Obsesif-kompulsiv buzilish - Obsessive–compulsive disorder

"OKB" bu erga yo'naltiriladi. Bu bilan aralashmaslik kerak Obsesif-kompulsiv shaxs buzilishi. Boshqa maqsadlar uchun qarang OKB (ajralish).

Obsesif-kompulsiv buzilish
OCD handwash.jpg
Tez-tez, ortiqcha qo'l yuvish OKB bilan kasallangan ba'zi odamlarda uchraydi
MutaxassisligiPsixiatriya
AlomatlarBiror narsani qayta-qayta tekshirish, bajarish zarurligini his eting bir necha marta muntazam ravishda, bor ba'zi fikrlar bir necha bor[1]
AsoratlarTiklar, tashvish buzilishi, o'z joniga qasd qilish[2][3]
Odatiy boshlanish35 yoshdan oldin[1][2]
SabablariNoma'lum[1]
Xavf omillariBolalarga nisbatan zo'ravonlik, stress[2]
Diagnostika usuliAlomatlar asosida[2]
Differentsial diagnostikaAnksiyete buzilishi, katta depressiv buzilish, ovqatlanishning buzilishi, obsesif-kompulsiv shaxs buzilishi[2]
DavolashMaslahat, serotoninni qaytarib olishning selektiv inhibitörleri, klomipramin[4][5]
Chastotani2.3%[6]

Obsesif-kompulsiv buzilish (OKB) a ruhiy buzuqlik unda odam bor ba'zi fikrlar bir necha bor ("obsesyonlar" deb nomlanadi) yoki bajarish zarurligini his qiladi bir necha marta muntazam ravishda ("majburlash" deb nomlanadi) qayg'uga olib keladigan yoki umumiy ishlashga putur etkazadigan darajada.[1][2] Shaxs qisqa vaqt ichida na fikrlarini va na harakatlarini boshqara olmaydi.[1] Umumiy majburlashlarga quyidagilar kiradi qo'lni yuvish, narsalarni sanash va eshik qulflanganligini tekshirish.[1] Ushbu tadbirlar odamning kundalik hayotiga salbiy ta'sir ko'rsatadigan darajada sodir bo'ladi,[1] ko'pincha kuniga bir soatdan ko'proq vaqtni oladi.[2] Ko'pchilik kattalar xatti-harakatlarning mantiqiy emasligini tushunadilar.[1] Vaziyat bilan bog'liq tiklar, tashvish buzilishi va xavfning ortishi o'z joniga qasd qilish.[2][3]

Sababi noma'lum.[1] Ba'zi birlari bor ko'rinadi genetik ikkalasi bilan ham komponentlar bir xil egizaklar bir xil bo'lmagan egizaklarga qaraganda tez-tez ta'sir qiladi.[2] Xavf omillari tarixini o'z ichiga oladi bolalarga nisbatan zo'ravonlik yoki boshqa stress - o'quv tadbirlari.[2] Ba'zi holatlar quyidagicha sodir bo'lishi uchun hujjatlashtirildi infektsiyalar.[2] Tashxis simptomlarga asoslanib, giyohvandlik yoki tibbiy boshqa sabablarni bartaraf etishni talab qiladi.[2] Kabi reyting o'lchovlari Yel-jigarrang obsesif kompulsiv o'lchov (Y-BOCS) zo'ravonlikni baholash uchun ishlatilishi mumkin.[7] Shunga o'xshash alomatlarga ega bo'lgan boshqa kasalliklar orasida tashvishlanish buzilishi, katta depressiv buzilish, ovqatlanishning buzilishi, tik kasalliklari va obsesif-kompulsiv shaxs buzilishi.[2]

Davolashni o'z ichiga oladi psixoterapiya, kabi kognitiv xulq-atvor terapiyasi (CBT) va ba'zan antidepressantlar, kabi serotoninni qaytarib olishning selektiv inhibitörleri (SSRI) yoki klomipramin.[4][5] OKB uchun KBT, takrorlanadigan xatti-harakatlarning paydo bo'lishiga yo'l qo'ymasdan, muammolarni keltirib chiqaradigan narsalarga ta'sir qilishni kuchaytirishni o'z ichiga oladi.[4] Bunga zid ravishda, metakognitiv terapiya o'zlarining ular haqidagi fikrlari bilan munosabatlarni o'zgartirish uchun marosim xatti-harakatlarini rag'batlantiradi.[8] Klomipramin SSRI bilan bir qatorda ishlayotgan bo'lsa-da, u ko'proq yon ta'sirga ega va shuning uchun odatda ikkinchi darajali davolash sifatida saqlanadi.[4] Atipik antipsikotiklar davolashga chidamli holatlarda SSRI dan tashqari foydalanganda ham foydali bo'lishi mumkin, ammo yon ta'sirining kuchayishi bilan ham bog'liq.[5][9] Davolashsiz bu holat ko'pincha o'nlab yillar davom etadi.[2]

Obsesif-kompulsiv buzuqlik hayotning biron bir davrida taxminan 2,3% odamlarga ta'sir qiladi[6] har qanday yil davomida stavkalar taxminan 1,2% ni tashkil qiladi.[2] Semptomlar 35 yoshdan keyin paydo bo'lishi odatiy hol emas va odamlarning yarmi 20 yoshdan oldin muammolarga duch kelishadi.[1][2] Erkaklar va ayollar teng darajada ta'sirlanishadi[1] va bu butun dunyo bo'ylab sodir bo'ladi.[2] Bu ibora obsesif-kompulsiv ba'zida OKB bilan bog'liq bo'lmagan norasmiy tarzda birovni haddan tashqari ehtiyotkor deb ta'riflash uchun ishlatiladi, mukammallik, so'riladi yoki boshqa yo'l bilan o'rnatiladi.[10]

Belgilari va alomatlari

OKB turli xil alomatlarni namoyon qilishi mumkin. Semptomlarning ma'lum guruhlari odatda birgalikda sodir bo'ladi. Ushbu guruhlar ba'zida asosiy jarayonni aks ettirishi mumkin bo'lgan o'lchovlar yoki klasterlar sifatida qaraladi. OKB uchun standart baholash vositasi Yel-jigarrang obsesif kompulsiv o'lchov (Y-BOCS), 13 ta aniqlangan belgilar toifasiga ega. Ushbu alomatlar uchdan beshta guruhga to'g'ri keladi.[11] A metanalitik simptom tuzilmalarini ko'rib chiqish to'rt omilli tuzilmani (guruhlashni) eng ishonchli deb topdi. Kuzatilgan guruhlarga "simmetriya faktori", "taqiqlangan fikrlar omili", "tozalovchi omil" va "to'plash omili" kiradi. "Simmetriya faktori" buyurtma berish, hisoblash va simmetriya bilan bog'liq obsesyonlar hamda takroriy majburlar bilan juda bog'liq edi. "Taqiqlangan fikrlar omili" zo'ravonlik, diniy yoki jinsiy xarakterdagi intruziv va bezovta qiluvchi fikrlar bilan juda bog'liq. "Tozalash faktori" ifloslanish va tozalash bilan bog'liq bo'lgan majburiyatlar bilan juda bog'liq edi. "Yig'ish omili" faqatgina xazina bilan bog'liq obsesyon va majburlashni o'z ichiga olgan va boshqa alomatlar guruhlaridan ajralib turishi aniqlangan.[12]

