Obsessive compulsive disorders is the sixth most disabling mental health disorder.The persistent intrusive thoughts compels the individual to perform the ritualistic behavior repeatedly which significantly impairs the normal functioning of life activities of a person. During the recent years where the mental disorders have greatly increased among the individuals many new research advances have been advocated in this category. The presence of comorbid diagnoses predicts the severity and prognosis and helps to plan the treatment with medications and psychological treatment accordingly.This review focuses on the impact of homeopathic medicine in adjunction with psychological therapy for alleviating the sufferings of the patients.Many research studies have shown the effectiveness of the homoeopathic medicines for many psychiatric conditions.
Obsessive compulsive disorder, psychiatric,comorbid,anxiety,depression,
Obsession are the persistent intrusive and unwanted thoughts and images about contamination,sex or harming etc which causes anxiety and distress in the individual whereas compulsions are the repetitive behaviours and acts performed in response to these obsessions. Obsessive compulsive disorder is the sixth most disabling mental health illness among other psychiatric disorders. In the United States, the lifetime prevalence rate of OCD is estimated at 2.3% in adults and around 1%-2.3% in children and adolescents under 18.Obsessive compulsive disorder is classified as an anxiety disorder in the DSM-IV-TR ; however theDSM-V fifth edition categorized OCD as a separate entity.Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen.covid-19 has significantly accentuated the negative impact on the mental health of the patients.The most common comorbities in pediatric cases are ADHD, disruptive behavior disorders, major depression, and other anxiety disorders. In adults, the most prevalent comorbids are social anxiety, major depression, and alcohol abuse. The homoeopathic medications along with the relaxation techniques or counseling can alleviate the sufferings of the patient.
The exact cause of ocd is unknown but many research studies have shown the correlation between some variables and the disorder.
Research studies have shown that Monozygotic Twins and with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen.
Brain Structure and Functioning
Functional neuroimaging studies have illustrated that a hyperactive brain circuit exists in OCD; areas involved include the orbitofrontal cortex, anterior cingulate, thalamus, and striatum. In addition, some patients appear to develop or experience an exacerbation of OCD symptoms following beta-hemolytic streptococcal infection. and treatment trials suggest that abnormalities in serotonin (5-HT) neurotransmission in the brain are meaningfully involved in this disorder.
An association between childhood trauma and obsessive-compulsive symptoms has been reported in some studies.
Obsessions are persistent thoughts, intrusive urges, or unwanted thoughts about sex or harming others or self that cause anxiety and distress. Common obsessions include-
Fear of germs or contamination
Unwanted forbidden or taboo thoughts involving sex, religion, or harm
Aggressive thoughts towards others or self harming.
Having things symmetrical or in a perfect order
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include-
Excessive cleaning and/or handwashing
Ordering and arranging things in a particular, precise way and excessive counting.
Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off.
Not all rituals or habits are compulsions. Everyone double checks things sometimes but the frequency and severity of compulsions can be a differentiating parameter.
According to the American Psychiatric Association (APA), the diagnostic criteria for OCD include-
the presence of obsessions, compulsions or both
the obsessions and compulsions are time-consuming like spending one hour day or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
the obsessive-compulsive symptoms are not due to the physiological effects of a substance, for example, drug abuse or medication for another condition.
the disturbance is not better explained by another mental disorder.
If the above criteria are met, a diagnosis of OCD might be given.
COVID-19-TRIGGER FACTOR OR INTENSIFICATION FOR OBSESSIVE COMPULSIVE DISORDER
The emergence of covid-19 has significantly led to the rise of many psychiatric illness like anxiety disorders among which Obsessive compulsive disorder patients quality of life has been greatly affected.Fear of contamination has increased considerably among them leading to increased frequencyof performing ritualistic acts resulting in the acute exacerbation of their existing condition.Fear of contamination/virus has also made some patients refrain from consulting the clinician and taking medicines. Relaxation techniques like meditation,yoga,behavioural exercises etc along with proper guidance, psychoeducation and support of the family members would positively influence their behavior and encourage them to get adapted to the present situation.
Medications recommended by the physicians for this disorders are selective serotonin reuptake inhibitors(SSRI) and anti-psychotics.
Research shows that psychotherapy and cognitive behavioral therapy including Exposure and Response Prevention spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing) is effective in reducing compulsive behaviors in OCD. In 2018, the FDA approved Transcranial Magnetic Stimulation (TMS) and deep brain stimulation as an adjunct in the treatment of OCD in adults.
MANAGEMENT DURING COVID CRISIS
Online consultation with clinician and counseling centres offers services through telephone. Engage yourself in some hobbies like painting, cooking, etc. relaxation techniques like meditation, yoga, behavioral exercises are highly recommended.Gather information about the current scenario only from the authentic sources only.Medications if any should not be discontinued otherwise the withdrawal symptoms would adversely affect them. Educate patients about how to adapt themselves with the present situation and to carry out normal routine life activities.Educate the family members of patients to provide guidance, support and involve them actively in any activities of their interest. Care must be taken that in the name of social distancing they should not isolate themselves completely with family and friends because many tend to suffer from depression. Proper diet, sleep and exercise should be maintained.
Argentum nitricum-Fearful and nervous; impulse to jump out of window. Faintish and tremulous. Melancholic; apprehensive of serious disease. Time passes slowly (Cann ind). Memory weak. Errors of perception. Impulsive; wants to do things in a hurry (Lilium). Peculiar mental impulses. Fears and anxieties and hidden irrational motives for actions.
