Assuntos
Dieta , Transtorno Obsessivo-Compulsivo/dietoterapia , Transtorno Obsessivo-Compulsivo/etiologia , Transtornos de Tique/dietoterapia , Transtornos de Tique/etiologia , Adulto , Suplementos Nutricionais , Progressão da Doença , Ingestão de Alimentos/fisiologia , Ingestão de Alimentos/psicologia , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/patologia , Transtornos de Tique/patologia , Tiques/patologia , Adulto JovemRESUMO
Recently, calcium was suggested to be the active moiety of acamprosate. We examined plasma calcium concentrations in association with severity of alcohol dependence and its interaction with regulating pathways and alcohol craving in alcohol-dependent patients. 47 inpatient alcohol-dependent patients undergoing detoxification treatment underwent laboratory testing, including calcium, sodium, liver enzymes as well as serum concentrations of calcitonin, parathyroid hormone and vitamin D. The psychometric dimension of craving was analyzed with the Obsessive Compulsive Drinking Scale (OCDS). The severity of withdrawal was measured with the Alcohol Dependence Scale (ADS) and with the Alcohol Dependence Scale for high-risk sample (ADS-HR). The main findings of our investigation are: a) a negative correlation of plasma calcium concentrations with alcohol craving in different dimensions of the OCDS; b) a negative correlation of plasma calcium concentrations with breath alcohol concentration; c) lowered calcitonin concentration in the high-risk sample of alcoholics; d) lowered plasma vitamin D concentrations in all alcoholic subjects. Our study adds further support for lowered plasma calcium concentrations in patients with high alcohol intake and especially in patients with increased craving as a risk factor for relapse. Lowered calcitonin concentrations in the high-risk sample and lowered vitamin D concentrations may mediate these effects. Calcium supplementation could be a useful intervention for decreasing craving and relapse in alcohol-dependent subjects.
Assuntos
Alcoolismo/sangue , Alcoolismo/psicologia , Cálcio/sangue , Fissura , Adulto , Alcoolismo/complicações , Comportamento Aditivo , Calcitonina/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/sangue , Transtorno Obsessivo-Compulsivo/etiologia , Hormônio Paratireóideo/sangue , Escalas de Graduação Psiquiátrica , Psicometria , Vitamina D/sangueRESUMO
Structural brain lesions can be a rare cause of refractory psychiatric symptoms. The analysis of such cases may lead to insights into psychiatric neurobiology. Here we present a case of a dronabinol-responsive obsessive-compulsive syndrome after thalamic infarct.
Assuntos
Infarto Encefálico/complicações , Dronabinol/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/etiologia , Psicotrópicos/uso terapêutico , Tálamo/diagnóstico por imagem , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/tratamento farmacológico , Terapia Cognitivo-Comportamental , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The etiology of mental illness has been attributed to many different causes by people of various cultural backgrounds, including supernatural beliefs. This in turn affects the help-seeking behavior. Aim of this study was to explore the supernatural belief and pathways of care in patients with obsessive compulsive disorder (OCD) attending a tertiary care hospital located in north India. METHODOLOGY: In all, 89 consecutive patients diagnosed with OCD (according to the International Classification of Diseases-10th Revision (ICD-10)) and ≥ 15 years of age were evaluated for their supernatural belief and help seeking. RESULTS: More than half of the patients (54%) believed in supernatural causes and 57.3% attributed their illness to supernatural causes. In addition to supernatural causes, many patients also attributed their illness to stress (household/work-related stress) or chemical imbalance in the body and or mind. About two-thirds of the patients (n = 58; 65.2%) first contacted a psychiatrist for their symptoms of OCD. Those who first contacted faith healers believed in one of the supernatural causations. CONCLUSION: Patients with OCD hold multiple beliefs regarding the etiology and treatment of mental illness which can affect their pathways to care.
