety surrounding the obsession and compulsion decreases in a process referred to as habituation. This behavioral therapy operates on a reconditioning therapy technique which alters the directional nature of the brain. That is, it affects the bi-directional way through which the brain processes information. For instance, the brain an OCD patient with an obsession on germs usually compels the person to wash hands as an output requirement to an anxious input. If the output is altered, for instance by not washing the hands after touching a can of garbage, the brain process is rerouted due to the lack of the hand washing output. The altering of the information processing route eventually alters the emotional state of the person and has a positive effect of decreasing the obsessions and compulsions in the OCD patient. The brain is termed as plastic in that information connections are increasingly linked and as such, establishing a new information processing link can improve the patients condition over time. For instance, the worry circuit is a complex linkage between an input and a desired output. If a person has an obsession on germs, any thought that provokes the presence of germs compels the person to produce an output that would deal with the brain stimulus. The aim therefore in behavioral therapy is to break this chain of worry circuit by forcefully denying the urge to fulfill compulsive response requirements. This therapy works effectively when the sufferer consciously disregards brain compulsions to act on a certain impulse. For human beings, this therapy is possible since human beings have the capability to choose the signals they wish to react to from the brain.
Side Effects
CAMH (2009) identifies a number of side effects associated with SRIS. Often, individuals will experience the side effects before the drugs show their full effectiveness. Some of the known side effects include sweating, constipation, dry mouth, and drowsiness, sexual dysfunctions such as delayed orgasm, low sex drive, dizziness, blurred vision and tremor. On rare events, there have been reported cases of seizures and manic episodes. One of the SRIS used, clomipramine has been associated with significant weight gain. Although inorganic medicine has been widely used for treating OCD cases, there are alternative treatments that patients allergic to inorganic medicine may explore. Such includes herbal treatment which should be taken after consulting knowledgeable doctors. Generally, SRIS are safe to use and are recommended together with reinforcements through behavioral counseling.
Case Study Specifics
The theoretical background and literature above are significant in the case study which will analyze a medical condition exhibited by Maria, a 38-year old married woman with four children. In her ordinary life discourse, Maria has shown uptight devotion especially towards religion, cleanliness and orderliness. The concern in this study is based on a peculiar obsessive character exhibited by Maria in regard to perfection surrounding her domestic and religious rites. For instance, she often worries whether she is devout enough whether she has done her daily chores well and these worries have become remarkably intense in the recent past. What makes Maria a study case is especially her obsession and compulsion towards religious rites and cleanliness that makes her wash her hands for six to eight hours a day to the point of cracking and bleeding. The fact that she is compelled to scrub fixtures that are already gleaming and her recent insistent that members of her family wash their hands and shower frequently to the chagrin of her family is the concern of this study.
Whether Marias condition has a genetic bearing or not may not be very obvious though there are general case observations that are likely correlates. First, her mother was highly superstitious and once stopped growing petunias in her flower garden for fears that they would bring bad luck. In addition, one of Marias sons was previously diagnosed with ADHD disorder and the daughter has become involved with a ritual of cutting herself. Considering the biological connection between these parties, and the considerable out-of normal characteristics they exhibit, it may be prudent to infer some genetic influence and transmission of the disorder.
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