Arsenium Album-Thoughts of death and of the incurability of his complaints.Thoughts crowd upon him; he is too weak to keep them off or to hold on to one idea. This is one form of his anxiety; when tormented with thoughts, he is anxious. In the delirium he sees all kinds of vermin on his bed.Picks the bedclothes.Delirium during sleep, unconscious mania.Whimpering and gnashing teeth.Lamentations, despair of life.
Calcarea carbonica-Apprehensive; worse towards evening; fears loss of reason, misfortune, contagious diseases. Forgetful, confused, low-spirited. Anxiety with palpitation. Obstinacy; slight mental effort produces hot head. Averse to work or exertion.
Carcinosin-Their sensitivities can lead to codependency and messy relationships. They tend to be in relationships as the caretaker due to a tender heart, low self-esteem and emotional neediness. There is a tendency to have a history of an unhappy childhood where their needs were not met and a sense of self was not fostered. This shaky sense of identity leads to a “lost and lonely” quality. Empathy and intuition makes Carcinosinum types gifted healers.
Causticum-Child does not want to go to bed alone. Least thing makes it cry. Sad, hopeless. Intensely sympathetic. Ailments from long-lasting grief, sudden emotions. Thinking of complaints, aggravates, especially hemorrhoids.
Hyoscyamus niger- Indicated in people who are obsessed with thoughts of sex. They constantly pick at clothes and resort to obscene gesturing.
Lachesis mutans -Great loquacity. Amative. Sad in the morning; no desire to mix with the world. Restless and uneasy; does not wish to attend to business; wants to be off somewhere all the time. Jealous (Hyos). Mental labor best performed at night. Euthanasia. Suspicious; nightly delusion of fire. Religious insanity . Derangement of the time sense.
Medorrhinum: Indicated when there is obsession to wash hands repeatedly. There is also an intense fear of going insane and the dark.
Natrum Muriaticum: When there is such intense fear of being robbed that they keep checking locks. Obsessed about being in control of a situation.
Nux-vomica-Very irritable: sensitive to all impressions. Ugly, malicious. Cannot bear noises, odors, light, etc. Does not want to be touched. Time passes too slowly. Even the least ailment affects her greatly. Disposed to reproach others. Sullen, fault-finding.
Silicea terra: Obsessive fear of pins and needles. Keep collecting and counting them. These people are mentally very alert and oversensitive to sounds.
Sulphur-Very forgetful. Difficult thinking. Delusions; thinks rags beautiful things-that he is immensely wealthy. Busy all the time. Childish peevishness in grown people. Irritable. Affections vitiated; very selfish, no regard for others. Religious melancholy. Averse to business; loafs-too lazy to arouse himself. Imagining giving wrong things to people, causing their death. Sulphur subjects are nearly always irritable, depressed, thin and weak, even with good appetite.
Syphilinum-Loss of memory; remembers everything previous to his illness. Apathetic; feels as if going insane or being paralyzed. Fears the night, and the suffering from exhaustion on awakening. Hopeless; despairs of recovery.
Thuja occidentalis-Fixed ideas, as if a strange person were at his side; as if soul and body were separated; as if something alive in abdomen (Croc). Emotional sensitiveness; music causes weeping and trembling.
Some of the major rubrics to be considered are enlisted below-
THOUGHTS: Persistent: Disease, of: Alum, Aral, Ars, Aur, Chel, Cygn-c, Harp, Hura, Kali-p, Lepi, Loxo-r, Merc, Murx, Nat-m, Nat-p, Ph-ac, Phos, Sabal, Sep, Sulph, Tax-br, Zinc
WASHING, GENERAL: Hands, always, washes the: Allox, Ars, Carc, Coca, Cur, Lac-c, Med, Nat-m, Nat-sil, Plat, Psor, Sep, Sil, Sulph, Syph, Thuj
HOUSEKEEPING, GENERAL: Obsessed, with house cleaning: Ars, Calc, Carc, Lac-f, Nux-v, Rhus-g, Sep, Sil, Sulph, Syph, Thuj
FEARS, PHOBIAS, GENERAL: Contamination, germs, of: Ars, Bor, Bov, Calc, Carc, Cur, Lac-c, Lach, Med, Nat-m, Psor, Sil, Sulph, Syph, THUJ
Obsessive compulsive disorder is the long term chronic mental comorbidity which adversely affect the quality of life of an individual.The comorbities determines the prognosis of the case. Proper case taking and diagnosis can lead to the selection of similimum in a particular case.Many research advances have been advocated in ocd which led to successfully manage the condition without disturbing the quality of life of an individual. The homeopathy medications along with proper relaxation techniques and cognitive behavioral therapy can significantly reduce the frequency and severity of the symptoms and restoration of patients to normal life.
1. Boericke William;Boericke’s New Manual of Homoeopathic Materia Medica with Repertory;9th edition;2011;B.Jain Publishers; New Delhi.
2. Nash E B;Leaders in therapeutics with grouping and classification;sixth edition; 2008;B.Jain Publishers Pvt Ltd;NewDelhi
3. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(DSM-5).5thed.Arlington:American Psychiatric Publishing; 2013.
4. Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, et al. Should OCD be classified as an anxiety disorder in DSM-V? Depress Anxiety 2010;27:495-506.
5. Janardhan Reddy Y C, Sundar A S, Narayanaswamy JC, Math SB. Clinical practice guidelines for Obsessive-Compulsive Disorder.IndianJPsychiatry 2017;59, Suppl S1:74-90
6. Davidson Stanley;Principles and Practice of Medicine;22nd edition;2010;Elsevier health -UK
7. Lilienthal Samuel;Homoeopathic Therapeutics,2015,B. Jain publishers Pvt Ltd new Delhi