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some neuroscience stuff

some neuroscience stuff

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Published by: Brittany on Nov 04, 2006
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Raskin Brittany AdlerPsych 60 11/14/05
Obsessive Compulsive Disorder
An obsessive compulsive individual engages in ritualistic behaviors in order torelieve anxiety caused by repeated, intrusive thoughts. Although she feels that thebehaviors will attenuate her obsession, the behaviors are burdensome and often are notassociated with the obsession in a realistic way. Obsessive Compulsive Disorder (OCD)has a lifetime prevalence rate in the US of 2.5% and is the fourth most commonpsychiatric disorder. No studies thus far have found any sex differences in the prevalenceof OCD. Risk of developing OCD is elevated prior to puberty and from 40-50 years of age (Husted et al.).The syndrome PANDAS, in which a child acquires OCD or tic symptoms after astreptococcal infection, suggests that these disorders may have an autoimmune basis.Only a small proportion of children develop a neuropsychiatric disorder followingstreptococcal infection. It is likely that OCD symptomatology in PANDAS patients iscaused by targeting of the basal ganglia by antistreptococcal-antineuronal antibodies(Husted et al.). PANDAS symptoms are caused by Group A Streptococcus (GAS) and aregenerally episodic or sawtooth. One study by Murphy et al. sought to determine arelationship between the symptom course (episodic, sawtooth, stable or remitting) andGAS antibody fluctuations. In this study, 25 referred children from 6-17 years of age
 
were diagnosed with a Tic disorder and/or OCD according to the CYBOCS and YGTSS.Over a 9 to 22 month period, changes in symptoms, severity of choreiform movements,and GAS titers (to measure streptococcal antibodies) within each subject were measured 6to 15 times. The children were grouped according to their symptom course into a 15-person ESC (episodic/sawtooth) group and a 10-person SRC (stable/remitting) group.The ESC group thus resembled the fluctuating symptom intensity observed in PANDASsyndrome. Similar to children with PANDAS, the ESC group was largely male and had ashorter duration of OCD, although there was no significant difference in duration for theTic disorder. This study found neurologic criteria, measured by choreiform movements,unable to distinguish between ESC and SRC groups. Furthermore, PANDAS-like ESCchildren had elevated streptococcal titers associated with symptom exacerbation(measured by a greater than 9-point change on CYBOCS and 14-point change onYGTSS). The titers rarely normalized in this group throughout the period of observation,suggesting that recent exposure to GAS may have lead to the drastic symptomfluctuations apparent in ESC (and PANDAS) children. This idea was further supportedby the finding that Tic symptom exacerbations and titer increases occurred mostfrequently in the fall/winter, when GAS infections are at their peak (Murphy et al).OCD is a chronic illness and few afflicted individuals ever experience a completeremission of symptoms, even after treatment. Only a 25-35% reduction in the patient’sscore on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is considered an
 
adequate response to a treatment. 40-60% of patients do not even experience this modestdegree of symptom relief. Such nonresponsive patients are placed in two categories: 1)treatment-resistant patients, who do not respond to at least two SRI trials and 2) the moresevere treatment-refractory patients, who fail to respond to at least three SRI trials, twoaugmentation strategies, and behavioral therapy. 30-40% of patients are treatment-refractory (Husted et al.).Glutamatergic neurons in the orbitofrontal cortex are overactive in OCD patients.Because 5-HT inhibits these neurons, drugs that increase 5-HT release (such as SRIs) areoften effective in treating OCD. Increased levels of dopamine in the cortico-striatal-thalamic-cortical system are also implicated in OCD, which may explain why atypicalantipsychotics (dopamine antagonists) are effective augmentation strategies. One double-blind, placebo-controlled study found that risperidone combined with an SRI improvedOCD symptoms compared to an SRI and placebo (Hustsed et al.).Several studies have shown clomipramine (an SRI) to be more effective thanSSRIs in reducing OCD symptoms in adults. However, there is no consensus onresponses in OCD children and adolescents to various drugs. In a meta-analysis by Gelleret al. of 12 double-blind, controlled studies totaling 1044 children and adolescents, theefficacies of 4 SSRIs (paroxetine, fluoxetine, fluvoxamine, and sertraline) andclomipramine were assessed. There was overall a significant (.46) mean differencebetween drug and placebo treatments that amounted to a 4 point difference on the Y-

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