Obsessive-compulsive disorder (OCD)

Japanese: 強迫神経症（強迫性障害） - きょうはくしんけいしょう（きょうはくせいしょうがい）（英語表記）Obsessive-compulsive disorder (OCD)

What is the disease?

Anxious or unpleasant thoughts come to your mind against your will, and you cannot suppress them no matter how hard you try. Obsession ( Today is the last day of the year ) ), or repeating pointless actions to try to negate such thoughts ( Compulsions ( Today's exhibition ) These symptoms are called obsessive-compulsive symptoms, and obsessive-compulsive disorder is a type of neurosis in which obsessive-compulsive symptoms are the main symptom.

I know that these thoughts and actions are stupid, ridiculous, and irrational, but when I try to stop them, my anxiety grows and I can't stop. Because anxiety is the basis of this illness, it is classified as an anxiety disorder and is now called obsessive-compulsive disorder (this is now the official name).

What is the cause?

Although it is a type of neurosis, it is more likely to be caused by psychological or environmental factors than by the causes of neurosis. Basal ganglia ( Great excitement ) , Limbic system ( Transformation ) The above-mentioned disorders in specific areas of the brain and abnormal functions of the nervous system, which uses serotonin and dopamine as neurotransmitters, are presumed to be the most likely mechanisms behind the onset of the condition. Although it can develop after a stressful event, in most cases it develops gradually without any particular trigger.

Also, originally Meticulous ( Precise ) This tends to be common among people with perfectionist personality types (obsessive-compulsive personality).

How symptoms manifest

Obsessions and compulsions can vary widely. The most common are:

Hostility and impulsive thoughts: For example, obsessions about accidentally hurting or killing someone

- Obsessions related to uncleanliness and dirt: Obsessions accompanied by fears of being contaminated by feces, urine, germs, etc., and therefore avoidance behaviors such as not getting close to people or touching things, and compulsions to wash hands repeatedly after touching things (washing compulsions)

・Nosy ( Investigative ) : Persistently prying into the reasons behind small things and sometimes asking questions

- Suspiciousness: You constantly have doubts about whether what you have done was correct, and you feel uneasy unless you check it over and over again (compulsion to check)

・Calculation habit: I am concerned about the number of things and the number of times I do them, and I can't feel at ease unless I count them

And more.

There is also a type of patient known as the "involvement type" (meaning involving others) in which the patient is unable to feel reassured by simply checking for themselves and asks for repeated confirmations from others, often their mothers, seeking reassurance; this type is often seen in severely ill patients.

The course of obsessive-compulsive disorder is generally chronic, beginning in adolescence and continuing for many years with periods of improvement and worsening. Another characteristic is that more than half of patients suffer from depression, which increases the patient's suffering and requires attention to the risk of suicide.

Testing and diagnosis

Obsessive symptoms include depression, Schizophrenia ( Togo City Council ) These symptoms can also be seen in other mental disorders, so it is necessary to differentiate them from other disorders such as encephalitis, cerebrovascular disease, and epilepsy. Organic brain ( Noise level ) Since it can also be seen in diseases, if these are suspected, tests for differentiation (blood, Cerebrospinal fluid ( Station ) Other tests such as head CT scans, MRI scans, and electroencephalograms will be necessary.

Drug and gambling Addiction ( Isonsho ) It is similar to obsessive-compulsive disorder in that "you know you have to stop but you can't." However, the difference is that with addiction the act is accompanied by pleasure, whereas with obsessive-compulsive disorder it is only painful, not pleasurable.

Treatment methods

Treatment options include medication and psychotherapy.

Medications include SSRIs (selective serotonin reuptake inhibitors: fluvoxamine (Depromel, Luvox, etc.)), clomipramine (Anafranil), benzodiazepine derivatives (clonazepam: Rivotril, bromazepam: Lexotan, etc.), and in severe cases, small amounts of antipsychotics. The effectiveness rate is around 50%.

In psychotherapy, Exposure and Response Prevention ( How to protect against bombs ) A form of cognitive behavioral therapy called "cognitive therapy" is effective. The patient is forced to face situations that tend to produce obsessive-compulsive symptoms, and is instructed not to perform the compulsive act, remaining in that situation until the anxiety naturally disappears. The drawbacks are that it is only applicable to a limited number of people, and there are still few experts on it, but it is said to be as effective as or more effective than drugs.

What to do if you notice an illness

If you notice any of these symptoms, you should see a psychiatrist. Since it could be the early stages of depression or schizophrenia, or it could be another illness, a professional diagnosis and examination are required.