Assuntos
Cultura , Transtorno Obsessivo-Compulsivo/psicologia , Adulto , Atitude Frente a Saúde , Atenção à Saúde/estatística & dados numéricos , Cura pela Fé/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Masculino , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Superstições/psicologia , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
BACKGROUND AND OBJECTIVES: Thought-action fusion (TAF), or maladaptive cognitions regarding the relationship between mental events and behaviours, has been implicated in the development and maintenance of obsessive-compulsive disorder (OCD). As some religions promote TAF-like appraisals, it has been proposed that religiosity may play a role in the transformation of normally occurring intrusive thoughts into clinically distressing obsessions. No research, however, has experimentally investigated the mediating role of TAF on the relationship between religiosity and OC symptoms. METHODS: 85 Christian, Jewish, and Atheist/Agnostic participants were exposed to an experimental thought-induction protocol and reported on their associated levels of distress, guilt, feelings of responsibility, and urge to suppress target intrusions experienced during a 5-min monitoring period. Participants also completed measures of obsessive-compulsive symptomatology, TAF beliefs, and general psychopathology. RESULTS: Using PROCESS and bootstrapping analyses, a test of the conditional indirect effects of religiosity on obsessive-compulsive symptoms revealed that Christianity moderated the effects of religiosity on moral TAF beliefs, which in turn mediated the relationship between religiosity and obsessive-compulsive symptoms. Furthermore, in the Christian group, moral TAF beliefs mediated the relationship between religiosity and ratings of guilt and responsibility following the experimental protocol. LIMITATIONS: The use of university students with moderate levels of religiosity. CONCLUSIONS: Collectively the results suggest that obsessional thinking is not attributable to religion per se, but that teachings underlying certain religious doctrines may fuel TAF beliefs that are implicated in the maintenance of OCD.
Assuntos
Cognição , Transtorno Obsessivo-Compulsivo/psicologia , Espiritualidade , Pensamento , Adulto , Feminino , Culpa , Humanos , Inibição Psicológica , Masculino , Modelos Psicológicos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/etiologia , Escalas de Graduação Psiquiátrica , Responsabilidade Social , Estresse Psicológico/psicologiaRESUMO
Obsessive Compulsive Disorder (OCD) involves failures in two main inhibitory processes, namely cognitive (obsessions) and behavioral (compulsions). Recent research has supported two cortical-subcortical pathways on OCD pathogenesis: (a) the frontostriatal loop (dorsolateral-caudate-striatum-thalamus) responsible for impairments of behavioral inhibition; (b) the orbitofrontal loop (orbitofrontal, medial prefrontal and cingulate) responsible for impairments with cognitive inhibitory processes. These failures in both cognitive and motor inhibitory systems may mediate several neuropsychological deficits in these patients, namely memory, attention, planning and decision making. But are those deficits related to specific hemispheric effects, namely functional imbalance between hemispheres? In this article we hypothesize that: (1) OCD patients have an inter-hemispheric functional imbalance, probably due to inadequate filtering at the thalamic level; (2) the restoration of inter-hemispheric balance, will be correlative to symptomatic improvement.
Assuntos
Lateralidade Funcional/fisiologia , Modelos Neurológicos , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Tálamo/patologia , Transtornos Cognitivos/fisiopatologia , Vias Eferentes/fisiopatologia , HumanosRESUMO
OBJECTIVE: Deep brain stimulation has been used in the treatment of refractory obsessive-compulsive disorder (OCD). Our principal objective was to determine the safety and effectiveness of deep brain stimulation of the inferior thalamic peduncle in the treatment of refractory OCD. METHODS: An open protocol was performed from March 2003 to April 2007 in 5 patients with OCD refractory to conventional treatments. Bilateral stereotactic implantation of tetrapolar electrodes was aimed at the inferior thalamic peduncle and corroborated by electrophysiological responses and magnetic resonance imaging. All patients were off stimulation for 1 month after implantation. In the on-stimulation period, parameters were set at 5 V, 450 microseconds, 130 Hz in bipolar and continuous mode. Clinical changes were evaluated every 3 months for 12 months by means of the Yale-Brown Obsessive Compulsive Scale and the Global Assessment of Functioning scale. Statistical significance was assessed by the Friedman and Wilcoxon tests. RESULTS: The mean Yale-Brown Obsessive Compulsive Scale score decreased from 35 to 17.8 (P < 0.001), and the mean Global Assessment of Functioning scale score improved from 20% to 70% (P < 0.0001). The neuropsychological battery did not show significant changes, and there were no side effects related to electrical stimulation in the chronic period. CONCLUSION: We conclude that inferior thalamic peduncle stimulation is a safe procedure and may be an effective alternative in the treatment of those OCD cases refractory to conventional treatments.