OKBni neyropsikologik nuqtai nazardan bir hil kasallik deb hisoblashgan bo'lsa-da, ko'plab taxminiy nöropsikologik defitsitlar birgalikda kasalliklarga bog'liq bo'lishi mumkin. Bundan tashqari, ba'zi bir kichik tiplar, masalan, ba'zi bir vazifalarni bajarish samaradorligini oshirish bilan bog'liq naqshni aniqlash (yuvish subtipi) va fazoviy ishchi xotira (obsesif fikr pastki turi). Kichik guruhlar, shuningdek, neyroimaging natijalari va davolanishga javoblari bilan ajralib turdi. Neyroimaging tadqiqotlari bu borada juda kam bo'lgan va xulosalar chiqarish uchun o'rganilgan subtiplar juda katta farq qilgan. Boshqa tomondan, pastki turga bog'liq bo'lgan davolash reaktsiyasi o'rganilgan va to'plangan pastki turi doimiy ravishda davolanishga eng kam ta'sir ko'rsatgan.[13]

Obsesiyalar

Asosiy maqola: Intruziv fikr
Shuningdek qarang: Asosan obsesif obsesif kompulsiv kasallik
OKB bilan kasallangan odamlar shayton haqidagi fikrlar kabi intruziv fikrlarga duch kelishlari mumkin (ko'rsatilgan do'zaxning bo'yalgan talqini ko'rsatilgan)

Obsesiyalar - bu ularni e'tiborsiz qoldirish yoki ularga qarshi kurashish harakatlariga qaramay takrorlanib turadigan va davom etadigan fikrlar.[14] OKB bo'lgan odamlar tez-tez vazifalarni bajaradilar yoki majburlash, obsesyon bilan bog'liq tashvishlardan xalos bo'lish uchun. Shaxslar ichida va ular orasida dastlabki obsesyonlar yoki tajovuzkor fikrlar aniqligi va ravshanligi bilan farq qiladi. Nisbatan noaniq obsesyon muvozanat saqlanib qolganda hayot odatdagidek davom eta olmaydi degan ishonch bilan birga umumiy buzuqlik yoki keskinlik tuyg'usini o'z ichiga olishi mumkin. Kuchliroq obsesiya o'lishi bilan yaqin odamning fikri yoki qiyofasi bilan ovora bo'lishi mumkin[15][16] yoki "bilan bog'liq tajovuzlarmunosabatlarning to'g'riligi ".[17] Boshqa obsesyonlar, kimdir yoki o'zidan boshqasi, masalan, Xudo, shayton yoki kasallik kabi, OKB kasalligiga chalingan odamga yoki odamlarga yoki odam unga g'amxo'rlik qiladigan narsalarga zarar etkazishi ehtimoli bilan bog'liq. OKB bilan og'rigan boshqa odamlar o'zlarining tanasidan chiqadigan ko'rinmas o'simtalarni his qilishlari yoki jonsiz narsalarga berkitilganlik hissi bilan qarashlari mumkin.[18]

OKB tajribasi bo'lgan ba'zi odamlar jinsiy obsesyonlar bu "o'pish, teginish, erkalash, og'iz jinsiy aloqa, anal jinsiy aloqa, jinsiy aloqa, qarindoshlar va zo'rlash "begonalar, tanishlar, ota-onalar, bolalar, oila a'zolari, do'stlar, hamkasblar, hayvonlar va diniy arboblar bilan" va "o'z ichiga olishi mumkin"heteroseksual yoki gomoseksual kontent "har qanday yoshdagi shaxslar bilan.[19] Boshqa intruziv, yoqimsiz fikrlar yoki tasvirlarda bo'lgani kabi, ba'zida bezovta qiladigan jinsiy fikrlar odatiy holdir, ammo OKB bilan kasallangan odamlar bu fikrlarga g'ayrioddiy ahamiyat berishlari mumkin. Masalan, obsesif qo'rquv jinsiy orientatsiya OKB bilan kasallangan odamga, hatto atrofdagilarga ham inqiroz kabi ko'rinishi mumkin jinsiy o'ziga xoslik.[20][21] Bundan tashqari, OKB bilan birga kelgan shubha odamni bezovta qiladigan fikrlarga ta'sir qilishi yoki o'z-o'zini tanqid qilishiga yoki nafratlanishiga olib kelishi mumkinligi to'g'risida noaniqlikka olib keladi.[19]

OKB bilan kasallangan ko'pchilik odamlar ularning tushunchalari haqiqatga mos kelmasligini tushunadilar; ammo, ular o'zlarining tushunchalari to'g'ri bo'lganidek harakat qilishlari kerak deb o'ylashadi. Masalan, shug'ullanadigan shaxs majburiy yig'ish noorganik moddalarni tirik organizmlarning ruhiyati yoki huquqlariga ega bo'lgan kabi davolashga moyil bo'lishi mumkin, shu bilan birga bunday xatti-harakatlar yanada intellektual darajada mantiqsizdir. Yig'ishni boshqa OKB belgilari bilan ko'rib chiqish kerakmi yoki yo'qmi degan munozaralar mavjud.[22]

OKB ba'zida Obsessional OKB deb ataladigan ochiq majburlashsiz namoyon bo'ladi. Aniq majburlashsiz OKB, taxminlarga ko'ra, OKB holatlarining 50 foizidan 60 foizigacha xarakterlanishi mumkin.[23]

Majburlar

Asosiy maqola: Majburiy xatti-harakatlar
Terini terishning buzilishi

OKBga chalingan ba'zi odamlar majburiy marosimlarni o'tkazadilar, chunki ular tushunarsiz ravishda o'zlarini his qilishadi, boshqalari esa o'ziga xos obsesif fikrlardan kelib chiqadigan xavotirni yumshatish uchun majburan harakat qilishadi. Shaxs, bu harakatlar qandaydir tarzda dahshatli voqea sodir bo'lishining oldini oladi yoki voqeani ularning fikrlaridan siqib chiqaradi deb o'ylashi mumkin. Har holda, shaxsning fikri shunday o'ziga xos yoki OKB bilan og'rigan odam yoki uning atrofidagilar uchun katta qayg'uga olib kelishi buzilgan. Haddan tashqari terini terish, soch olish, tirnoq tishlash, va boshqa tanaga yo'naltirilgan takrorlanadigan xatti-harakatlarning buzilishi hammasi obsesif-kompulsiv spektr.[2] OKBga chalingan ayrim shaxslar ularning xatti-harakatlari oqilona emasligini bilishadi, lekin vahima yoki qo'rquv tuyg'usini engish uchun ular bilan birga borishga majbur.[2][24]

Ba'zi odatiy majburlashlarga qo'llarni yuvish, tozalash, narsalarni tekshirish (masalan, eshiklardagi qulflar), takroriy harakatlar (masalan, kalitlarni yoqish va o'chirish), buyumlarga ma'lum tarzda buyurtma berish va o'zlariga ishontirishni talab qilish kiradi.[25] Majburlashlar boshqacha tiklar (teginish, teginish, ishqalash yoki miltillatish kabi)[26] va stereotipli harakatlar (odatda boshni urish, tanani silkitib qo'yish yoki o'z-o'zini tishlash kabi), ular odatda unchalik murakkab emas va obsesyon bilan cho'ktirilmaydi.[2] Ba'zida majburlash va murakkab tiklar o'rtasidagi farqni aniqlash qiyin bo'lishi mumkin.[2] OKB bilan kasallangan odamlarning taxminan 10% dan 40% gacha, umr bo'yi savdo buzilishi mavjud.[27]

