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Obsessivecompulsive disorder

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"OCD" redirects here. For other uses, see OCD (disambiguation).
Not to be confused with Obsessivecompulsive personality disorder.
Obsessivecompulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that
produce uneasiness, apprehension, fear, or worry; by repetitive behaviors aimed at reducing the associated
anxiety; or by a combination of such obsessions and compulsions. Symptoms of the disorder include
excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or
religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such
as opening and closing a door a certain number of times before entering or leaving a room. These symptoms
can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of
those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally
recognize their obsessions and compulsions as irrational and may become further distressed by this
realization.
Obsessivecompulsive disorder affects children and adolescents, as well as adults. Roughly one third to one
half of adults with OCD report a childhood onset of the disorder, suggesting the continuum of anxiety
disorders across the life span.
[1]

The phrase obsessivecompulsive has become part of the English lexicon, and is often used in an informal or
caricatured manner to describe someone who is excessively meticulous, perfectionistic, absorbed, or
otherwise fixated.
[2]
Although these signs are present in OCD, a person who exhibits them does not
necessarily have OCD, but may instead have obsessivecompulsive personality disorder (OCPD), an autism
spectrum disorder, disorders where perseveration is a possible feature (ADHD, PTSD, bodily disorders or
habit problems),
[3]
or no clinical condition.
Despite the irrational behaviour, OCD is sometimes associated with above-average intelligence.
[4][5]
Its
sufferers commonly share personality traits such as high attention to detail, avoidance of risk, careful
planning, exaggerated sense of responsibility and a tendency to take time in making decisions.
[6]
Multiple
psychological and biological factors may be involved in causing obsessivecompulsive syndromes.
Standardized rating scales such as YaleBrown Obsessive Compulsive Scale can be used to assess the
severity of OCD symptoms.
[7]
Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions,
are upsetting or distressing, and can be difficult to manage or eliminate.
[1]
When they are associated with obsessive-
compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit
hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive
thoughts may also be associated with episodic memory, unwanted worries or memories from OCD,
[2]
posttraumatic
stress disorder, other anxiety disorders, eating disorders, or psychosis.
[3]
Intrusive thoughts, urges, and images are of
inappropriate things at inappropriate times, and they can be divided into three categories: "inappropriate aggressive
thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts".
[4]
Compulsive behavior
Dermatophagia - extreme nail biting / biting of skin to point of an obsessive compulsive disorder (OCD) or
other condition leading to self mutilating behaviour such as autistic spectrum disorders (as is the case in this
example) or Lesch-Nyhan Syndrome.
Compulsive behavior is defined as performing an act persistently and repetitively without it leading to an
actual reward or pleasure.
[1]
Compulsive behaviors could be an attempt to make obsessions go away.
[2]
The
act is usually a small, restricted and repetitive behavior, yet not disturbing in a pathological way.
[1]

Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to
abstain or control.
[3]
A major cause of the compulsive behaviors is said to be obsessivecompulsive disorder
(OCD).
[2]
The main idea of compulsive behavior is that the likely excessive activity is not connected to the
purpose it appears to be directed to.
[1]
Also, as well as being associated with obsessivecompulsive
disorder,
[4]
Furthermore, there are many different types of compulsive behaviors including, shopping,
hoarding, eating, gambling, trichotillomania and picking skin, checking, counting, washing, sex, and more.
Also, there are cultural examples of compulsive behavior.
Attention deficit hyperactivity disorder
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(Redirected from ADHD)
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Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a
psychiatric disorder
[1][2]
of the neurodevelopmental type
[3][4]
in which there are significant problems of
attention, hyperactivity, or acting impulsively that are not appropriate for a person's age.
[5]
These symptoms
must begin by age six to twelve and be present for more than six months for a diagnosis to be made.
[6][7]
In
school-aged individuals the lack of focus may result in poor school performance.
Despite being the most commonly studied and diagnosed psychiatric disorder in children and adolescents, the
cause in the majority of cases is unknown. It affects about 67% of children when diagnosed via the DSM-IV
criteria
[8]
and 12% when diagnosed via the ICD-10 criteria.
[9]
Rates are similar between countries and
depend mostly on how it is diagnosed.
[10]
ADHD is diagnosed approximately three times more frequent in
boys than in girls.
[11][12]
About 3050% of people diagnosed in childhood continue to have symptoms into
adulthood
[13]
and between 25% of adults have the condition.
[1]
The condition can be difficult to tell apart
from other disorders as well as that of high normal activity.
[7]