Assuntos
Estimulação Encefálica Profunda/métodos , Transtorno Obsessivo-Compulsivo/terapia , Tálamo/anatomia & histologia , Tálamo/fisiopatologia , Adulto , Idoso , Estimulação Encefálica Profunda/instrumentação , Avaliação da Deficiência , Eletrodos Implantados , Feminino , Humanos , Núcleos Intralaminares do Tálamo/anatomia & histologia , Núcleos Intralaminares do Tálamo/fisiopatologia , Sistema Límbico/anatomia & histologia , Sistema Límbico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Núcleos da Linha Média do Tálamo/anatomia & histologia , Núcleos da Linha Média do Tálamo/fisiopatologia , Vias Neurais/anatomia & histologia , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Córtex Pré-Frontal/anatomia & histologia , Córtex Pré-Frontal/fisiopatologia , Técnicas Estereotáxicas , Resultado do Tratamento , Adulto JovemRESUMO
Wilson's disease (WD) is a genetic neurodegenerative disorder; it exhibits wide heterogeneity in symptoms and usually presents with liver disease and/ or neuropsychiatric manifestations. The common neurological manifestations observed are dysarthria, gait disturbance, dystonia, rigidity, tremor, dysphagia and chorea. The frequent psychiatric manifestations reported are personality and mood changes, depression, phobias, cognitive impairment, psychosis, anxiety, compulsive and impulsive behavior. Isolated obsessive-compulsive disorder (OCD) is a rare presentation of WD. Reported herein is a case of a 17-year-old boy with isolated OCD. He presented to the psychiatrist with symptoms of contamination obsessions and washing compulsions, along with compulsion of repeated feet tapping and was treated with adequate doses of fluoxetine for 6 months but did not improve. Later on, he was diagnosed as a case of WD and showed improvement with chelating and behavior therapy. This implies the importance of the occurrence of isolated psychological symptoms in WD.
Assuntos
Degeneração Hepatolenticular/complicações , Degeneração Hepatolenticular/diagnóstico , Transtorno Obsessivo-Compulsivo/etiologia , Adolescente , Terapia por Quelação , Degeneração Hepatolenticular/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Bilateral subthalamic stimulation is a very effective neurosurgical treatment for advanced Parkinson's disease. Despite the range and frequency of psychiatric symptoms occurring in the postoperative state, most of these symptoms are transient and manageable. In clinical practice, preoperative psychiatric vulnerability, as with that of preoperative cognitive status, takes on an important role. Psychiatric assessment and active preoperative and postoperative intervention can potentially modify psychiatric outcomes. These psychiatric and psychological issues will take on greater importance, particularly with the rapid expansion of the number of neurosurgical sites and the need for adequate assessment and optimal management of patients. The paucity of the literature underscores the need for well-designed studies on psychiatric issues investigating both pathophysiology and clinical outcomes.
Assuntos
Sintomas Comportamentais/etiologia , Terapia por Estimulação Elétrica/efeitos adversos , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiopatologia , Núcleo Subtalâmico/efeitos da radiação , Ansiedade/etiologia , Sintomas Comportamentais/classificação , Transtorno Bipolar/etiologia , Transtornos Cognitivos/etiologia , Depressão/etiologia , Emoções/fisiologia , Alucinações/etiologia , Humanos , Transtorno Obsessivo-Compulsivo/etiologia , Núcleo Subtalâmico/patologiaRESUMO
Case 1. This is believed to be the first report of acupuncture treatment for traumatic radial nerve paralysis in a wild fox. From the first treatment, improvement in the range of mobility and sensation of the limb was evident. Additionally, the attitude of this wild animal changed from fear and aggression to complete cooperation: he lay peacefully during every treatment in a calm, drowsy state. Case 2. This reports the calming effects of acupuncture on a fox which had been showing aggressive behaviour and obsessive circling following toxoplasma infection.
Assuntos
Terapia por Acupuntura/métodos , Terapia por Acupuntura/veterinária , Comportamento Animal , Raposas , Paralisia/veterinária , Neuropatia Radial/veterinária , Animais , Animais Selvagens , Feminino , Masculino , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia , Paralisia/terapia , Neuropatia Radial/terapia , Toxoplasmose Animal/complicaçõesRESUMO
The authors report on a patient with Parkinson disease (PD) and severe obsessive-compulsive disorder (OCD), in whom bilateral stimulation of the subthalamic nucleus (STN) was used to treat both PD and OCD symptoms. This 49-year-old man had displayed symptoms of PD for 13 years. Progressively, his motor disability became severe despite optimal medical treatment. In parallel, he suffered severe OCD for 16 years, with obsessions of accumulation and compulsions of gathering and rubbing that lasted more than 8 hours per day. Bilateral high-frequency STN stimulation was performed to treat motor disability. After surgery (at 1-year follow up), motor and OCD symptoms were dramatically improved. The pre- and postoperative Yale-Brown Obsessive-Compulsive Scale scores were 32 and 1, respectively. No additional antiparkinsonian drugs were administered. This case and other recent reports indicate that OCD symptoms can be improved by deep brain stimulation, a finding that opens new perspectives in the surgical treatment of severe and medically intractable OCD.