Odamlar majburlashlarga o'zlarining obsesif fikrlaridan qochish sifatida ishonadilar; ammo, ular yengillik faqat vaqtinchalik ekanligini, tajovuzkor fikrlar tez orada qaytib kelishini bilishadi. Ba'zi odamlar o'zlarining obsesyonlarini keltirib chiqarishi mumkin bo'lgan vaziyatlardan qochish uchun majburlash usullaridan foydalanadilar. Garchi ba'zi odamlar ba'zi bir ishlarni qayta-qayta qilsalar ham, bu harakatlarni majburiy ravishda bajarish shart emas. Masalan, yotish tartibi, yangi mahoratni o'rganish va diniy amallar majburiy emas. Xulq-atvor majburlash yoki odat bo'ladimi yoki yo'qmi, xatti-harakatlar amalga oshiriladigan kontekstga bog'liq. Masalan, kuniga sakkiz soat davomida kitoblarni tartibga solish va buyurtma qilish kutubxonada ishlaydigan kishidan kutilgan bo'lishi mumkin, ammo boshqa holatlarda g'ayritabiiy bo'lib ko'rinadi. Boshqacha qilib aytadigan bo'lsak, odatlar hayotni samaradorlikka olib keladi, majburlash esa uni buzadi.[28]

Odatda OKB bilan birga keladigan xavotir va qo'rquvdan tashqari, azob chekuvchilar har kuni bir necha soat davomida bunday majburlashni amalga oshirishi mumkin. Bunday vaziyatlarda odamga o'z ishini, oilasini yoki ijtimoiy rollarini bajarish qiyin bo'lishi mumkin. Ba'zi hollarda, bu xatti-harakatlar salbiy jismoniy alomatlarni ham keltirib chiqarishi mumkin. Masalan, qo'llarini obsesif ravishda yuvadigan odamlar antibakterial sovun va issiq suv ularning terisini qizarib va ​​xom holga keltirishi mumkin dermatit.[29]

OKB bilan kasallangan odamlar o'zlarining xatti-harakatlarini tushuntirish uchun ratsionalizatorlardan foydalanishlari mumkin; ammo, bu ratsionalizatsiya umumiy xatti-harakatga emas, balki har bir misol uchun alohida-alohida qo'llaniladi. Masalan, old eshikni majburiy ravishda tekshirayotgan kishi, eshikni yana bir marta tekshirib ko'rganligi uchun sarf qilingan vaqt va stress, o'g'irlik bilan bog'liq vaqt va stressdan ancha kam ekanligini ta'kidlashi mumkin va shuning uchun tekshirish bu eng yaxshi variant. Amalda, ushbu tekshiruvdan so'ng, odam hali ham ishonchim komil emas va shunday deb hisoblaydi hali ham yana bitta tekshirishni amalga oshirganingiz ma'qul, va bu mulohaza zarur qadar davom etishi mumkin.

Yilda Kognitiv xulq-atvor terapiyasi, OKB kasallaridan hech qanday majburlashni qilmasdan intruziv fikrlarni engib o'tishlari so'raladi. Ularga urf-odatlar OKBni kuchli tutadi, ularni bajarmaslik esa OKBni zaiflashishiga olib keladi.[30]

Tushunish

DSM-V OKB ning tushuncha darajasi uchun uchta aniqlovchini o'z ichiga oladi. Yaxshi yoki adolatli tushuncha, obsesif-kompulsiv e'tiqodlar haqiqat yoki haqiqat emasligini tan olish bilan tavsiflanadi. Yomon tushuncha, obsesif-kompulsiv e'tiqodlar ehtimol haqiqat ekanligiga ishonch bilan tavsiflanadi. Tushunishning yo'qligi obsesif-kompulsiv e'tiqodlarni keltirib chiqaradi xayoliy fikrlari va OKB bilan kasallangan odamlarning taxminan 4 foizida uchraydi.[31]

G'oyalar juda qimmat

OKB bilan kasallangan ba'zi odamlar ma'lum bo'lgan narsalarni namoyish qilmoqdalar g'oyalar. Bunday holatlarda OKB bilan og'rigan odam, albatta, ularni majburlashni amalga oshirishga olib keladigan qo'rquv mantiqsiz yoki yo'qligiga ishonch hosil qilmaydi. Biroz munozaradan so'ng, odamni qo'rquvlari asossiz bo'lishi mumkinligiga ishontirish mumkin. Buni qilish qiyinroq bo'lishi mumkin ERP terapiyasi bunday odamlarga, chunki ular hech bo'lmaganda dastlab hamkorlik qilishni xohlamasliklari mumkin. Odamni OKB kontekstida beqiyos e'tiqodga ega bo'lgan og'ir holatlar mavjud, ularni farqlash qiyin psixotik kasalliklar.[32]

Kognitiv ishlash

Bir vaqtlar u o'rtacha darajadan yuqori razvedka bilan bog'liq deb hisoblangan bo'lsa-da, bu albatta shunday emas.[33] 2013 yilgi tekshiruvda OKB bilan kasallangan odamlar ba'zida engil, ammo keng ko'lamli tanqisliklarga ega bo'lishi mumkinligi haqida xabar berilgan; bilan bog'liq fazoviy xotira, bilan kamroq darajada og'zaki xotira, ravonlik, ijro funktsiyasi va ishlov berish tezligi, eshitish e'tiboriga sezilarli ta'sir ko'rsatmadi.[34] OKB bilan og'rigan insonlar ma'lumotni kodlash, siljish va motorli va kognitiv inhibisyonni tashkil etish strategiyasini shakllantirishda nuqsonlarini ko'rsatadilar.[35]

OKBda simptom o'lchamlarining o'ziga xos pastki turlari o'ziga xos bilim etishmovchiligi bilan bog'liq.[36] Masalan, yuvish va tekshirish alomatlarini taqqoslagan bir meta-tahlil natijalari shuni ko'rsatdiki, yuvish mashinalari o'nta testdan sakkiztasida shashkadan ustun bo'lishgan.[37] Kontaminatsiya va tozalashning semptom o'lchovi inhibisyon va og'zaki xotira testlarida yuqori ko'rsatkichlar bilan bog'liq bo'lishi mumkin.[38]

Bolalar

Bolalarning taxminan 1-2% OKB kasalligiga chalingan.[39] Obsesif-kompulsiv buzuqlik belgilari 10-14 yoshdagi bolalarda tez-tez rivojlanib boradi, erkaklarda simptomlar erta yoshda va ayollarga qaraganda og'irroq bo'ladi.[40] Bolalarda simptomlarni kamida to'rt turga bo'lish mumkin.[11]

Birlashtirilgan shartlar

OKB bilan og'rigan odamlarga boshqa holatlar, shuningdek OKB o'rniga tashxis qo'yish mumkin, masalan, yuqorida aytilgan obsesif-kompulsiv shaxs buzilishi, katta depressiv buzilish, bipolyar buzilish,[41] umumiy tashvish buzilishi, asabiy anoreksiya, ijtimoiy tashvish buzilishi, bulimiya nervoza, Tourette sindromi, transformatsiya obsesyoni, autizm spektri buzilishi, diqqat etishmasligi giperaktivlik buzilishi, dermatillomaniya (terini majburiy terish), tana dismorfik buzilishi va trikotillomaniya (soch olish) Odamlarning 50 foizidan ko'pi o'z joniga qasd qilish tendentsiyasini boshdan kechirmoqda va 15 foiz o'z joniga qasd qilishga urinishgan.[7] Depressiya, xavotir va o'z joniga qasd qilishga urinishlar kelajakda o'z joniga qasd qilish xavfini oshiradi.[42]

