INDIA  :   Health

OCD treatment in India

Saturday , 16 January 2016

Globally, Obsessive Compulsive Disorder (OCD) is known to be the fourth most common mental disorder. This week, we take a look at treatment options for OCD in India

Shoaib Ismail (35), a Jeddah-based civil engineer has been an Obsessive Compulsive Disorder (OCD) patient for the last five years. Although he was diagnosed with the disorder in 2010, it was only in December 2014 that he started his treatment in Mumbai’s Saifee Hospital. Only when his obsession for perfection started affecting his work and personal life, he was forced to seek medical help.

Shoaib’s doctor said the delay in starting treatment led to an aggravation of the symptoms of OCD which flared up and manifested as gastric problems and other behavioural issues including self-doubt, anxiety and stress. So much so that he turned into an introvert.

Doctors say that many OCD patients like Shoaib do not think of getting treated for the disorder unless it starts affecting their normal life. While the exact prevalence rate of OCD is not known, psychiatrists say it is the fourth most common mental illness in the world, following phobias, substance abuse and major depression.

The World Health Organisation (WHO) in its 2001 mental report stated that OCD was found to be among the top 20 causes of illnessrelated disability. “OCD can interfere with a person’s daily life. It can affect children and adults irrespective of gender, race and ethnicity. Although worrying and being plagued by doubts are common symptoms in OCD patients, the brain gets stuck on a particular thought or urge. The person finds it difficult to get out of it,” said Dr Anju Dhawan, psychiatrist at AIIMS, Delhi. According to doctors, OCD is rising in individuals between the age group of 15 to 44.

Symptoms and diagnosis

The most common symptom of OCD is a person worrying constantly about catching a disease or spreading germs. They are also constantly obsessed about dirty hands and can wash their hands up to a hundred times a day. “A person with OCD suffers from aggressive impulses, fear of contamination and persistent thoughts of harming oneself or others. They are also constantly cross-checking or counting things, repeatedly cleaning objects around them or washing their hands very often,” said Dr Harish Shetty, psychiatrist at Dr LH Hiranandani Hospital.

Doctors say an OCD patient is anxious and emotional and can display non- OCD symptoms such as extreme tension, excessive worry and depression. “OCD can have shortterm and long-term effects on the patient and his/her family. Therefore, if you suspect that someone has OCD, medical help should be sought,” said Dr Shetty. (Check BOX for types of OCD) Diagnosis of OCD involves self-assessment followed by psychological evaluation by a trained psychiatrist.

Treating OCD

While OCD has no permanent cure, psychiatrists say that a combination of psychotherapy and medication can be effective to a large extent “In some cases, the OCD patient is treated via psychotherapy and in others with medication. Medical researchers say that a combination of psychotherapy and medication works better,” said Dr Parul Tank, psychiatrist at Fortis Group of Hospitals.

In psychotherapy, the patient is gradually exposed to an object he/she fears or something he/she is obsessed about. “During psychotherapy sessions, the patient’s obsession/fear is evaluated. He/she is then gradually inducted into a regimen of facing the fear/ obsession (systematic desensitisation and flooding). The patient is aided with relaxation techniques to cope with his/her anxiety too,” said Dr Tank.

Psychotherapy also involves therapy sessions with the family. “A family’s role in psychotherapy is crucial. We also have group sessions where experiences of other OCD people are shared,” informed Dr Tank.

Dr Seema Hingoranny, a well-known psychologist in Mumbai said that anti-depressants are the first line of treatment tried by doctors to treat OCD patients. “There are certain drugs such as clomipramine, fluvoxamine, fluoxetine, paroxetine and sertraline that are used in OCD treatment,” said Dr Hingoranny.

She also added that experimenting with several medications to treat OCD is not unusual. “Doctors do experiment with medicines to find out which one actually works better. In some cases, doctors combine anti-depressants with antipsychotic drugs for effective management of OCD symptoms,” said Dr Hingoranny.

Doctors emphasise that medications should not be stopped without consulting a doctor first, as it may lead to a relapse of OCD symptoms. “Many OCD patients take the treatment lightly. As soon as the symptoms disappear, they stop medication. This often leads to a relapse. One should therefore consult the doctor for a gradual tapering of the medication,” said Dr Tank.

OCD is also treated via a specific therapy approach called EMDR (Eye Movement Desensitisation and Reprocessing). “It is known to be effective for many people with OCD. It is a complex therapeutic intervention that includes a number of elements common to a number of cognitive behavioural approaches,” said Dr Hingoranny.

Treating OCD with surgery

Surgery is also an optional treatment for severe OCD. At Jaslok hospital, Mumbai, the neuro-surgery team is known to perform a deep brain stimulation procedure to treat psychiatric disorders like OCD and depression.

“Patients, who do not respond to traditional treatment, can consider surgery. We successfully performed DBS on an Australian citizen, who was suffering from severe depression. OCD can also be treated similarly if there is medical indication for the surgery,” said Dr Paresh Doshi, neurosurgeon at Jaslok Hospital.

Elaborating on the surgery, Dr Doshi said that DBS targets a small brain structure known as Area 25, the “ringleader” for the brain circuits that control our moods. “The surgery involves implanting a small stimulating electrode into the Subgenual Cingulate Gyrus (SCG) area of the brain. The electrodes are powered by a battery-powered device that generates the stimulation,” he said.

Dr Sanjay Mongia, neurosurgeon at Lilavati Hospital, Mumbai uses gamma knife surgery to treat OCD. “Gamma knife surgery is recognised worldwide. It is a non-invasive cerebral surgery,” said Dr Mongia.

Why India…

India is popular for its internationally- trained psychiatrists who can diagnose and treat all types of psychiatric disorders, including OCD.

A large number of patients with mental disorders come to India as the centres here have exclusive multi-speciality care options for better management of the emotional and social well-being of the patient and his/her family.

Indian corporate hospitals also provide surgical treatment options for OCD patients. “Psycho-surgery is a subset of neuro-surgery. It is intended to modulate the performance of the brain. Neurosurgeons are now concentrating on treating disorders like OCD with modern neurosurgery like DBS and minimally invasive techniques like the gamma knife radiation,” said Dr Mongia.

Common symptoms of OCD

  • Compulsion – urge to frequently wash hands or shower.
  • Overzealous cleaning – repeating cleaning routines until it feels ‘perfect’.
  • Checking – excessive double checking of locks, stoves, light switches etc.
  • Organising – arranging, re-arranging or aligning things (according to one’s level of perfection).
  • Hoarding – collecting and hoarding useless junk.
  • Trichotillomania — the recurrent urge to pull out scalp hair, eyelashes, eyebrows or other body hair.
  • Body Dysmorphic Disorder — imagining exaggerated defects in one’s physical appearance.
  • Eating disorders – such as bulimia or anorexia nervosa.
  • Substance Hypochondriasis — having an unfounded fear of suffering from a serious disease.