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Time management is a hot topic these days. Whether related to the workplace, school, homemaking, child-rearing, or our personal lives, there just never seems to be enough time to do all the things we need, or want, to do. If you have obsessive-compulsive disorder (OCD), there’s a good chance you’ll have even more challenges to deal with.
We are so overloaded that there are self-help books, as well as experts and entire companies dedicated to this subject. When did it all get so complicated?
To me, one of the most frustrating aspects of my son Dan’s severe OCD was how much time he appeared to spend doing absolutely nothing. He had schoolwork and other responsibilities to attend to, yet he’d just sit in a “safe” chair for hours and hours on end. I now know that he spent this time focusing on his obsessions and compulsions, which were in his mind and not obvious to me. As Dan’s OCD improved, the chair sitting stopped, but he still often took longer than others to complete his school assignments. This seemed to be attributed to his difficulty balancing details within the big picture as well as overthinking.
While Dan’s problem of appearing to waste time is common for those with OCD, the opposite end of the spectrum can also be an issue. Some OCD sufferers might feel the constant need to be busy and productive, as well as have every event and task of the day carefully reviewed and planned. For Dan, spur-of-the-moment plans were not even a possibility when his OCD was in control.
Something else OCD sufferers might deal with in regard to time management is lack of punctuality. This might be because they feel the need to finish whatever task they are working on before they can move on to something else (even if most people wouldn’t consider it important), or perhaps it is due to trouble with transitions. Of course, time spent attending to obsessions and compulsions can always account for any struggles with time management.
From what I’ve written, it is easy to conclude that those with OCD do not manage their time well, and might even be perceived as lazy. I believe the opposite is true. OCD sufferers work harder than ever just to get through the day, and they are also excellent time managers. Look at everything they have to manage!
For example, even though my son Dan sat in his “safe” chair for hours on end, somehow he was still able to meet all his responsibilities. Many of those with OCD not only fulfill their own obligations, they meet the “obligations” of their disorder as well. Talk about multi-tasking! Add to this the fact that many OCD sufferers are also perfectionists and it is not surprising that their burdens might eventually become too much to handle.
In my opinion, those with OCD don’t need lessons in time management. What they need is to fight their OCD, and the frontline treatment for the disorder is Exposure and Response Prevention Therapy. Obsessions and compulsions are time-consuming, as is constant worry. Getting back the time that OCD steals is nothing short of a gift and can open up a world of possibilities not only to OCD sufferers, but to the people who want to spend time with them.
Biological Reasons for OCD (Obsessive-Compulsive Disorder)
Obsessive-compulsive disorder is a mental health disorder characterized by obsessions, or unpleasant, intrusive and uncontrollable thoughts, and compulsions, which are repetitive behaviors that you feel driven to do in order to reduce the stress of the obsessions. There has been a considerable amount of research on the potential causes of this debilitating disorder, including investigations as to the biological reasons for OCD. The consensus seems to be that genetics and an insufficiency of serotonin, an important brain neurotransmitter, play an important role in the development of OCD. According to the Centre for Addiction and Mental Health, some researchers believe that frequent streptococcal infections in childhood are linked to the sudden development of OCD in children. The antibodies that fight the streptococcus infection are thought to attack the basal ganglia, the part of the brain associated with OCD. However, there is no current evidence to support the theory that streptococcal infections are related to adult-onset OCD. Children who develop OCD experience a gradual onset of the illness, not developing symptoms all at once, as is thought to occur by researchers who believe that streptococcal infections may be a cause. At this time, there is not enough evidence to support the theory.