OKB bilan kasallangan shaxslar ham ta'sirlanishlari aniqlandi kechiktirilgan uyqu fazasi sindromi keng jamoatchilikka nisbatan sezilarli darajada yuqori.[43] Bundan tashqari, jiddiy OKB alomatlari doimiy ravishda ko'proq uyqu buzilishi bilan bog'liq. OKB bilan og'rigan odamlarda umumiy uyqu vaqti va uxlash samaradorligining pasayishi kuzatilgan, uxlashning boshlanishi va ofseti kechiktirilgan va kechiktirilgan uyqu fazasi buzilishining tarqalishi oshgan.[44]

Xulq-atvorga ko'ra, ular o'rtasida bog'liqlikni ko'rsatadigan ba'zi tadqiqotlar mavjud giyohvandlik va tartibsizlik ham. Masalan, har qanday bezovtalik buzilishi bo'lganlar orasida giyohvandlik xavfi yuqori (ehtimol bu usul sifatida) engish ning yuqori darajalari bilan tashvish ), ammo OKB bilan kasallangan odamlar orasida giyohvandlik bir turi bo'lib xizmat qilishi mumkin majburiy xatti-harakatlar va bu nafaqat kurashish mexanizmi sifatida. Depressiya shuningdek, OKB bilan kasallangan odamlar orasida juda keng tarqalgan. OKB populyatsiyalari orasida yuqori depressiya darajasi uchun bitta tushuntirishni Mineka, Uotson va Klark (1998) bergan, ular OKB bilan kasallanganlar (yoki boshqa har qanday kishi) tashvish buzilishi ) "nazoratsiz" tuyg'u turi tufayli tushkunlikni his qilishi mumkin.[45]

OKB belgilarini namoyish qiladigan odamda OKB bo'lishi shart emas. Obsesif yoki majburiy ko'rinishga ega bo'lgan (yoki shunday ko'rinadigan) xatti-harakatlar bir qator boshqa holatlarda ham bo'lishi mumkin, shu jumladan obsesif-kompulsiv shaxsiyat tartibsizlik (OCPD), autizm spektri buzilishi, buzilishlar qaerda qat'iyat mumkin bo'lgan xususiyat (DEHB, TSSB, tana buzilishi yoki odatdagi muammolar)[46] yoki sub-klinik jihatdan.

OKB bilan og'riganlarning ba'zilari odatda Tourette sindromi bilan bog'liq xususiyatlarga ega, masalan, motorli tiklarga o'xshash ko'rinishi mumkin bo'lgan kompulsiyalar; bu "tic bilan bog'liq OKB" yoki "Tourettic OKB" deb nomlangan.[47][48]

OKB ko'pincha ikkalasi bilan birga bo'ladi bipolyar buzilish va katta depressiv buzilish. OKB bilan kasallanganlarning 60-80% orasida hayotlarida katta depressiya epizodi kuzatiladi. Uslubiy farqlar tufayli komorbidlik darajasi 19-90% orasida qayd etilgan. Bipolyar buzilishi bo'lganlarning 9-35% orasida OKB ham bor, umumiy populyatsiyada 1-2%. OKB bilan kasallanganlarning 50% atrofida siklotimik xususiyatlar yoki gipomanik epizodlar mavjud. OKB, shuningdek, anksiyete kasalliklari bilan bog'liq. OKB uchun umr bo'yi birgalikda kasallik 22% da qayd etilgan o'ziga xos fobiya Uchun, 18% ijtimoiy tashvish buzilishi, Vahima buzilishi uchun 12%, uchun esa 30% umumiy tashvish buzilishi. OKB va DEHB uchun komorbidlik darajasi 51% gacha yuqori bo'lganligi haqida xabar berilgan.[49]

Sabablari

Asosiy maqola: Obsesif-kompulsiv buzilishning sababi

Sababi noma'lum.[1] Ham atrof-muhit, ham genetik omillar ta'sir qiladi deb ishoniladi. Xavf omillari tarixini o'z ichiga oladi bolalarga nisbatan zo'ravonlik yoki boshqa stress - o'quv tadbirlari.[2]

Giyohvand moddalar bilan bog'liq OKB

Ko'plab turli xil dorilar ilgari hech qachon alomatlari bo'lmagan bemorlarda sof OKBni yaratishi / keltirib chiqarishi mumkin. OKB haqida yangi bo'lim DSM-5 (2013) hozirda giyohvand moddalar bilan bog'liq OKBni o'z ichiga oladi.

Atipik antipsikotiklar (ikkinchi avlod antipsikotiklari), masalan olanzapin (Zyprexa), bemorlarda de-novo OKB ni keltirib chiqarishi isbotlangan.[50][51][52][53]

Genetika

Ba'zi birlari bor ko'rinadi genetik bilan komponentlar bir xil egizaklar bir xil bo'lmagan egizaklarga qaraganda tez-tez ta'sir qiladi.[2] Bundan tashqari, OKB bilan og'rigan shaxslar, birinchi darajadagi oila a'zolarining bir xil kasalliklarga duch kelishlari, mos keladigan boshqaruvlarga qaraganda ko'proq. OKB bolalik davrida rivojlanadigan holatlarda, keyinchalik kattalar davrida OKB rivojlanib boradigan holatlarga qaraganda, kasallikning oilaviy aloqasi ancha kuchli. Umuman olganda, genetik omillar buzilishi aniqlangan bolalarda OKB belgilari o'zgaruvchanligining 45-65% ini tashkil qiladi.[54] 2007 yilgi tadqiqotlar OKB uchun merosxo'rlik xavfini qo'llab-quvvatlovchi dalillarni topdi.[55]

A mutatsiya inson serotonin tashuvchisi genida topilgan, hSERT, OKB bilan bog'liq bo'lmagan oilalarda.[56]

Tizimli tekshiruv shuni ko'rsatdiki, ikkala allel ham OKB bilan bog'lanmagan bo'lsa-da, kavkazlarda L allel OKB bilan bog'liq.[57] Boshqa bir meta-tahlil homozigotli S alleliga ega bo'lganlarda yuqori xavfni kuzatdi, ammo LS genotipini OKB bilan teskari bog'liqligini aniqladi.[58]

Genomni keng assotsiatsiyalashgan tadqiqotlar OKBni BTBD3 yaqinidagi SNP va ikkita SNP bilan bog'liqligini aniqladi DLGAP1 trio asosidagi tahlilda, ammo vaziyatni nazorat qilish ma'lumotlari bilan tahlil qilinganida, hech qanday SNP ahamiyatga ega bo'lmagan.[59]

Bir meta-tahlil polimorfizm o'rtasida kichik, ammo muhim bog'liqlikni topdi SLC1A1 va OKB.[60]

OKB va o'rtasidagi bog'liqlik COMT izchil bo'lmagan, chunki bitta meta-tahlil, faqatgina erkaklarda bo'lsa ham, muhim birlashma haqida xabar bergan,[61] va boshqa hech qanday assotsiatsiyani bildirmagan meta-tahlil.[62]

Bu tomonidan e'lon qilingan evolyutsion psixologlar kompulsiv xatti-harakatlarning o'rtacha versiyalari evolyutsion afzalliklarga ega bo'lishi mumkin. Masalan, dushmanlar uchun gigiena, o'choq yoki atrofni mo''tadil doimiy tekshirish mumkin. Xuddi shunday, to'plash evolyutsion afzalliklarga ega bo'lishi mumkin. Ushbu nuqtai nazardan OKB, ehtimol, predispozitsiya qiluvchi genlarning yuqori miqdori tufayli bunday xatti-harakatlarning o'ta statistik "dumi" bo'lishi mumkin.[63]

