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Þráhyggjuárátturöskun - falinn sjúkdómur

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Authors
Magnús Haraldsson
Issue Date
2015-02

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Other Titles
Obsessive-compulsive disorder. A hidden disorder
Citation
Læknablaðið 2015, 101 (2):87-94
Abstract
Þráhyggjuárátturöskun er algeng og oft langvinn geðröskun sem leitt getur til verulegrar skerðingar á starfsgetu og lífsgæðum. Einkenni lýsa sér með óþægilegum, uppáþrengjandi og óviðeigandi kvíðavaldandi þrá- hyggjuhugsunum og tímafrekum og hamlandi áráttum. Einkennum fylgir oft mikil skömm og þekking almennings og heilbrigðisstarfsfólks á þessari geðröskun er víða takmörkuð. Því er algengt að röskunin greinist seint eða að einstaklingar fái ranga greiningu. Rannsóknir hafa sýnt að erfða- þættir eiga þátt í orsökum þráhyggjuárátturöskunar og nýlega hafa komið fram vísbendingar um að truflanir í tengingum ákveðinna heilasvæða eigi þátt í meingerð röskunarinnar. Ýmsar sálfræðikenningar um orsakir röskunarinnar sem studdar eru rannsóknum hafa einnig verið settar fram. Gagnreynd meðferð er annars vegar með lyfjum sem hafa áhrif á virkni serótóníns í heila og hins vegar ákveðnu afbrigði hugrænnar atferlismeð- ferðar sem nefnist berskjöldun með svarhömlun. Þörf er á bættum með- ferðarúrræðum þar sem allt að þriðjungur einstaklinga svarar meðferð lítið eða ekki. Hér er lýst tveimur tilfellum þráhyggjuárátturöskunar. Annars vegar ungum manni með dæmigerð einkenni sem svarar vel hefðbundinni meðferð og hins vegar miðaldra konu með mikil og hamlandi einkenni sem ekki svarar hefðbundinni lyfja- og sálfræðimeðferð. Í tilfelli konunnar var ákveðið að reyna raförvun á ákveðnum svæðum heilans með rafskautum sem komið var fyrir með þrívíddarísetningu í skurðaðgerð. Um er ræða meðferð sem er enn á tilraunastigi og hefur verið beitt í alvarlegustu tilfellum þráhyggjuáráttu sem ekki svara hefðbundinni meðferð.
Obsessive-compulsive disorder is a common and often chronic psychiatric illness that significantly interferes with the patient´s functioning and quality of life. The disorder is characterized by excessive intrusive and inappropriate anxiety evoking thoughts as well as time consuming compulsions that cause significant impairment and distress. The symptoms are often accompanied by shame and guilt and the knowledge of the general public and professional community about the disorder is limited. Hence it is frequently misdiagnosed or diagnosed late. There are indications that the disorder is hereditary and that neurobiological processes are involved in its pathophysiology. Several psychological theories about the causes of obsessive-compulsive disorder are supported by empirical evidence. Evidence based treatment is either with serotoninergic medications or cognitive behavioral therapy, particularly a form of behavioral therapy called exposure response prevention. Better treatment options are needed because almost a third of people with obsessive-compulsive disorder respond inadequatly to treatment. In this review article two cases of obsessive-compulsive disorder are presented. The former case is a young man with typical symptoms that respond well to treatment and the latter is a middle aged lady with severe treatment resistant symptoms. She underwent stereotactic implantation of electrodes and received deep brain stimulation, which is an experimental treatment for severe obsessive-compulsive disorder that does not respond to any conventional treatment.
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Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn
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Icelandic Journal Articles (Peer Reviewed)

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