ADHD management usually involves some combination of counseling, lifestyle changes, and medications.
Medications are only recommended as a first-line treatment in children who have severe symptoms and may
be considered for those with moderate symptoms who either refuse or fail to improve with counseling.
[14]:p.317

Long term effects of medications are not clear and they are not recommended in preschool-aged children.
Adolescents and adults tend to develop coping skills which make up for some or all of their impairments.
[15]

ADHD and its diagnosis and treatment have been considered controversial since the 1970s.
[16]
The
controversies have involved clinicians, teachers, policymakers, parents and the media. Topics include
ADHD's causes, and the use of stimulant medications in its treatment.
[17][18]
Most healthcare providers accept
ADHD as a genuine disorder with debate in the scientific community mainly around how it is diagnosed and
treated.
[19][20

Conditions comorbid to autism spectrum disorders
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Autism spectrum disorders (ASD), including Asperger syndrome, are neurological disorders that begin in
early childhood, persist throughout adulthood, and affect three crucial areas of development: communication,
social interaction and restricted patterns of behavior.
[1]
There are many conditions comorbid to autism
spectrum disorders, such as fragile X syndrome and epilepsy. In medicine and in psychiatry, comorbidity
describes the effect of other diseases an individual patient might have other than the primary disease of
interest. About 1015% of autism cases have an identifiable Mendelian (single-gene) condition, chromosome
abnormality, or other genetic syndrome,
[2]
and ASD is associated with several genetic disorders.
[3]

Distinguishing between ASDs and other diagnoses can be challenging because the traits of ASDs often
overlap with symptoms of other disorders and the characteristics of ASDs make traditional diagnostic
procedures difficult.
[4][5]

Anxiety[edit]
Anxiety disorders are common among children with ASD, although there is no firm data. Symptoms are
likely affected by age, level of cognitive functioning, degree of social impairment, and ASD-specific
difficulties. Many anxiety disorders, such as social anxiety disorder, are not commonly diagnosed in people
with ASD because such symptoms are better explained by ASD itself, and it is often difficult to tell whether
symptoms such as compulsive checking are part of ASD or a co-occurring anxiety problem. The prevalence
of anxiety disorders in children with ASD has been reported to be anywhere between 11% and 84%; the wide
range is likely due to differences in the ways the studies were conducted.
[6]

Attention-deficit hyperactivity disorder[edit]
Previously, the diagnosis manual DSM-IV did not allow the co-diagnosis of ASD and attention-deficit
hyperactivity disorder (ADHD) . However, following years of clinical research, the most recent publication
(DSM-5) in 2013 removed this prohibition of co-morbidity. Thus, individuals with autism spectrum disorder
may also have a diagnosis of ADHD, with the modifiers of inattentive, hyperactive, combined-type, or not
otherwise specified. Clinically significant symptoms of these two conditions commonly co-occur, and
children with both sets of symptoms may respond poorly to standard ADHD treatments. Individuals with
autism spectrum disorder may benefit from additional types of medications or from behavioral or other
therapies, such as applied behavior analysis and neuro-feedback.
[7][8]

Bipolar disorder[edit]
Pediatric bipolar disorder, or manic-depression, is a highly controversial diagnosis
[9]
and is itself often
claimed to be comorbid with a number of conditions, including autism.
[10]
Autism includes some symptoms
commonly found in mood and anxiety disorders.
[11]