Autoimmun

Ziddiyatli gipoteza[64] bolalar va o'spirinlarda OKB tez boshlanishining ba'zi holatlariga bog'liq bo'lgan sindrom sabab bo'lishi mumkin A guruhi streptokokk infektsiyalari, streptokokk infektsiyalari bilan bog'liq pediatrik otoimmun neyropsikiyatrik kasalliklar deb nomlanuvchi (PANDAS ).[64] OKB va tik kasalliklari post-post natijasida bolalarning bir qismida paydo bo'lishi taxmin qilinmoqda.streptokokk otoimmun jarayon.[65][66][67] PANDAS gipotezasi tasdiqlanmagan va ma'lumotlar bilan qo'llab-quvvatlanmagan va ikkita yangi toifalar taklif qilingan: KANALLAR (pediatrik o'tkir boshlangan nöropsikiyatrik sindrom) va CANS (bolalik davridagi o'tkir nöropsikiyatrik sindrom).[66][67] CANS / PANS gipotezalari o'tkir boshlangan nöropsikiyatrik sharoitlarda yuzaga kelishi mumkin bo'lgan turli xil mexanizmlarni o'z ichiga oladi, ammo GABHS infektsiyasini ayrim shaxslarning sabablari sifatida istisno qilmaydi.[66][67] PANDAS, PANS va CANS klinik va laboratoriya tadqiqotlarining markazidir, ammo tasdiqlanmagan bo'lib qolmoqda.[65][66][67] PANDASning boshqa savdo kasalliklaridan yoki OKBdan farq qiluvchi alohida shaxs ekanligi haqida bahs yuritiladi.[68][69][70][71]

Bazalga qarshi ganglionlarni tekshiradigan tadqiqotlar antikorlar OKBda umumiy populyatsiyaga nisbatan OKB bo'lganlarda anti-bazal ganglion antikorlari bo'lish xavfi ortdi.[72]

Mexanizmlar

Asosiy maqola: Obsesif-kompulsiv buzilish biologiyasi

Neyroimaging

OKBda g'ayritabiiy faoliyat ko'rsatadigan miyaning ayrim qismlari

Semptomni qo'zg'atish paytida funktsional neyroimaging, anormal faollikni kuzatdi orbitofrontal korteks, chap dorsolateral prefrontal korteks, to'g'ri prekotor korteks, chap ustun vaqtinchalik girus, globus pallidus externus, gipokampus va to'g'ri noaniq. Chapda anormal faoliyatning zaifroq o'choqlari topildi kaudat, orqa singulat korteksi va yuqori parietal lob.[73] Shu bilan birga, OKBdagi funktsional neyroimagingning eski meta-tahlilida yagona izchil funktsional neyroimaging topilmalari orbital girus va kaudat yadrosining boshidagi faollik oshganligi, ACC aktivatsiyasining anormalliklari juda mos kelmaganligi haqida xabar berilgan.[74] Ta'sirchan va ta'sirchan bo'lmagan vazifalarni taqqoslagan meta-tahlilda keskinlik, odat, maqsadga yo'naltirilgan xatti-harakatlar, o'ziga yo'naltirilgan fikrlash va bilimni boshqarish bilan bog'liq bo'lgan mintaqalardagi nazorat bilan farqlar kuzatildi. Ta'sir qilmaydigan vazifalar uchun insula, ACC va kaudat / putamen boshida giperaktivlik, gipoaktivlik esa medial prefrontal korteks (mPFC) va orqa kaudat. Ta'sirchan vazifalar aktivatsiyaning kuchayishi bilan bog'liqligi kuzatildi prekuneus va orqa singulat korteksi (PCC), pallidum, ventral oldingi talamus va orqa kaudatda faollashuvning pasayishi aniqlandi.[75] Ning ishtiroki kortiko-striato-talamo-kortikal OKBda tsikl, shuningdek OKB bilan komorbiditening yuqori darajasi DEHB ba'zilarini o'zlarining mexanizmlariga bog'lashga undashdi. Kuzatilgan o'xshashliklarga funktsiyalarning buzilishi kiradi oldingi singulat korteksi va prefrontal korteks, shuningdek ijro funktsiyalaridagi umumiy kamchiliklar.[76] OKBda orbitofrontal korteks va dorsolateral prefrontal korteksning ishtiroki bipolyar buzilish va ularning yuqori darajadagi komorbidligini tushuntirishi mumkin.[77] OKBda dorsolateral prefrontal korteksning ijro etuvchi funktsiyaga bog'liq hajmining kamayishi ham kuzatildi.[78]

OKB bilan kasallangan odamlar ko'paygan kulrang modda hajmi ikki tomonlama lentikulyar yadrolar, kaudat yadrolariga qadar cho'zilib, ikki tomonlama dorsalda kulrang moddalar miqdori kamayadi medial frontal /oldingi singulat gyri.[79][80] Ushbu topilmalar boshqa bezovtalik kasalliklariga chalingan odamlarga qaraganda farq qiladi, ular kamayadi (aksincha) kulrang modda hajmi ikki tomonlama lentikulyar / kaudat yadrolari, shuningdek, ikki tomonlama dorsalda kulrang moddalar miqdori kamayadi medial frontal /oldingi singulat gyri.[80] OKBda oq materiya hajmining oshishi va oldingi o'rta chiziqdagi fraksiyonel anizotropiyaning pasayishi kuzatilgan, bu tolaning kesishishi ko'payganligidan dalolat beradi.[81]

Kognitiv modellar

Odatda OKB uchun ikkita toifadagi modellar joylashtirilgan, birinchisi ijro funktsiyalaridagi kamchiliklarni, ikkinchisi modulyatsion boshqaruvdagi kamchiliklarni o'z ichiga olgan. Ijro etishmovchiligining birinchi toifasi dlPFCda kuzatilgan strukturaviy va funktsional anormalliklarga asoslangan, striatum va talamus. Funktsional bo'lmagan modulyatsion nazoratni o'z ichiga olgan ikkinchi toifaga asosan ACC, mPFC va OFCdagi kuzatilgan funktsional va tarkibiy farqlarga tayanadi.[82][83]

Taklif qilingan modellardan biri disfunktsiyani OFK xatti-harakatlarning noto'g'ri baholanishiga va xatti-harakatlarning nazoratining pasayishiga olib keladi, amigdala faollashuvida kuzatilgan o'zgarishlar esa haddan tashqari qo'rquv va salbiy stimullarning namoyon bo'lishiga olib keladi.[84]

OKB belgilarining heterojenligi tufayli simptomlarni farqlovchi tadqiqotlar o'tkazildi. Semptomlarga xos neyroimaging anormalliklari, marosimlarni tekshirishda kaudat va ACC ning giperaktivligini, ifloslanish bilan bog'liq simptomlarda kortikal va serebellar mintaqalarning faolligini oshirishni o'z ichiga oladi. Intruziv fikrlarning mazmunini ajratib turuvchi neyroimaging, tabu fikrlardan farqli o'laroq, tajovuzkorlar orasidagi farqni topdi, amigdala, ventral striatum va ventromedial prefrontal korteksning tajovuzkor alomatlarida, ventral striatum va insula o'rtasida jinsiy / diniy aloqalar kuchayganligini kuzatdi. intruziv fikrlar.[85]