Assuntos
Terapia por Estimulação Elétrica , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Núcleo Subtalâmico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/terapia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The family physician's holistic approach to patients forms the basis of good health care for adults with Down syndrome. Patients with Down syndrome are likely to have a variety of illnesses, including thyroid disease, diabetes, depression, obsessive-compulsive disorder, hearing loss, atlantoaxial subluxation and Alzheimer's disease. In addition to routine health screening, patients with Down syndrome should be screened for sleep apnea, hypothyroidism, signs and symptoms of spinal cord compression and dementia. Patients with Down syndrome may have an unusual presentation of an ordinary illness or condition, and behavior changes or a loss of function may be the only indication of medical illnesses. Plans for long-term living arrangements, estate planning and custody arrangements should be discussed with the parents or guardians. Because of improvements in health care and better education, and because more people with this condition are being raised at home, most adults with Down syndrome can expect to function well enough to live in a group home and hold a meaningful job.
Assuntos
Síndrome de Down/complicações , Síndrome de Down/terapia , Planejamento de Assistência ao Paciente/organização & administração , Adulto , Doença de Alzheimer/etiologia , Doença de Alzheimer/terapia , Surdez/etiologia , Surdez/terapia , Diabetes Mellitus/etiologia , Diabetes Mellitus/terapia , Emprego , Lares para Grupos , Nível de Saúde , Humanos , Programas de Rastreamento , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia , Guias de Prática Clínica como Assunto , Doenças da Glândula Tireoide/etiologia , Doenças da Glândula Tireoide/terapiaRESUMO
The phenomenology of OCD and TS seem to match perfectly with the existing conceptualization of the functional relationship between frontal cortical and subcortical circuits. Failed editing of thoughts and impulses, perseverative patterns, and inhibitory deficits are the most convenient descriptors of the symptoms, and some operationalized measures can capture evidence for such deficits in TS and OCD patients. Beyond these expectations borne from conceptual models and some broad patterns of distributed metabolic disturbances in neuroimaging studies, a specific causal pathology within CSPT circuitry needs to be identified in these disorders. This is not a criticism of the existing studies of TS and OCD; to the contrary, the scarcity of pathologic material, the limits of resolution of existing technologies, and the heterogeneity of the phenotypes make the accomplishments of these studies more impressive. As clinicians strive to integrate clinical and scientific findings into coherent models for the pathophysiology of OCD and TS, it is useful to identify practical and effective strategies for therapeutic interventions.
Assuntos
Corpo Estriado/fisiopatologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Transtorno Obsessivo-Compulsivo/terapia , Tálamo/fisiopatologia , Transtornos de Tique/fisiopatologia , Transtornos de Tique/terapia , Terapia Comportamental , Psiquiatria Biológica , Terapia Combinada , Antagonistas de Dopamina/uso terapêutico , Humanos , Neurobiologia , Neuroquímica , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/etiologia , Prevalência , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Transtornos de Tique/diagnóstico , Transtornos de Tique/etiologiaRESUMO
OBJECTIVE: The authors assessed selective basal ganglia involvement in a subgroup of children with obsessive-compulsive disorder (OCD) and/or tics believed to be associated with streptococcal infection. METHOD: Using computer-assisted morphometric techniques, they analyzed the cerebral magnetic resonance images of 34 children with presumed streptococcus-associated OCD and/or tics and 82 healthy comparison children who were matched for age and sex. RESULTS: The average sizes of the caudate, putamen, and globus pallidus, but not of the thalamus or total cerebrum, were significantly greater in the group of children with streptococcus-associated OCD and/or tics than in the healthy children. The differences were similar to those found previously for subjects with Sydenham's chorea compared with normal subjects. CONCLUSIONS: These results support the hypothesis that there is a distinct subgroup of subjects with OCD and/or tics who have enlarged basal ganglia. These findings are consistent with the hypothesis of an autoimmune response to streptococcal infection.
