Obsessive-compulsive disorder

The main manifestation of the diseases of this group is obsessive (obsessive) thoughts, which are stereotypically repeated. These ideas are very hard to be tolerated by the subject due to his aggressiveness (the patient, for example, is frightened that he can suddenly beat his beloved dog, but at the same time knows that he does not want to cause suffering not only to his faithful friend, but to any living being in general) or his absurdity (the patient is unable to replace a prematurely soiled shirt, as he only does so on Mondays and Thursdays).

There may also be insane images (bloodied traffic victims) or attractions (such as picking your nose or twirling your hair around your finger in front of other people). Let us emphasize that neither images, nor drives, nor ideas are accompanied by a feeling of imposing them from the outside by some magical power, confidence that the patient himself is the object of control by someone else (such a symptom is characteristic of obsessive thoughts in the structure of the schizophrenic process).

Other typical manifestations of the disorder are compulsive (i.e., with a struggle of motives) actions (rituals), which are no less burdensome for existence than obsessive thoughts. They are not associated with satisfaction from the performance of internal useful tasks (for example, the need to wash hands several times a day without a real need, or to iron first shirts, then linen, and then pants, or skip a vehicle and wait for the next one if its number starts to an odd digit, etc.). Rituals aimed at preventing unlikely events that can harm the patient himself or his environment (including from the patient’s side). In general, ritual thinking is a rudimentary component of the human mentality; it was widely used at the stage of the formation of a person as a thinking, social being, when the underdevelopment of algorithmic approaches to processing information about the environment and ignorance of the causes of many phenomena were compensated by the activity of such a rudimentary psychological function as faith. Religious beliefs or anniversaries of special occasions are nothing more than manifestations of ritual thinking. Honoring the heroes of the day is a ritual that everyone obediently adheres to, not realizing that in this way people demonstrate a desire to protect the life of a person who has already reached a certain age from possible further misfortunes and fatal accidents. Therefore, it is sometimes difficult to determine whether a particular ritual in a patient is a manifestation of a mental disorder or is it a part of that collective unconscious (according to K. Jung), which he carries within himself as part of a certain ethnosocial and cultural layer. In addition to rituals, slowness and indecision are also considered compulsive actions.

Researchers have noted a positive correlation between obsessive states and depression, which led to attempts to use antidepressants ( cipralex , paxil , fevarin , remeron, or the previous generation antidepressant – anafranil ) in the treatment of obsessive states . Sometimes, in this way, it is possible to achieve success and relieve the patient from the suffering associated with obsessions . This disorder is more common in individuals with anankastic features, does not depend on gender, and begins at a young or adolescent age. Its course is chronic. Compulsive ritual actions respond better to behavioral therapy than obsessive thoughts, but, unfortunately, both manifestations in the same patient tend to coexist.

Given the great importance of obsessive- compulsive disorder for the general practitioner, here are its criteria:

1. Obsessive- compulsive symptoms should be regarded as one’s own thoughts or impulses. 

2. There is at least one thought or action with which the patient struggles unsuccessfully (if he has even completely reconciled with others). 

3. The thought of performing an obsessive action should not in itself be pleasant for the patient. However, there is some decrease in anxiety or tension after performing the ritual. 

4. Obsessive thoughts, images or actions are repeated, breaking the desire of their “carrier” to get rid of the unpleasant “accompaniment”. 

5. Finally, there must be a violation of the social functioning of the individual, and the obsessive- compulsive disorders themselves act as a source of distress. 

We will not dwell on neurasthenia separately. Note that today the view of neurasthenia is significantly different from that that dominated among psychiatrists of the previous generation: most consider neurasthenia not as a separate psychogenic disease, but as one of the manifestations at the level of asthenic syndrome of low-symptom (latent) organic brain damage. The neuroses of childhood are characterized by the predominance of fears, somatovegetative (enuresis, vomiting) and movement disorders (tics, logoneurosis , hysterical paralysis). The younger the child’s age, the more monotonous the neurotic picture.

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