The study found that, For patients with obsessive-compulsive disorder, From the onset of the disease to seeking help from a doctor, Probably 10 years apart, For even longer, It may be due to the stigma caused by obsessive-compulsive disorder, especially those patients who have obsessive-compulsive concepts related to sex or violence against their will. When patients find out that they suffer from obsessive-compulsive disorder, they will try their best to hide their obsessive-compulsive behaviors or obsessive-compulsive concepts in their life, trying to look like ordinary people on the surface.
Family members may accommodate some unreasonable demands or behaviors of obsessive-compulsive disorder patients, Even over-protection, Or take the behavior of ignoring and avoiding, and some will have conflicts. When other family members do not follow the requirements of obsessive-compulsive disorder patients, the patients may also have conflicts with family members. Other family members may take other measures to deal with the situation, but it may further worsen the situation. Finally, the family members will seek help.
Psychotherapy
Before psychotherapy, The obsessive-compulsive disorder patients should first understand the purpose of treatment, It is not to cure obsessive-compulsive disorder, but to gradually reduce patients’ obsessive-compulsive behavior, obsessive-compulsive concept, anxiety, etc. through psychological treatment, to correctly recognize their own personality characteristics and diseases, to have objective judgment on the surrounding environment and the actual situation, and to lose mental burden to reduce insecurity.
At the same time, mobilize their family members and colleagues to neither accommodate the patients nor excessively correct their compulsive behaviors, and help the patients actively engage in sports, entertainment and social activities, so as to gradually extricate them from the dilemma of compulsive concepts/behaviors.
Drug therapy
At present, there is good evidence that selective serotonin reuptake inhibitors (SSRIs) and clomipramine can benefit obsessive-compulsive patients and prevent recurrence of obsessive-compulsive disorder in the short and long term.
When deciding to administer antipsychotic drugs to patients, the drugs should be administered experimentally at low doses within 4 weeks to determine whether the drugs take effect. At present, there is other evidence to use other drugs, including lamotrigine, topiramate and acetylcysteine.
Neurosurgical ablation
Systematic psychotherapy, drug therapy or a combination of the two have no effect. The patient is determined to be an extremely refractory type of obsessive-compulsive disorder. Neurosurgical ablation can be used to relieve obsessive-compulsive disorder by cutting off and destroying nerve fibers in neural circuits related to obsessive-compulsive disorder. However, it is rarely used and there is no completed control test.
Deep brain stimulation
At the same time, neurosurgical ablation and lesion has certain lesion and high incidence of postoperative complications in the treatment of obsessive-compulsive disorder. At present, deep brain stimulation (DBS) can be used as an alternative therapy for neurosurgical ablation and lesion, and a brain stimulator with certain electrical energy is placed near the internal capsule of the patient.
By adjusting the electric quantity of the brain stimulator and the frequency of electrical stimulation, the excitation level of the neural circuit is adjusted to relieve and eliminate obsessive-compulsive disorder. This technique is non-destructive, reversible, less traumatic to the brain, less postoperative complications, but expensive.
Transcranial magnetic stimulation
A systematic review shows that transcranial magnetic stimulation (TMS) is ineffective in the treatment of obsessive-compulsive disorder.
Course of disease and prognosis
In neurosis, The curative effect and prognosis of obsessive-compulsive disorder belong to the category of poor. The course of obsessive-compulsive disorder is often prolonged, but some patients can be relieved within one year. If it exceeds one year, it is usually a continuously fluctuating course, which can reach several years or more than ten years. The prognosis of patients with severe obsessive-compulsive symptoms or accompanied by obsessive-compulsive personality characteristics and continuous exposure to more stress events is poor.
People with poor prognosis usually account for 1/3, which is refractory and seriously affects daily life and social function. Another 40-60% of patients can obviously improve after adequate treatment, but most of them need to take medicine for more than one year for a long time, and some patients may need to take medicine for life.
Concluding remarks
To sum up, the typical manifestation of obsessive-compulsive disorder is the coexistence of obsessive-compulsive disorder and anti-obsessive-compulsive disorder. The confrontation between the two leads to anxiety, depression and other emotions, and then produces some obsessive-compulsive behaviors to relieve them. Obsessive-compulsive disorder is [interesting] and also very painful, because in the eyes of ordinary people, these ideas or behaviors of obsessive-compulsive disorder patients are meaningless or even ridiculous.
But as a patient, And know that, But can’t get rid of it, There is nothing I can do, Without the understanding of family members or others, Therefore, as a family member or friend of obsessive-compulsive disorder, patients with obsessive-compulsive disorder must give him/her support, but they cannot blindly accommodate. They should create a supportive environment for her and actively encourage patients to accept and persist in treatment.
Six Problems to be Solved Urgently on Obsessive-compulsive Disorder
(1) Effectiveness of low-intensity/computerized cognitive behavioral therapy for mild to moderate obsessive-compulsive disorder?
(2) Is the effectiveness of intensive cognitive behavioral therapy consistent with standard cognitive behavioral therapy?
(3) what is the best treatment for refractory severe obsessive-compulsive disorder?
(4) How can a family better cope with obsessive-compulsive disorder?
(5) How to predict the effectiveness of individual obsessive-compulsive disorder patients on cognitive behavioral therapy or drug therapy?
(6) How to reduce the risk factors for recurrence of obsessive-compulsive disorder?