Obsessive-compulsive Disorder

This is a mental disorder characterised by persistent unwanted and intrusive thoughts known as obsessions and / or repetitive, stereotyped and unnecessary behaviours know as compulsions that a person feels obliged to do in response to these obsessions. These compulsions and obsessions are time consuming (more than 1 hour per day) and can cause significant distress, Impairment of work and social functioning.

Common content of obsessional thoughts include:

• Fear of dirt or contamination
• Extreme concern for order, symmetry or precision
• Disturbing sexual thoughts or images
• Fear of things not being complete
• Fear of losing or discarding important things
• Fear of perpetuating aggression or harm to self or a loved one
• Religious thoughts

Some compulsive behaviours to these obsessions include

• Excessive hand washing, showering, cleaning of surfaces etc.
• Ordering or arranging things in a particular way
• Constantly checking locks, switches, electrical gadgets etc. to be sure they are safe
•  Constantly seeking approval or reassurance
• Constantly avoiding certain people, places and situations

Even though many people have occasional unwanted thoughts or engage in repetitive behaviours, in people with OCD, these thoughts tend to be excessive and distressing to the person.

70% of individuals with OCD usually have at least one comorbid disorder such as other anxiety disorders, depressive disorders, eating disorders, alcohol and drug – use related disorder, ADHD, Tourette’s syndrome, Autism spectrum disorder and mood disorders

Management of OCD involves a thorough psychiatric assessment by Psychiatrist and Psychologist. Definitive treatment involves medications and use of Psychotherapy such as Family therapy cognitive behavioural therapy and exposure and response prevention therapy.

Problems arising from OCD may include:

• Excessive time wasting on these rituals
• Difficulty maintaining relationships
• Health issues such as contact dermatitis from constant washing
• Poor quality of life
• Difficulty attending social gathering, work etc.

Obsessive-Compulsive Personality Disorder

OCPD is a mental health condition which involves extensive preoccupation with orderliness, symmetry, perfectionism and control. Individuals with OCPD usually have an excessive need for rules and regulations. They experience extreme difficulty with flexibility and are unable to adapt to change.

OCD is different from OCPD in the sense that, individuals with OCD have intrusive thoughts and repetitive behaviours where as individuals with OCPD have strict and inflexible personality traits. OCPD is likely to affect people with anxiety disorders, mood disorders such as bipolar and mild to moderate substance – use related disorders.

Symptoms usually begin during early adulthood and may include:

• Preoccupation with details, rules, schedules, lists and organizational.
• Unwillingness to throw out worn-out or worthless objects, even those without any sentimental value
• Increasing need to do something perfectly such that it interferes with completion of the said task
• Excessive devotion to work and productivity leading to neglect of leisure activities and spending time with loved ones
• Excessive conscientiousness and inflexibility regarding ethical and moral issues and values
• Unwillingness to delegate task to other because they fear it won’t be done like they would have
• A miserly approach to spending money because they see money as something to be saved for the future
• Rigid and strong headed
• Constant struggle with decision making and accepting criticism or feedback

The exact cause of OCPD is not known but is believed to be related to genetic and non genetic factors. Individuals suspected to have OCPD must be assessed thoroughly by Psychiatrists and Psychologists and managed appropriately with medications and Psychotherapy.

Oppositional Defiant Disorder

This is a conduct disorder characterised by an enduring pattern of negative, hostile and defiant behaviour towards familiar adults and other authority figures. These emotional and behavioural issues can cause serious problems with family life, social activities, school and work.

The exact cause of ODD is not known but theories have been made surrounding developmental issues and learning negative attitudes whiles growing up. It is usually diagnosed in preschool years. ODD is more likely in children with mood or anxiety disorders, conduct disorders and ADHD. Some common symptoms include;

• Angry and irritable mood; losing their temper easily, frequent temper tantrums,  often angry and resentful
• Argumentative and Defiant behaviour; Always questioning rules and refusing to follow rules, argues with adults, blames others for their misbehaviours
• Hurtful and revengeful behaviour; saying unkind things to others, seeking revenge, deliberately harming others.

Management of ODD involves a thorough psychiatric assessment by a Child Psychiatrist and Psychologist. Definitive treatment will require the combination of medications and the use of Psychotherapy such as cognitive behavioural therapy, family therapy, parental management training, social skills training and occupational therapy.

Opioids are a class of drugs used to reduce moderate to severe pain. Some common examples include; heroin, morphine, codeine, fentanyl, tramadol, methadone and oxycodone.

Tolerance: Reduced responsiveness to a drug such that there is a need to increase doses to achieve the desired effect.

Dependence: characterised by repeated self administration of the drug such that a reduction in dose or stopping of the drug causes withdrawal symptoms. See Addiction

Withdrawal: This is a life threatening condition resulting from dependence. Some common withdrawal symptoms are abdominal cramps, cravings, agitation, diarrhoea, pupil dilatation, anxiety, elevated blood pressure and heart rate, sneezing, sweating, tearing, rhinorrhoea, muscle pain, insomnia etc.

Intoxication: After opioid use, individuals experience euphoria, Decreased pain, increased sleep, constipation, nausea and confusion

Opioid Use Disorder is a mental health disorder that involves chronic use of opioids that causes clinically significant distress and impairment.

The cause of Opioid use disorder is a combination of biological, environmental, genetic and psychosocial factors. Opioid use disorder can occur in persons from all educational and socioeconomic backgrounds. It may develop from recreational or therapeutic use of opioids and result in physical dependence, tolerance and withdrawal symptoms when you try to stop or reduce it. It may also lead to negative physical, psychosocial and social issues including overdose and death.

To make the diagnosis of Opioid Use Disorder, the individual should be using opioids with repeated occurrence within 12 months of two or more of the following:

• Continued use of opioids despite worsening physical or psychological health
• Continued use leading to social and interpersonal consequences
• Decreased social or recreational activities
• Difficulty performing professional duties at work or school
• Excessive time wasting to obtain opioids or recover from taking them
• Taking in more than intended
• Cravings for these opioids
• Unable to decrease the amount being used
• Tolerance
• Withdrawal

Management of OUD involves a combination of medications, behavioural therapy and support groups.

See a Psychiatrist as soon as possible for thorough psychiatric assessment and detoxification. Long term maintenance and rehabilitation is required to prevent return to dependent use after treatment has been initiated.