Bowel disease[edit]
Some children with autism also have gastrointestinal (GI) symptoms, but there is a lack of published rigorous
data to support the theory that autistic children have more or different GI symptoms than usual.
[12]
It has been
claimed that up to fifty percent of children with autism experience persistent gastrointestinal tract problems,
ranging from mild to moderate degrees of inflammation in both the upper and lower intestinal tract. This has
been described as a syndrome, autistic enterocolitis, by Dr. Andrew Wakefield; this diagnostic terminology,
however, has been questioned by medical experts, and Wakefield's 1998 paper has since been shown to be
fraudulent. Constipation, often with overflow, or encopresis, is often associated with developmental
disorders in children, and is often difficult to resolve, especially among those with behavioral and
communication problems.
[13]

Developmental coordination disorder[edit]
The initial accounts of Asperger syndrome
[14]
and other diagnostic schemes
[15]
include descriptions of
developmental coordination disorder. Children with ASD may be delayed in acquiring motor skills that
require motor dexterity, such as bicycle riding or opening a jar, and may appear awkward or "uncomfortable
in their own skin". They may be poorly coordinated, or have an odd or bouncy gait or posture, poor
handwriting, or problems with visual-motor integration, visual-perceptual skills, and conceptual
learning.
[14][16]
They may show problems with proprioception (sensation of body position) on measures of
developmental coordination disorder, balance, tandem gait, and finger-thumb apposition.
[14]

Fragile X syndrome[edit]
Fragile X syndrome is the most common inherited form of intellectual disability. It was so named because
one part of the X chromosome has a defective piece that appears pinched and fragile when under a
microscope. Fragile X syndrome affects about two to five percent of people with ASD.
[17]
It is important to
have a person with autism checked for Fragile X, especially if the parents are considering having another
child. If one child has Fragile X, there is a 50% chance that boys born to the same parents will have Fragile
X (see Mendelian genetics). Other members of the family who may be contemplating having a child may
also wish to be checked for the syndrome.
Intellectual disability[edit]
The fraction of autistic individuals who also meet criteria for intellectual disability has been reported as
anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing autistic intelligence.
[18]

For example, a 2001 British study of 26 autistic children found about 30% with intelligence in the normal
range (IQ above 70), 50% with mild to moderate retardation, and about 20% with severe to profound
retardation (IQ below 35). For ASD other than autism the association is much weaker: the same study
reported normal intelligence in about 94% of 53 children with PDD-NOS.
[19]
Estimates are that 4069% of
individuals with ASD have some degree of intellectual disability,
[20]
with females more likely to be in severe
range of intellectual disability. Learning disabilities are also highly comorbid in individuals with an ASD.
Approximately 2575% of individuals with an ASD also have some degree of learning disability,
[21]
although
the types of learning disability vary depending on the specific strengths and weaknesses of the individual.
A 2006 review questioned the common assumption that most children with autism have ID.
[22]
It is possible
that the association between intellectual disability and autism is not because they usually have common
causes, but because the presence of both makes it more likely that both will be diagnosed.
[23]

Neuroinflammation and immune disorders[edit]
The role of the immune system and neuroinflammation in the development of autism is controversial. Until
recently, there was scant evidence supporting immune hypotheses, but research into the role of immune
response and neuroinflammation may have important clinical and therapeutic implications. The exact role of
heightened immune response in the central nervous system (CNS) of patients with autism is uncertain, but
may be a primary factor in triggering and sustaining many of the comorbid conditions associated with
autism. Recent studies indicate the presence of heightened neuroimmune activity in both the brain tissue and
the cerebrospinal fluid of patients with autism, supporting the view that heightened immune response may be
an essential factor in the onset of autistic symptoms.
[24]
A 2013 review also found evidence of microglial
activation and increased cytokine production in postmortem brain samples from people with autism.
[25]

