Obsessive compulsive disorders affect about 6 million Americans. This type of condition is characterized by repetitive thinking and the inability to repel this thinking process, which is very forceful, practically taking over the mind. It doesn't allow you to think about anything else. Compulsions are urges that are extremely demanding and have to be carried out. Some of the main compulsions are double-checking and hand washing. If the compulsion isn't carried out, there is anxiety that will cease or diminish if it is. This sickness has been medically described for at least 200 years.
It takes about seven years or so for a patient to come for consultation, which tells us that the condition is gradual and fits into our system in a very, very slow manner. It occurs with equal frequency in males and females. Fifty percent of obsessive compulsive patients manifest their sickness during childhood or adolescence. Later on--primarily after the age of 40—it fades away, and it becomes very rare after the age of 50.
As to why this condition exists, a learning process that takes place during childhood may be involved. There is a theory that is now slowly being accepted about a biochemical process at work related to changes in neurotransmitters in the brain, primarily serotonin. Neurotransmitters are chemical substances that build bridges between neurons in the nervous cell so that they can transmit signals from the outside into our system or, in the reverse direction, have us act to affect the outside world.
To treat obsessive compulsive disorders, behavioral therapy, and an amino acid approach, such as use of L-tryptophane, would be the treatment of choice, along with some medications.
We basically treat with behavioral therapy. We try to use thought-stopping, to prevent the brain from repeating the same thought. That is difficult, so we also use cognitive therapy to explain the reasons we think the things we do, and try to modify the thought.
Compulsions are the area where behavioral therapy is most effective. We expose the patient, either in reality or in his or her imagination, to face what he is afraid of. If you have fears of AIDS or of blood, you are exposed to blood or taken to the hospital where there might be patients with AIDS. Or you will read articles on the condition if it is just an imaginary technique.
If it is contamination from dirt the patient is afraid of, we teach the person how to touch objects and not to be afraid of them. Then we prevent the patient from washing their hands; in other words, they must remain unclean for awhile. I'm talking about patients who, when they are seriously ill, might use one or two bars of soap per day. They might engage in rituals of washing for many hours. They may wash their hands sometimes a hundred or more times a day. Some of these patients, in addition, will clean their hands with alcohol or other substances. Sometimes their skin becomes extremely raw. I've seen cases where patients require plastic surgery.
Overall, the treatment takes about six months. With medication there is improvement up to 60 or 70 percent of the time.
We were the first to use tryptophane and with it we were able to reduce and almost eliminate completely the use of drugs for this condition, and we obtained very good results. Unfortunately, tryptophane has been banned so we can no longer use it. We were using between 3000 and 9000 mg per day.
Then we used vitamin B6, 100 mg, three times a day. Vitamin B6, pyridoxine phosphate, is a vitamin that is very important for the breakdown of tryptophane into serotonin. The idea behind this was that either we didn't have enough serotonin in our brain or we were very dependent on serotonin, or tryptophane was not being converted into serotonin.
When we found by measuring that there was a lack of serotonin, this could be reversed by the administration of L-tryptophane with niacin and vitamin B6. Some medications do this, but with medications we face many types of side effects.
About 30 percent of patients do not respond to any form of therapy. But it is not a closed chapter. An investigation has to be conducted. Now that we have brain imaging, we are able to visualize the brain. We can measure, for instance, the metabolism of sugar in the brain. We find, for instance, the frontal and temporal lobes and the basal ganglia, that are related to Parkinson's disease, disrupted. We see the metabolism of the breakdown of sugar and also images of an abnormal brain. The same can be seen with some electrophysiological measurements of brain wave tests and so forth.
Interestingly, work has been going on using pure behavioral therapy before and after measuring serotonin. With just behavioral therapy, we were able to modify the levels of serotonin in the body. In other words, we may not need medication to change or challenge the presence of a neurotransmitter such as serotonin. Simply the mere interaction of behavioral technique may have an effect.
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