Family and close friends should understand the patient's symptoms. You may think, "Why would you be so concerned about such trivial things?" but the fact that you are concerned is itself a disease. It is important to note that the patient's suffering is more serious than it appears, and is often accompanied by depression.

どんな病気か

　自分の意に反して、不安あるいは不快な考えが浮かんできて、抑えようとしても抑えられない（強迫観念(きょうはくかんねん)）、あるいはそのような考えを打ち消そうとして、無意味な行為を繰り返す（強迫行為(きょうはくこうい)）。このような症状を強迫症状といいますが、強迫神経症は、強迫症状を主症状とする神経症の一型です。

　自分でもそのような考えや行為は、つまらない、ばかげている、不合理だとわかっているのですが、やめようとすると不安が募ってきて、やめられないのです。不安が基礎になっている病気なので、不安障害に分類され、強迫性障害（現在ではこのほうが正式）と呼ばれます。

原因は何か

　神経症の一型ですが、神経症の原因とされる心因（心理的・環境的原因）よりも、大脳基底核(だいのうきていかく)、辺縁系(へんえんけい)など、脳内の特定部位の障害や、セロトニンやドーパミンを神経伝達物質とする神経系の機能異常が推定され、発症メカニズムとして有力視されています。ストレスフルな出来事のあとで発症することもありますが、多くは特別なきっかけなしに徐々に発症してきます。

　また、もともと几帳面(きちょうめん)、完璧主義などの性格（強迫性格）の人に多い傾向があります。

症状の現れ方

　強迫観念や強迫行為の内容にはさまざまなものがあります。よくみられるのは、

・敵意や衝動に関するもの：たとえば「誤って他人を傷つけたり殺してしまったりしやしないか」などの強迫観念

・不潔や汚れに関するもの：「便、尿、ばい菌などで汚染されたのではないか」などの不潔恐怖を伴った強迫観念、そのため人に近づけない、物に触れないなどの回避行動、触ったあとに何度も手を洗う強迫行為（洗浄強迫）

・詮索癖(せんさくへき)：些細なことの理由などをしつこく詮索し、時には質問してまわる

・疑惑癖：自分のしたことが完全だったかどうか、絶えず疑惑が生じてきて何度も確かめないと気がすまない（確認強迫）

・計算癖：物の数や回数が気になって、数えないと気がすまない

などです。

　自分で確認するだけでは安心できず、他人、多くの場合、母親などに何度も確認させ、保証を求める「巻き込み型」（他人を巻き込むという意味）といわれるタイプもあり、重症の患者さんに多くみられます。

　強迫神経症の経過は一般に慢性で、青年期に発症してよくなったり悪くなったりしながら、年余にわたって続くのが普通です。また、半数以上にうつ病が合併してくることも特徴で、そうなると患者さんの苦痛はより大きなものとなり、自殺の危険などへの注意も必要になってきます。

検査と診断

　強迫症状はうつ病、統合失調症(とうごうしっちょうしょう)など、他の精神疾患でもみられるため、それらとの鑑別が必要です。脳炎、脳血管障害、てんかんなど、脳器質性(のうきしつせい)疾患でもみられるので、これらが疑われる場合は鑑別のための検査（血液・髄液(ずいえき)などの検査、頭部CT、MRIなどの画像検査、脳波検査など）が必要になります。

　薬物やギャンブルへの依存症(いぞんしょう)も、「やめなければいけないとわかっていながら、やめられない」という点では強迫性障害に似ていますが、依存症ではその行為に快感を伴うのに対し、強迫性障害では快感はなく苦痛のみである点が異なっています。

治療の方法

　治療法には、薬物療法と精神療法があります。

　薬物ではSSRI（選択的セロトニン再取り込み阻害薬：フルボキサミン〈デプロメール、ルボックスなど〉）、クロミプラミン（アナフラニール）、ベンゾジアゼピン誘導体（クロナゼパム：リボトリール、ブロマゼパム：レキソタンなど）、症状が重い場合は少量の抗精神病薬も用いられます。有効率は50％前後です。

　精神療法では、「曝露反応妨害法(ばくろはんのうぼうがいほう)」と呼ばれる認知行動療法が有効です。強迫症状が出やすい状況に患者さんをあえて直面させ、かつ強迫行為を行わないように指示し、不安が自然に消失するまでそこにとどまらせるという方法です。適応が限られ、まだ専門家が少ないのが難点ですが、薬物と同等以上の効果があるといわれています。