Nonverbal learning disorder[edit]
See also: Nonverbal learning disorder
Obsessive-compulsive disorder[edit]
Obsessive-compulsive disorder is characterized by recurrent obsessional thoughts or compulsive acts. About
30% of children with autism spectrum disorders also have OCD.
[26]

Tourette syndrome[edit]
The prevalence of Tourette syndrome among individuals with autism is estimated to be 6.5%, higher than the
2% to 3% prevalence for the general population. Several hypotheses for this association have been advanced,
including common genetic factors and dopamine, glutamate or serotonin abnormalities.
[3]

Seizures[edit]
ASD is also associated with epilepsy, with variations in risk of epilepsy due to age, cognitive level, and type
of language disorder.
[27]
One in four autistic children develops seizures, often starting either in early
childhood or adolescence.
[28]
Seizures, caused by abnormal electrical activity in the brain, can produce a
temporary loss of consciousness (a "blackout"), a body convulsion, unusual movements, or staring spells.
Sometimes a contributing factor is a lack of sleep or a high fever. An EEG can help confirm the seizure's
presence. Typically, onset of epilepsy occurs before age five or during puberty.
[29]
and is more common in
females and individuals who also have a comorbid intellectual disability.
Sensory problems[edit]
Further information: Sensory processing disorder
Unusual responses to sensory stimuli are more common and prominent in autistic children, although there is
no good evidence that sensory symptoms differentiate autism from other developmental disorders.
[30]

Sensory processing disorder is comorbid with ASD, with comorbidity rates of 4288%.
[31]

Several studies have reported associated motor problems that include poor muscle tone, poor motor planning,
and toe walking; ASD is not associated with severe motor disturbances.
[32]

Tuberous sclerosis[edit]
Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other
vital organs. It has a consistently strong association with the autism spectrum. One to four percent of autistic
people also have tuberous sclerosis.
[33]
Studies have reported that between 25% and 61% of individuals with
tuberous sclerosis meet the diagnostic criteria for autism with an even higher proportion showing features of
a broader pervasive developmental disorder.
[34]
Sleep disorders are also commonly reported by parents of
children with ASDs, including late sleep onset, early morning awakening, and poor sleep maintenance.
[29]

Other mental disorders[edit]
See also: Schizophrenia and comorbid conditions
Phobias, depression and other psychopathological disorders have often been described along with ASD but
this has not been assessed systematically.
[35]

The presentation of depression in ASDs can depend on level of cognitive functioning, with lower functioning
children displaying more behavior issues and higher functioning children displaying more traditional
depressive symptoms.
[4]
Depression is thought to develop and occur more in high-functioning individuals
during adolescence, when they develop greater insight into their differences from others.
[20]

What Is Down Syndrome?Down syndrome is one of the most common birth defects. Usually, children born with the
condition have some degree of mental retardation, as well as characteristic physical features. Many of these children also have
other health problems.
Each year in the U.S., approximately one in every 800 to 1,000 newborns has Down syndrome. This results in
approximately 5,000 children born with Down syndrome each year.
Understanding Down Syndrome
Find out more about Down syndrome:
In the U.S. today, Down syndrome affects approximately 350,000 people. As many as 80% of adults with this condition
reach age 55, and many live longer.
The most common form of Down syndrome is often called "trisomy 21," because individuals with this condition have
three copies of the 21st chromosome.
What Causes Down Syndrome?
Normally, each cell in the human body contains 23 pairs of chromosomes, which contain the genetic material that
determines all our inherited characteristics. We receive half of each chromosome pair from our mother and the other
half from our father. Individuals with the most common form of Down syndrome, trisomy 21, have an extra 21st
chromosome.
No one knows exactly why this chromosomal error occurs, but it does appear to be related to the age of the mother. At
age 25, a woman has a one in 1,250 risk for having a child with Down syndrome. The risk increases to one in 952 at
age 30, to one in 378 at age 35, to one in 106 at age 40 and one in 35 at age 45. However, 80% of children born with
Down syndrome are born to mothers under the age of 35. This is because most babies, in general, are born to younger
women.