American Medical Association Family Medical Guide - American Medical Association [459]
Treatment
Without treatment, repeated panic attacks can occur for years, disrupting your relationships and interfering with your ability to do your job. You could start to avoid situations that you fear will trigger a panic attack and become severely depressed. Treatment of panic disorder usually includes antidepressants (see page 712) or antianxiety medication (see page 713) and cognitive-behavioral therapy (which changes the thought patterns that can trigger symptoms and attempts to change the person’s behavior). Seventy to 90 percent of people can expect near total relief of their symptoms with treatment.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder is marked by persistent, intense, and inappropriate thoughts or images known as obsessions, which a person tries to compensate for with repetitive behavior, called compulsions, that he or she feels driven to perform. Examples of common obsessions include recurring doubts (about having turned off the stove or locked the door, for example), thoughts about contamination (such as from touching a doorknob or shaking hands), requiring things in a certain order, violent or shocking impulses (such as to hurt someone or laugh out loud at a funeral), and intrusive sexual images. Compulsive behaviors performed to lessen the anxiety produced by such obsessive thoughts range from repeated hand washing or checking, to praying or counting. In the extreme, ritual compulsions can consume hours every day, disrupting a person’s life.
Obsessive-compulsive disorder is thought to result from abnormal activation of specific areas of the brain. In children with obsessive-compulsive disorder, infections with streptococcal bacteria (such as strep throat; see page 652) have been implicated in either triggering the disease or making it worse.
Symptoms
The obsessive thoughts characteristic of obsessive-compulsive disorder produce a great deal of anxiety and distress. The affected person may attempt to ignore or suppress such thoughts but inevitably feels compelled to perform the ritualistic action to get rid of the uncomfortable anxiety. The thoughts keep returning, prompting the compulsion, and the cycle repeats indefinitely. The person usually recognizes that this behavior is unreasonable but can’t keep from doing it. If he or she resists the compulsion, an overwhelming feeling of physical tension occurs, which can be relieved only by giving in to the compulsion. Some people with obsessive-compulsive disorder also have tics, which are repeated, purposeless actions or muscle contractions; examples include blinking, throat clearing, and mouth twitching.
Diagnosis
A doctor can make a diagnosis of obsessive-compulsive disorder from a person’s description of his or her feelings, physical symptoms, and behavior.
Treatment
Antidepressant drugs (see page 712) called selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for obsessive-compulsive disorder because they increase the availability of the brain chemical serotonin, which helps regulate mood and behavior. Half of all affected people benefit from these medications. Most doctors also prescribe a type of cognitive-behavioral therapy called desensitization, which exposes the person to a compulsion-producing situation (such as using a public bathroom) while attempting to reduce the compulsive response (such as repeated hand washing).
Posttraumatic Stress Disorder
Posttraumatic stress disorder is a condition that occurs after a terrifying experience, such as a violent personal attack, child abuse, a severe injury, a natural disaster, or military combat. The traumatizing event can be something that the person has either experienced or witnessed. After