78 Obsessive–compulsive disorder.pptVIP

Obsessive–compulsive disorder Epidemiology The lifetime prevalence of OCD in the general population is between 2 and 3 per cent, and therefore it is more prevalent than schizophrenia.(2,10) This rate has been confirmed across different cultures.(3) The prevalence of OCD among children and adolescents appears to be as high as among adults.(11) However, Nelson and Rice(12) and Stein et al.(13) have suggested that the diagnosis of OCD by the Diagnostic Interview Schedule administered by lay people leads to overdiagnosis, and so have proposed lower prevalence rates of 1 to 2 per cent. Men and women are equally likely to be affected, although some reports have suggested a slight female predominance.(3) During adolescence, boys are more commonly affected than girls. The mean age of onset is about 20 years of age. Single people are more commonly affected, probably representing the difficulty for people with OCD to maintain a relationship. Patients with OCD are commonly afflicted by other mental disorders; for instance, the lifetime prevalence for a major depressive episode in these patients is around 67 per cent.(3,14) Other common comorbid psychiatric diagnoses include alcohol-use disorders, social phobia, specific phobia, panic disorder, and eating disorders. The comorbidity with schizophrenia and with tic disorders raises interesting pathophysiological and therapeutic implications. The rate of tic disorders approaches 40 per cent in juvenile OCD, and there is an increase in the prevalence of Tourettes syndrome among the relatives of OCD patients.(15) The relationship between OCD and obsessive–compulsive personality disorder (OCPD) has been a focus of debate. Although prospective research is lacking, it appears that OCPD is not a prominent risk factor for developing OCD, as the prevalence of OCPD among patients with OCD is not far from its prevalence in other psychiatric disorders. Aetiology Neurotransmitters Many clinical trials of various serotonergic drugs lend suppo