The Role of Antioxidants in the Management of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that has a significant effect on the quality of life. The most effective treatment for OCD is the combination of selective serotonin reuptake inhibitors (SSRI) with cognitive behavior therapy (CBT). However, several adverse effects have been linked with this usual pharmacotherapy, and it is unsuccessful in many patients. The exact pathophysiology of OCD is not completely known, though the role of oxidative stress in its pathogenesis has been proposed recently. This review presents an overview of animal and human studies of antioxidant treatment for OCD. The use of antioxidants against oxidative stress is a novel treatment for several neurodegenerative and neuropsychiatric disorders. Among antioxidants, NAC was one of the most studied drugs on OCD, and it showed a significant improvement in OCD symptoms. Thus, antioxidants could be promising as an adjuvant treatment for OCD. However, a limited number of human studies are conducted on these agents, and for better judgment, human studies with a large sample size are necessary.
Estimates indicate that 1–3% of the population are affected by obsessive-compulsive disorder (OCD) as a chronic neuropsychiatric disease, which severely harms the quality of life . Hoarding, skin picking (excoriation), and hair-pulling disorder (trichotillomania) formerly known as OCD nevertheless, in the Diagnostic and Statistical Manual of Mental Disorders-version 5 (DSM-5), they are in the obsessive-compulsive-related disorders (OCRD) section (Figures 1) . The risk factors of OCD are environmental factors, impaired neurotransmissions, autoimmune processes, genetic factors, infections, and stressors or trauma-driven incidents [3–8]. The most well-known pathophysiology of OCD is anomalies of the central nervous system (CNS), particularly in the serotonin, dopamine, and glutamate pathways [9, 10]. According to clinical guidelines , the first line of OCD treatment is cognitive behavior therapy and exposure and response prevention (CBT/ERP) or one selective serotonin reuptake inhibitor (SSRI) or a combination of one SSRI with CBT/ERP. So far, the superiority of either of these three types of treatment has not been proven. OCD symptoms are manageable using a variety of approaches, such as switching to a different SSRI or clomipramine, increasing SSRI dose, or augmenting with an atypical neuroleptic drug, such as risperidone and aripiprazole . Anxiety, insomnia, nausea, diarrhea, constipation, dizziness, sedation, and sexual dysfunction are complications of SSRIs at higher dosages . Although the existing therapeutic methods are highly efficient, the treatment cannot be initiated or completed in many OCD patients furthermore, a number of patients are resistant to these therapeutic managements [13, 14].
So far, the exact pathophysiology and etiology of OCD remain unknown however, besides neurotransmitter imbalance, oxidative stress could somewhat imply the pathophysiology of OCD. Oxidative stress is caused by the lack of balance between the generation of oxidative free radicals and neutralizing antioxidants . Free radicals are defined as reactive nitrogen species (RNS) or reactive oxygen species (ROS), with a shortened half-life. Some mechanisms, such as ischemia, lipid peroxidation, and trauma, can produce free radicals . Oxidative stress can severely damage the brain due to these reasons: (1) moderate antioxidant defenses, (2) redox-catalytic metals, (3) high percentage of phospholipids, and (4) high oxygen utilization . Oxidative stress in the brain can cause harmful damages, including neuroinflammation, mitochondrial dysfunction, inhibition of neurogenesis, impaired neurotransmission, acceleration of aging and apoptosis, impaired neuroplasticity, and dysfunctional neuronal integrity (Figure 2) . In particular, basal ganglia have vulnerability to injury by free radicals because of high concentrations of catecholamines in this area. Abnormal neurotransmission at the dopaminergic nerve cell endings may arise due to injuries to cells throughout the catecholamine metabolic process through free radicals [19, 20]. A higher association of the existence of free radicals in comorbidity of OCD and major depressive disorder (MDD) was reported in a study. Even so, there is an apparent relationship between pure OCD and the antioxidant enzyme deficits . Recent studies have shown more activity of free radical metabolism and the weakness of antioxidant defense system in OCD. By increasing free radicals, cell membranes become less permeable through disrupted structures of phospholipids