The obsessive compulsive disorder (OCD) is characterized by obsessions and / or constraints. Obsessions are irresistible, persistent ideas, images or impulses to do something. Constraints of pathological urge to respond to a pulse that, when resisted, leading to excessive anxiety and distress. Constraints cause great suffering and interfere with school performance or social interaction. The diagnosis is made clinically. The treatment consists of behavioral therapy and SSRI.

(Obsessive-Compulsive and Related Disorders).

The obsessive compulsive disorder (OCD) is characterized by obsessions and / or constraints. Obsessions are irresistible, persistent ideas, images or impulses to do something. Constraints of pathological urge to respond to a pulse that, when resisted, leading to excessive anxiety and distress. Constraints cause great suffering and interfere with school performance or social interaction. The diagnosis is made clinically. The treatment consists of behavioral therapy and SSRI. (Obsessive-Compulsive and Related Disorders). The mean age at onset of obsessive-compulsive disorder 19 to 20 years; over 25% of cases start before the age of 14 years. Compulsive disorders include several related disorders, including body dysmorphic disorder (BDD) Horten (Hoarding Disorder ( “compulsive hoarding”)) trichotillomania (Haarziehen- trichotillomania) skin picking (excoriation (skin picking) Disorder) Some children, especially boys, also have a tic disorder (tics and Tourette’s syndrome in children and adolescents). Etiology studies suggest that there is a familial component. However, no specific genes have been identified, although animal studies indicate an abnormality in the genes that influence the function of microglia. Some cases have been associated with an infection. Those that are associated with ?-hemolytic group A streptococci are, PANDAS ( “pediatric autoimmune neuropsychiatric disorder associated with streptococcus”) called. Those who are associated with other infections are called PANS ( “Pediatric Acute-Onset Neuropsychiatric Syndrome”). This aspect is explored thoroughly at the moment; in cases of suspected PANDAS or PANS an expert should therefore be consulted. Symptoms and complaints The OCD typically has a gradual, insidious onset. Most children hide their symptoms and report that they have for years struggled with the symptoms before a final diagnosis is made. Obsessions are usually experienced as anxiety and fear of injury, eg. As the fear of contracting a fatal disease to sin and he would go to hell or to add itself or other injuries. Constraints are deliberate, intentional acts which are normally carried out with the intention to neutralize compulsive fears or compensate for such. B. control behavior, excessive washing, counting, sorting u. v. m. The connection between obsession and compulsion may include a logic element such. As washing hands to prevent a disease. In other cases, the connection can be illogical and idiosyncratic, z. As to count again to 50 in order grandfather gets a heart attack. When children are prevented from carrying out their compulsions, they are overly anxious and worried. Most children are aware that their constraints and their obsession are not normal. Many affected children are bashful and reserved. Common symptoms include rough, torn hands spend as conspicuous symptom of compulsive washing Prolonged stays in the bathroom very much time for homework (because of an obsession about errors) Many own corrections in schoolwork performing repetitive or strange behavior, such. B. control the door locks, while eating perform a certain number of chews per bite or not touching certain objects. Frequent anxious inquiries in the hope of reassuring answers for. As dozens or even hundreds of times to ask: Do I have a fever? Could a tornado come here? Do you think the car will jump to? What if we’re late? What if the milk is sour? What if intruders come? “Diagnosis Clinical examination The diagnosis is made clinically. Once a relationship of trust is built with an unbiased therapist, the child concerned disclosed in general, many obsessions and related compulsions. However, as a rule, several appointments are necessary to establish first of all trust. Children with OCD often have symptoms of other anxiety disorders, including panic attacks, separation anxiety and specific phobias. These symptoms can sometimes overlap and thus complicate the diagnosis. Forecast in 5% of cases, the disorder is overcome after a few years at about 40%, they will be overcome before young adulthood. Treatment can then be stopped. For other children, the disorder tends to be chronic, but everyday life can be overcome with an accompanying treatment usually. Approximately 5% of children can not be treated and remain severely impaired. Therapy Cognitive behavioral therapy Usually SSRI Cognitive behavior therapy is helpful if the children are motivated and able to cope with the implementation of the tasks. SSRIs are the most effective drugs and are well tolerated in general (see table: drugs for long-term treatment of anxiety and related disorders); all are equally effective. However, about 50% of patients respond only partially to SSRIs and may require an SSRI plus other drugs that serotonergic activity (eg., Lithium) or glutamatergic activity (eg. As riluzole) have. Another alternative is clomipramine, a tricyclic antidepressant to be more effective and better response rate than SSRIs may have, even though it has a higher risk for heart effects and seizures. There are no guidelines for the treatment of PANDAS and PANS. Antibiotics that dampen the glutamatergic activity (eg. As ?-lactams), can help in some cases.

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