Boshqa model shuni ko'rsatadiki, ta'sirchan regulyatsiya odat bo'yicha harakatlarni tanlashga haddan tashqari bog'liqlikni bog'laydi[86] majburlash bilan. Buni OKB bilan kasallanganlar pul mukofotini kutish paytida ventral striatumning faollashuvi pasayganligini va VS va OFC o'rtasidagi funktsional aloqani oshirayotganligini kuzatish bilan qo'llab-quvvatlaydi. Bundan tashqari, OKB bilan kasallanganlar, pavlovian qo'rquvni yo'q qilish vazifalari, amigdaladagi qo'rqinchli ogohlantirishlarga nisbatan yuqori sezuvchanlik va ijobiy valansli stimullarga duch kelganda amigdalada gipo-ta'sirchanlikni kamaytiradi. Rag'batlantirish akkumulyator yadrosi ikkalasini ham yaratishda affektiv disregulyatsiyaning rolini qo'llab-quvvatlab, obsesyonni ham, majburlashni ham samarali ravishda yengillashtirgani kuzatilgan.[84]

Neyrobiologik

OKBda antidepressantlarning samaradorligini kuzatishdan OKBning serotonin gipotezasi ishlab chiqilgan. Serotoninning periferik markerlarini o'rganish, shuningdek, proserotonerjik birikmalar bilan bog'liq muammolar, natijada serotonerjik tizimlarning bazal giperaktivligiga ishora qiluvchi dalillarni o'z ichiga olgan.[87] Serotonin retseptorlari va transporterlarni bog'lash bo'yicha tadqiqotlar qarama-qarshi natijalarga olib keldi, jumladan yuqori va pastki serotonin retseptorlari 5-HT2A va serotonin tashuvchisi SSRI bilan davolash orqali normallashtirilgan majburiy potentsial. Topilgan anormallik turlarining nomuvofiqligiga qaramay, dalillar OKBdagi serotonerjik tizimlarning disfunktsiyasiga ishora qilmoqda.[88] Orbitofrontal korteks haddan tashqari faollik muvaffaqiyatli javob bergan odamlarda susayadi SSRI dori-darmon, natijada stimulyatsiyani kuchayishiga olib keladi serotonin retseptorlari 5-HT2A va 5-HT2C.[89]

Dopamin va OKB o'rtasidagi murakkab munosabatlar kuzatildi. Garchi antipsikotiklar tomonidan bajariladigan antagonizatsiya qiluvchi dopamin retseptorlari OKBning ayrim holatlarini yaxshilashi mumkin, ular boshqalarni tez-tez kuchaytiradi. OKBni davolash uchun ishlatiladigan past dozalarda antipsikotiklar, aslida dopaminning ko'payishini ko'paytirishi mumkin. prefrontal korteks, inhibe qilish orqali autoreseptorlar. Vaziyatlarni yanada murakkablashtirishi - bu samaradorlik amfetaminlar, kamaydi dopamin tashuvchisi OKBda kuzatilgan faollik,[90] va past darajalar D2 majburiy striatum.[91] Bundan tashqari, chuqur miya stimulyatsiyasidan so'ng akumbens yadrosidagi dopaminning ko'payishi simptomlarning yaxshilanishi bilan bog'liq bo'lib, simptomlarni yaratishda rol o'ynaydigan striatumdagi dopaminning kamayishini ko'rsatmoqda.[92]

Anormalliklar glutamaterjik nörotransmisyon OKB bilan bog'liq. Serebrospinal glutamatning ko'payishi, neyroimaging tadqiqotlarida kuzatilgan kamroq izchil anormallik va glutamat inhibitori kabi ba'zi glutamaterjik dorilarning samaradorligi kabi topilmalar. riluzol OKBda glutamat mavjud.[91] OKB kamaytirilganligi bilan bog'liq N-atsetilpartik kislota mPFCda, bu aniq talqin qilinmagan bo'lsa-da, neyronlarning zichligi yoki funksionalligini aks ettiradi.[93]

Tashxis

Rasmiy tashxisni psixolog, psixiatr, klinik ijtimoiy xodim yoki boshqa ruhiy salomatlik bo'yicha mutaxassis tomonidan amalga oshirish mumkin. OKB tashxisi qo'yish uchun odamda obsesyon, majburlash yoki ikkalasi bo'lishi kerak Ruhiy kasalliklarning diagnostikasi va statistik qo'llanmasi (DSM). DSM-ning 2000 yilgi nashrida tezkor ma'lumotnomada bir nechta xususiyatlar xarakterli ekanligi ta'kidlangan klinik jihatdan ahamiyatli obsesyonlar va majburlashlar. Bunday obsesyonlar, deydi DSM, takrorlanadigan va doimiy fikrlar, impulslar yoki tajovuzkor sifatida boshdan kechirgan va sezilarli tashvish yoki bezovtalikka olib keladigan tasvirlar. Ushbu fikrlar, impulslar yoki tasvirlar tashqarida yotadigan daraja yoki turga ega normal an'anaviy muammolardan tashvishlanish doirasi.[94] Biror kishi e'tiborsiz qolishga urinishi mumkin yoki bostirish Bunday obsesyonlar yoki ularni boshqa biron bir fikr yoki harakatlar bilan zararsizlantirish va obsesyonlarni o'ziga xos yoki mantiqsiz deb bilishga moyil bo'ladi.

Majburlanishlar, agar odam o'zini obsesyonga javoban yoki qat'iy qo'llanilishi kerak bo'lgan qoidalarga binoan ularni bajarishga undashni his qilsa va shu sababli odam jiddiy qayg'uga duch kelsa yoki olib kelsa, klinik jihatdan ahamiyatli bo'ladi. Shuning uchun, OKBdan aziyat chekmaydigan ko'p odamlar OKB bilan bog'liq harakatlarni (masalan, omborxonadagi buyumlarga balandligi bo'yicha buyurtma berish) amalga oshirishi mumkin bo'lsa-da, klinik jihatdan muhim OKB bilan farqlash OKB bilan og'rigan odamda yotadi. kerak ushbu harakatlarni bajaring, aks holda ular sezilarli psixologik siqilishlarga duch kelishadi. Ushbu xatti-harakatlar yoki aqliy harakatlar tashvishlarning oldini olish yoki kamaytirishga yoki ba'zi dahshatli voqea yoki vaziyatlarning oldini olishga qaratilgan; ammo, ushbu tadbirlar mantiqiy yoki amaliy ravishda masala bilan bog'liq emas yoki ular haddan tashqari ko'pdir. Bundan tashqari, buzilish paytida biron bir vaqtda, shaxs o'z obsesyonlari yoki majburlashlari asossiz yoki haddan tashqari ekanligini tushunishi kerak.

Bundan tashqari, obsesyonlar yoki majburlashlar ko'p vaqt talab qilishi kerak (kuniga bir soatdan ko'proq vaqtni oladi) yoki ijtimoiy, kasbiy yoki o'quv ishlarining buzilishiga olib keladi.[94] OKBni davolashdan oldin va uning paytida simptomlar va buzilishlarning og'irligini aniqlash foydalidir. Odamning har kuni obsesif-kompulsiv fikrlar yoki xatti-harakatlarni yashirish uchun sarflagan vaqtini taxmin qilishdan tashqari, odamning ahvolini aniqlash uchun aniq vositalardan foydalanish mumkin. Bu kabi reyting o'lchovlari bilan amalga oshirilishi mumkin Yel-jigarrang obsesif kompulsiv o'lchov (Y-BOCS). Bunday o'lchovlar bilan psixiatrik konsultatsiya yanada aniqroq aniqlanishi mumkin, chunki u standartlashtirilgan.[7]

OKB ba'zan buzilishlar guruhiga joylashtiriladi obsesif-kompulsiv spektr.[95]

Differentsial diagnostika

OKB ko'pincha alohida holat bilan aralashtiriladi obsesif-kompulsiv shaxs buzilishi (OCPD). OKB egodistonik, buzilish azob chekayotgan bilan mos kelmasligini anglatadi o'z-o'zini anglash.[96][97] Egodistonik buzilishlar insonning o'z tushunchasiga zid bo'lgani uchun, ular ko'p qayg'uga duchor bo'lishadi. OCPD, boshqa tomondan egosintonik - natijada namoyon bo'lgan xususiyatlar va xatti-harakatlar ularga mos kelishini odamning qabul qilishi bilan belgilanadi o'z-o'zini tasvirlash, yoki boshqacha maqsadga muvofiq, to'g'ri yoki oqilona.

