Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- 13 Congenital disorders of cerebral cortical development
- 14 The aging brain: morphology, imaging and function
- 15 Neurodegenerative diseases
- 16 Aging and dementia: principles, evaluation and diagnosis
- 17 Alzheimer's Disease
- 18 Dementia with Lewy bodies
- 19 Frontotemporal dementia
- 20 Consciousness and its disorders
- 21 Mechanisms of memory and amnestic syndromes
- 22 Acquired disorders of language
- 23 Neglect
- 24 Brain death
- 25 Disorders of mood
- 26 Schizophrenia
- 27 Obsessive–compulsive disorder
- 28 Autism and autistic spectrum disorders
- 29 Attention deficit hyperactivity disorder: spectrum and mechanisms
- 30 The neurobiology of drug addition
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
27 - Obsessive–compulsive disorder
from PART II - DISORDERS OF HIGHER FUNCTION
Published online by Cambridge University Press: 05 August 2016
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- 13 Congenital disorders of cerebral cortical development
- 14 The aging brain: morphology, imaging and function
- 15 Neurodegenerative diseases
- 16 Aging and dementia: principles, evaluation and diagnosis
- 17 Alzheimer's Disease
- 18 Dementia with Lewy bodies
- 19 Frontotemporal dementia
- 20 Consciousness and its disorders
- 21 Mechanisms of memory and amnestic syndromes
- 22 Acquired disorders of language
- 23 Neglect
- 24 Brain death
- 25 Disorders of mood
- 26 Schizophrenia
- 27 Obsessive–compulsive disorder
- 28 Autism and autistic spectrum disorders
- 29 Attention deficit hyperactivity disorder: spectrum and mechanisms
- 30 The neurobiology of drug addition
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
Summary
Introduction
Obsessive–compulsive behaviour has long been described; religious scrupulosity is documented in medieval texts (Adams, 1973), repetitive hand washing as symbolic of guilt has been depicted by playwrights (Shakespeare: Macbeth) and ‘obsessive–compulsive neurosis’ generated by unconscious conflict was a cornerstone of psychodynamic theory (Freud, 1973). More recently, however, a new paradigm has emerged; obsessive–compulsive behaviour is now viewed as symptomatic of a highly prevalent medical disorder, characterized by specific psychobiological dysfunctions. Indeed, obsessive–compulsive disorder (OCD) is arguably one of the most incisive exemplars of a neuropsychiatric disorder, insofar as clear models now exist of how its characteristic psychopathology is mediated by specific neuroanatomical circuits and neurochemical systems. This chapter aims to provide a comprehensive review of the current state of knowledge on OCD, including epidemiology, clinical features, neurobiology and management.
Epidemiology
Prevalence
Until the 1980s OCD was viewed as a rare disorder, which only affected 0.005% of the population. These figures were based on a study by Rudin, which looked at the prevalence of OCD in a psychiatric in-patient population (Rudin, 1953). The Epidemiological Catchment Area (ECA) study of 1980–1984 radically changed views of the prevalence of OCD (Karno et al., 1988). Undertaken in five US communities, this study found lifetime prevalence rates for OCD to be 1.9–3.3%, making it the fourth most common psychiatric disorder, with a prevalence that was 25–60 times higher than previously believed. These figures were subsequently confirmed in similar studies in Canada (Kolada et al., 1994), Taiwan (Hwuh & Chang, 1989), and several other countries (Weismann et al., 1994), demonstrating that OCD is a disorder with a similar prevalence across nationalities.
The ECA figures, however, have been challenged. The ECA and cross-national study used the Diagnostic Interview Schedule (DIS); a structured interview designed for trained lay interviewers, to arrive at diagnoses. Several later studies have questioned the validity of DIS diagnoses. Nelson and Rice (1997) examined the 1-year temporal stability of the DIS and found it to be low, with only 19.2% of those who were originally diagnosed with OCD having this diagnosis confirmed on follow-up interview. Two follow-up studies of the ECA, using semistructured interviews conducted by psychiatrists (Antony et al., 1985; Helzer et al., 1985), supported these findings. However, these studies have been criticized in view of their small sample size and failure to use objective instruments to ascertain the diagnosis of OCD.
- Type
- Chapter
- Information
- Diseases of the Nervous SystemClinical Neuroscience and Therapeutic Principles, pp. 385 - 405Publisher: Cambridge University PressPrint publication year: 2002