Assuntos
Gânglios da Base/anatomia & histologia , Imageamento por Ressonância Magnética , Transtorno Obsessivo-Compulsivo/diagnóstico , Infecções Estreptocócicas/complicações , Tiques/diagnóstico , Doenças Autoimunes/etiologia , Autoimunidade , Gânglios da Base/imunologia , Encéfalo/anatomia & histologia , Núcleo Caudado/anatomia & histologia , Criança , Coreia/diagnóstico , Coreia/etiologia , Coreia/imunologia , Feminino , Globo Pálido/anatomia & histologia , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/imunologia , Putamen/anatomia & histologia , Infecções Estreptocócicas/imunologia , Tálamo/anatomia & histologia , Tiques/etiologia , Tiques/imunologiaRESUMO
Research has shown that obsessive compulsive disorder (OCD) is related to structural and functional abnormalities in the brain, and several authors have organized these findings into theories of OCD neuropsychiatric dysfunction. In this paper, these theories were used to develop a neural network model of OCD. OCD symptoms were hypothesized to result from a hyperactive orbitofrontal-striato-thalamic-orbitofrontal neural loop. The network was constructed and trained with a backpropagation algorithm, and it was then used to assess etiologic theories of OCD (e.g., basal ganglia dysfunction, inadequate dopaminergic inhibitory influence on basal ganglia and excessive input from the limbic system). The network was also observed in analogues of the treatment of OCD with serotonergic medications and behavior therapy. Results show that a) the network behaved both normally and abnormally, depending on what combinations of perceptual, motivational, and neurochemical inputs were presented to it; b) several etiologic mechanisms produced changes in the networks' behaviors similar to patients' subjective experiences of OCD symptoms; and c) different treatment strategies, both those modeled as pharmacologic and behavioral therapies, produced reductions in simulated OCD symptoms.
Assuntos
Encefalopatias/complicações , Encefalopatias/terapia , Modelos Neurológicos , Rede Nervosa , Redes Neurais de Computação , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia , Algoritmos , Análise de Variância , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/fisiopatologia , Terapia Comportamental , Encefalopatias/fisiopatologia , Córtex Cerebral/fisiopatologia , Distribuição de Qui-Quadrado , Simulação por Computador , Quimioterapia Combinada , Humanos , Sistema Límbico/efeitos dos fármacos , Sistema Límbico/fisiopatologia , Inibição Neural/efeitos dos fármacos , Núcleos da Rafe/fisiopatologia , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tálamo/fisiopatologiaRESUMO
The distribution of obsessive compulsive symptoms was compared in 16 individuals with primary obsessive compulsive disorder (OCD) and 16 individuals with Gilles de la Tourette syndrome (GTS) and associated obsessive compulsive behaviors (OCB). The two groups showed significant differences in the distribution of OC symptomatology. Furthermore, those OCD probands who shared a similar symptom profile with GTS individuals all had a positive family history of OCD. All of the other OCD probands were isolated cases. Implications of this finding on the etiology and pathogenesis of the two disorders are discussed.
Assuntos
Comportamento Compulsivo , Comportamento Obsessivo , Transtorno Obsessivo-Compulsivo/psicologia , Síndrome de Tourette/psicologia , Adolescente , Adulto , Gânglios da Base/fisiopatologia , Criança , Dopamina/fisiologia , Feminino , Lobo Frontal/fisiopatologia , Giro do Cíngulo/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/genética , Transtorno Obsessivo-Compulsivo/fisiopatologia , Testes Psicológicos , Serotonina/fisiologia , Tálamo/fisiopatologia , Síndrome de Tourette/etiologia , Síndrome de Tourette/genética , Síndrome de Tourette/fisiopatologiaAssuntos
Transtornos Cognitivos/etiologia , Transtorno Obsessivo-Compulsivo/etiologia , Doença de Parkinson/complicações , Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Córtex Cerebral/patologia , Circulação Cerebrovascular , Transtornos Cognitivos/diagnóstico , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtorno Obsessivo-Compulsivo/diagnóstico , Doença de Parkinson/diagnóstico , Tálamo/irrigação sanguínea , Tálamo/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
This article is intended to elucidate some of the neuropathogenetic mechanisms possibly operative in obsessive-compulsive disorder (OCD). Relevant literature is reviewed, with attention to psychologic, and pathologic considerations. Anatomy, neurochemistry, and known functional associations with neuropathological and behavioral abnormalities of implicated brain regions are discussed. The authors propose that dysfunction of neuronal circuits interconnecting the orbitofrontal cortex, basal ganglia/limbic striatum, and thalamus serves a critical role in the pathogenesis of OCD and that obsessive-compulsive symptoms occur when an aberrant positive feedback loop develops in the reciprocally excitatory frontothalamic neuronal interchange, which is inadequately integrated or inhibited by the ventromedial (limbic) portions of the striatum; the ventromedial striatum may serve to modulate activity in the frontothalamic circuit through a negative feedback loop.