Natijada, OKB bilan kasallangan odamlar ko'pincha o'zlarining xatti-harakatlari oqilona emasligini bilishadi, o'zlarining obsesyonlaridan norozi bo'lishadi, ammo shunga qaramay ular o'zlarini majburlashmoqda.[98] Aksincha, OCPD bilan kasallangan odamlar g'ayritabiiy narsa haqida bilishmaydi; ular nima uchun harakatlari oqilona ekanligini tushuntirib berishadi, odatda boshqacha tarzda ularni ishontirish mumkin emas va ular o'zlarining obsesyonlari yoki majburlovlaridan zavq olishga intilishadi.[98]

Menejment

"Deb nomlangan psixoterapiya shaklikognitiv xulq-atvor terapiyasi "(CBT) va psixotrop dorilar OKBni davolashning birinchi bosqichi.[1][99] Kabi boshqa psixoterapiya shakllari psixodinamik va psixoanaliz buzilishning ba'zi jihatlarini boshqarishda yordam berishi mumkin, ammo 2007 yilda Amerika psixiatriya assotsiatsiyasi (APA) etishmasligini ta'kidladi boshqariladigan tadqiqotlar "OKBning asosiy belgilari bilan kurashishda" ularning samaradorligini ko'rsatish.[100]

Terapiya

Ta'sir qilish va marosimlarni oldini olish bo'yicha tadbirlardan biri qulfni faqat bir marta tekshirib, keyin chiqib ketish bo'ladi

CBTda ishlatiladigan o'ziga xos texnika deyiladi ta'sir qilish va javob berishning oldini olish (ERP) bu obsesyon bilan bog'liq odatiy kompulsiv harakatlarni amalga oshirmasdan ("ta'sirni oldini olish") obsesif fikrlar va qo'rquvlarni ("ta'sir qilish") qo'zg'atadigan holatlar bilan ataylab aloqada bo'lishga o'rgatishni o'z ichiga oladi, shu bilan asta-sekin o'rganadi ritualistik xatti-harakatni amalga oshirmaslik bilan bog'liq noqulaylik va xavotirga toqat qilish. Dastlab, masalan, kimdir juda yumshoq "ifloslangan" narsaga tegishi mumkin (masalan, "ifloslangan" dan chiqqan kitobga tegib turgan tishpik uchi tegib ketgan boshqa to'qima bilan to'qilgan to'qima kabi). joy, masalan, maktab). Bu "ta'sir qilish". "Ritual oldini olish" yuvish emas. Yana bir misol, uydan chiqib ketish va orqaga qaytmasdan qulfni bir marta tekshirish (ta'sir qilish) va yana tekshirish (marosimlarning oldini olish). Odam juda tez odatlangan xavotirni keltirib chiqaradigan vaziyatga va ularning tashvish darajasi sezilarli darajada pasayganligini aniqlaydi; keyin ular ko'proq "ifloslangan" narsaga tegishi yoki qulfni umuman tekshirmasliklariga o'tishlari mumkin - yana yuvinish yoki tekshirishning marosimlarini o'tkazmasdan.[101]

ERP kuchli dalil bazasiga ega va u OKB uchun eng samarali davolash hisoblanadi.[101] Biroq, bu da'vo 2000 yilda ba'zi tadqiqotchilar tomonidan shubha uyg'otdi va ko'plab tadqiqotlar sifatini tanqid qildilar.[102] 2018 yilgi tekshiruv o'z-o'ziga yordam berishini aniqladi metakognitiv mashg'ulotlar OKBda yaxshilangan semptomlar.[103] 2007 yildagi Cochrane tekshiruvi shuni ham ko'rsatdiki, KBT modellaridan olingan psixologik aralashuvlar odatdagidek davolanishdan, samarasiz kutish ro'yxatidan yoki KBT bo'lmagan aralashuvlardan iborat bo'lgan davolanishdan ko'ra samaraliroq.[104]

Odatda, psixoterapiya psixiatrik dorilar bilan birgalikda faqatgina ikkala variantdan ham samaraliroq qabul qilingan.[105]

Dori-darmon

Pufakchalar to'plami klomipramin tovar nomi ostida Anafranil

Eng ko'p ishlatiladigan dorilar serotoninni qaytarib olishning selektiv inhibitörleri (SSRI).[4] Klomipramin, sinfiga tegishli dori trisiklik antidepressantlar, SSRI kabi ishlaydi, ammo yon ta'sirining darajasi yuqori.[4]

SSRIlar - bu kattalar obsesif kompulsiv buzilishining (OKB) engil funktsional buzilishi bo'lgan ikkinchi darajali davolash va o'rtacha yoki og'ir buzilganlarga birinchi navbatda davolash usuli. In children, SSRIs can be considered as a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects.[99] SSRIs are efficacious in the treatment of OCD; people treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo.[106][107] Efficacy has been demonstrated both in short-term (6–24 weeks) treatment trials and in discontinuation trials with durations of 28–52 weeks.[108][109][110]

In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines recommended antipsikotiklar for OCD that does not improve with SSRI treatment.[5] For OCD there is tentative evidence for risperidon and insufficient evidence for olanzapin. Ketiapin is no better than placebo with regard to primary outcomes, but small effects were found in terms of YBOCS score. The efficacy of quetiapine and olanzapine are limited by the insufficient number of studies.[111] A 2014 review article found two studies that indicated that aripiprazol was "effective in the short-term" and found that "[t]here was a small effect-size for risperidone or anti-psychotics in general in the short-term"; however, the study authors found "no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo."[5] While quetiapine may be useful when used in addition to an SSRI in treatment-resistant OCD, these drugs are often poorly tolerated, and have metabolic side effects that limit their use. None of the atypical antipsychotics appear to be useful when used alone.[9] Another review reported that no evidence supports the use of first generation antipsychotics in OCD.[112]

A guideline by the APA suggested that dekstroamfetamin may be considered by itself after more well supported treatments have been tried.[113]

Jarayonlar

Elektrokonvulsiv terapiya (ECT) has been found to have effectiveness in some severe and refractory cases.[114]

Jarrohlik may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical jarohat is made in an area of the brain (the singulat korteks ). In one study, 30% of participants benefitted significantly from this procedure.[115] Miyani chuqur stimulyatsiyasi va vagus asab stimulyatsiyasi are possible surgical options that do not require destruction of miya to'qimasi. In the United States, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption requiring that the procedure be performed only in a hospital with specialist qualifications to do so.[116]

In the United States, psychosurgery for OCD is a treatment of last resort and will not be performed until the person has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive kognitiv-xulq-atvor terapiyasi with exposure and ritual/response prevention.[117] Likewise, in the United Kingdom, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out.