as the pivotal constituent of cell membranes. Significant elevations occur in malondialdehyde (MDA) concentrations due to lipid peroxidation in OCD patients. In addition, a significant decrease is observed in the level of nonenzymatic antioxidant vitamin E, which is associated with an increase in MDA levels. Serotonin levels decreased in the brain, in the coupling sites, by a direct effect of MDA (Figure 3) [22, 23]. The antioxidant system does not adequately buffer systemic oxidative imbalance in OCD patients. Stress markers significantly increased in OCD patients, and this could increase cellular injury by oxidizing DNA and lipids. A systematic review revealed elevated levels of 8-hydroxideoxiguanosine (8-OHdG), MDA, glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) but diminished concentrations of total antioxidant status (TAS), vitamin C, and vitamin E (Vit. E) in OCD patients. DNA damage and an increase in lipid peroxidation are the main types of oxidative-stimulated cellular injury between patients with OCD . In a case-control study, patients with new OCD diagnosis were observed following a 12-week treatment with fluoxetine. At the same time, significant decreases and increases were reported in the oxidative stress indicator in serum, Thiobarbituric Acid Reacting Substances (TBARS), and the antioxidant parameter plasma (ascorbate), respectively. They also found that elevated lipid peroxidation was accompanied by an antioxidant balance impairment in OCD patients . Since there is evidence of the potential function of oxidative stress in neurodegenerative diseases, e.g., OCD, antioxidant therapy should be examined in OCD patients. Antioxidants suppress the chain reaction of oxidative stress and prevent damage to cell constituents . Antioxidants have to be provided only via dietary supplementation, as biologic systems are not able to manufacture them by nature. Here, we reviewed literature data on the treatment of OCD with the antioxidants.
The electronic database PubMed, Embase, and Scopus were searched using the following keywords from commencement to August 2020 for animal studies and clinical trials relevant to antioxidants and management of OCD. The searched keywords were obsessive-compulsive disorder, obsessive-compulsive related disorder, OCD, OCRD, trichotillomania, hoarding, excoriation, nail-biting, oxidative stress, antioxidants, lipid peroxidation, DNA damage, marble-burying behavior, N-acetyl cysteine, Crocus sativus, Benincasa hispida, Cannabis sativa, Hypericum perforatum, Citrus aurantium, Colocasia esculenta, Curcuma longa, Tabernaemontana divaricata, Lagenaria siceraria, Withania somnifera, Minocycline, L-carnosine, Echium amoenum, Silybum marianum, and Valeriana officinalis. Inclusion criteria were clinical trial or animal study on the use of antioxidants in OCD, and full texts accessible on-line in English, with no limits of publishing date. Exclusion criteria were duplicated published materials and review articles. Data were collected between April 2020 and August 2020 (Figure 4).
Finally, results comprised 11 and 15 investigations on animal and human studies, respectively, and four systematic reviews. Tables 1 and 2 summarize these studies. Among 11 animal studies, nine studies utilized the marble-burying model to evaluate obsessive and compulsive behaviors. This model has a good reputation for animals for the assessment of compulsive-like behaviors, which requires no behavioral trainings or pharmacologic manipulations . mCPP (the nonselective serotonin receptor agonist, m-chlorophenylpiperazine) was used in a trial to induce excessive self-grooming in an animal model . Excessive grooming behaviors in animals are considered to have similarity to the symptoms of OCD and trichotillomania . Grooming behaviors include vibration, face and head washing, body grooming, scratching, paw licking, head shaking, and genital grooming . In another research, compulsive behavior is stimulated by quinpirole. Duration and frequency of stops, occurrence of ritualistic behaviors, and number of visits to other objects were behavioral measures in this study . This model is produced by chronic therapy of rats with quinpirole (a dopamine (D2/D3) agonist) two times a week for 5 weeks . All of the clinical trials reviewed in this study used the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for assessing the OCD severity. This scale has 10 items for examining OCD, including the time expended on obsession/compulsions, interference and distress from obsession/compulsions, resistance, and control over the obsessions and compulsions .
) chronic treatment: ineffective (