Bolalar

Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents.[118] Similar to the treatment of adults with OCD, CBT stands as an effective and validated first line of treatment of OCD in children.[119] Family involvement, in the form of behavioral observations and reports, is a key component to the success of such treatments.[120] Parental interventions also provide positive reinforcement for a child who exhibits appropriate behaviors as alternatives to compulsive responses. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious", establishing it as one of the leading psychosocial treatments for youth with OCD.[119] After one or two years of therapy, in which a child learns the nature of his or her obsession and acquires strategies for coping, that child may acquire a larger circle of friends, exhibit less shyness, and become less self-critical.[121]

Although the causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD, and acknowledging these stressors can play a role in treating the disorder.[122]

Epidemiologiya

Yoshi standartlashtirilgan nogironlik bo'yicha tuzatilgan hayot yili estimated rates for obsessive-compulsive disorder per 100,000 inhabitants in 2004.
  ma'lumotlar yo'q
  <45
  45–52.5
  52.5–60
  60–67.5
  67.5–75
  75–82.5
  82.5–90
  90–97.5
  97.5–105
  105–112.5
  112.5–120
  >120

Obsessive–compulsive disorder affects about 2.3% of people at some point in their life.[6] Rates during a given year are about 1.2% and it occurs worldwide.[2] It is unusual for symptoms to begin after the age of thirty five and half of people develop problems before twenty.[1][2] Males and females are affected about equally.[1]

Prognoz

Quality of life (QoL) is reduced across all domains in OCD. While psychological or pharmacological treatment can lead to a reduction of OCD symptoms and an increase in QoL, symptoms may persist at moderate levels even following adequate treatment courses, and completely symptom-free periods are uncommon.[123][124] In pediatric OCD, around 40% still have the disorder in adulthood, and around 40% qualify for remissiya.[125]

Tarix

In the 7th century AD, Jon Klimak records an instance of a young monk plagued by constant and overwhelming "temptations to blasphemy" consulting an older monk,[126]:212 who told him, "My son, I take upon myself all the sins which these temptations have led you, or may lead you, to commit. All I require of you is that for the future you pay no attention to them whatsoever."[126]:212 Bilmasvoy buluti, a Christian mystical text from the late 14th century, recommends dealing with recurring obsessions by first attempting to ignore them,[126]:213 and, if that fails, "cower under them like a poor wretch and a coward overcome in battle, and reckon it to be a waste of your time for you to strive any longer against them",[126]:213 a technique now known as "emotional flooding ".[126]:213

From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual or other obsessive thoughts were egalik tomonidan shayton.[96][126]:213 Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through jinni chiqarish.[127][128] The vast majority of people who thought they were possessed by the devil did not suffer from hallucinations or other "spectacular symptoms",[126]:213 but "complained of anxiety, religious fears, and evil thoughts."[126]:213 In 1584, a woman from Kent, England named Mrs. Davie, described by a justice of the peace as "a good wife",[126]:213 was nearly xavf ostida yondi after she confessed that she experienced constant, unwanted urges to murder her family.[126]:213

Inglizcha atama obsesif-kompulsiv arose as a translation of Nemis Zwangsvorstellung ('obsession') used in the first conceptions of OCD by Karl Vestfal. Westphal's description went on to influence Per Janet, who further documented features of OCD.[31] In the early 1910s, Zigmund Freyd attributed obsessive–compulsive behavior to unconscious conflicts that manifest as symptoms.[127] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".[129] Freyd psixoanaliz remained the dominant treatment for OCD until the mid-1980s,[126]:210–211 even though medicinal and therapeutical treatments were known and available,[126]:210 because it was widely thought that these treatments would be detrimental to the effectiveness of the psixoterapiya.[126]:210 In the mid-1980s, psychiatry made a sudden "about-face" on the subject[126]:210 and began treating OCD primarily through medicine and practical therapy rather than psychoanalysis.[126]:210

E'tiborga loyiq holatlar

Jon Bunyan (1628–1688), the author of Ziyoratchilarning borishi, displayed symptoms of OCD (which had not yet been named).[126]:53–54 During the most severe period of his condition, he would mutter the same phrase over and over again to himself while rocking back and forth.[126]:53–54 He later described his obsessions in his autobiography Gunohkorlarning boshlig'iga inoyat ko'p,[126]:53–54 stating, "These things may seem ridiculous to others, even as ridiculous as they were in themselves, but to me they were the most tormenting cogitations."[126]:54 He wrote two pamphlets advising those suffering from similar anxieties.[126]:217–218 In one of them, he warns against indulging in compulsions:[126]:217–218 "Have care of putting off your trouble of spirit in the wrong way: by promising to reform yourself and lead a new life, by your performances or duties".[126]:218

British poet, essayist and lexicographer Samuel Jonson (1709–1784) also suffered from OCD.[126]:54–55 He had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps.[130][126]:55 He would touch every post on the street as he walked past,[126]:55 only step in the middles of paving stones,[126]:55 and repeatedly perform tasks as though they had not been done properly the first time.[126]:55

The American aviator and filmmaker Xovard Xyuz is known to have had OCD.[131] Friends of Hughes have also mentioned his obsession with minor flaws in clothing.[132] This was conveyed in Aviator (2004), a film biography of Hughes.[133]

Jamiyat va madaniyat

Bu lenta ifodalaydi Trikotillomaniya and other body focused repetitive behaviors. Concept for the ribbon was started by Jenne Schrader. Colors were voted on by the Trichotillomania Facebook community, and made official by Trichotillomania Learning Center in August 2013.

San'at, ko'ngil ochish va ommaviy axborot vositalari

Movies and television shows often portray idealized representations of disorders such as OCD. These depictions may lead to increased public awareness, understanding and sympathy for such disorders.[134]

  • Filmda Qanday yaxshi bo'lsa (1997), actor Jek Nikolson portrays a man "with Obsessive Compulsive Disorder (OCD)".[135] "Throughout the film, [he] engages in ritualistic behaviors (i.e., compulsions) that disrupt his interpersonal and professional life", a "cinematic representation of psychopathology [that] accurately depicts the functional interference and distress associated with OCD".[135]
  • Film Matchstick Men (2003), rejissyor Ridli Skott, portrays a con-man named Roy (Nikolas Keyj ) who has obsessive-compulsive disorder. The film "opens with Roy, at home, suffering with his numerous obsessive compulsive symptoms, which take the form of a need for order and cleanliness and a compulsion to open and close doors three times, whilst counting aloud, before he can walk through them".[136]
  • In AQSh tarmog'i Amerika komediya-drama detective mystery television series Monk (2002–2009), the titular Adrian Monk fears both human contact and dirt.[137][138]
  • Yilda Kaplumbağalar pastga tushishadi (2017), a yosh kattalar romani muallif tomonidan Jon Grin, teenage main character Aza Holmes struggles with OCD. It manifests as a fear of the human microbiome. Throughout the story, she repeatedly opens a never-fully-healed callus on her finger in an effort to drain out what she believes are pathogens. The novel is based on author Green's own experiences of OCD. He explained that Turtles All the Way Down is intended to show how “most people with chronic mental illnesses also live long, fulfilling lives”.[139]

Tadqiqot

The naturally occurring sugar inositol has been suggested as a treatment for OCD.[140]

μ-Opioids, kabi gidrokodon va tramadol, may improve OCD symptoms.[141] Administration of opiate treatment may be contraindicated in individuals concurrently taking CYP2D6 kabi inhibitorlar fluoksetin va paroksetin.[142]

Much current research is devoted to the therapeutic potential of the agents that affect the release of the neurotransmitter glutamat or the binding to its receptors. Bunga quyidagilar kiradi riluzol,[143] memantin, gabapentin, N-asetilsistein, topiramat va lamotrijin.[iqtibos kerak ]

Boshqa hayvonlar

Shuningdek qarang: Animal psychopathology § Obsessive compulsive disorder (OCD)

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