SWU SPED

'Eugenic Abortion’: With Pre-Natal Testing, 9 in 10 Down Syndrome Babies Aborted
Monday, October 13, 2008

One survey of 499 primary care physicians treating women carrying these babies, however, indicated that only 4 percent actively encourage women to bring Down syndrome babies to term.

Down syndrome, which occurs in individuals who have three rather than two copies of the 21^st chromosome, causes distinct physical characteristics such as low muscle tone and upward slanting eyes. It also causes mental retardation, which can range from mild to severe.

With the advent and increasing use of pre-natal testing, according to studies in the United States and United Kingdom, a diagnosis of Down syndrome has led to as many as nine out of 10 women choosing to abort the child.

A 2000 anonymous survey of 499 primary care physicians in the United States, published by Georgetown University, indicated that only 4 percent of physicians who attend women whose babies are pre-natally diagnosed encourage them to continue the pregnancy and allow the baby with Down syndrome to be born.

Thirteen percent of doctors attending pregnant mothers whose babies are discovered to have Down syndrome, this survey said, “emphasize” the negative aspects of Down syndrome and 10 percent said they “urge” the mothers to terminate the life of the baby.

Sixty three percent reported they “tired to be as unbiased as possible when delivering a pre-natal diagnosis” and 10 percent indicated they “emphasize” the positive aspects of Down Syndrome.

A 1998 study by the Department of Newborn Medicine at Brigham and Women’s Hospital at Harvard Medical School, published in Genetics of Medicine, concluded that in 1972, 1 in 1,000 babies were born with the extra chromosome that causes Down syndrome.

“There was no pre-natal detection between 1972 and 1974,” said the report, which then measured how many women aborted their Down syndrome babies between 1972 and 1994.

“Between 1972 and 1994 the percentage of infants with Down syndrome who were liveborn decreased dramatically,” the report said. “In the early 1980s, this decrease reflected the impact of amniocentesis among women 35 and older.

“By the late 1980s, pre-natal detection was common among women younger than 35 years and detection was by several modalities including AFP screening, sonography and amniocentesis. When the (Down syndrome) diagnosis was established before 24 weeks of gestation, 86% to 87% of the parents chose elective termination of the pregnancy,” it said.

Another 1998 study by Wayne State University published in the American Journal of Genetics concluded that almost 90 percent of Down syndrome babies were aborted between 1987 and 1997.

“In conclusion,” the report said, “our data confirm that most patients referred to a tertiary care center are likely to choose termination of pregnancy after the diagnosis of Down syndrome, even in the absence of severe ultrasound abnormalities.”

The 2004 annual report of the Down Syndrome Cytogenetic Register at the Wolfson Institute of Preventive Medicine in London found an even higher number of abortions were done after a pre-natal Down syndrome diagnosis in Great Britain. In 2003, 91 percent of cases with known outcomes resulted in abortion. The same percentage was recorded in 2004.

ACOG Wants More Testing

Studies show pre-natal testing for Down syndrome has become increasingly common over the last three decades, however, the American College of Obstetricians and Gynecologists (ACOG) in January 2007 called for even more testing.

“All pregnant women, regardless of age, should be offered screening for Down syndrome,” according to the new Practice Bulletin issued (Jan. 2, 2007) by the ACOG.

“ACOG also advises that all pregnant women, regardless of their age, should have the option of diagnostic testing,” the Bulletin states. “ACOG recognizes that a woman’s decision to have an amniocentesis or CVS is based on many factors, such as a family or personal history of birth defects, and the risk of pregnancy loss from an invasive procedure.”

But Dr. Will Johnston, president of Canadian Physicians for Life, reacted to ACOG’s pre-natal testing endorsement as another step toward eugenics.

“The progress of eugenic abortion into the heart of our society is a classic example of “mission creep,’ ” Johnson said in an article posted on the group’s Web site in February 2007. “In the 1960s, we were told that legal abortion would be a rare tragic act in cases of exceptional hardship. In the ‘70s abortion began to be both decried and accepted as birth control. In the ‘80s respected geneticists pointed out that it was cheaper to hunt for and abort Down’s babies than to raise them. By the ‘90s that observation had been widely put into action. Now we are refining and extending our eugenic vision, with new tests and abortion as our central tools.”


Today, women of all ages who seek pre-natal care with an obstetrician are offered screenings that can estimate the mother’s risk of carrying a Down syndrome baby.

These screenings include a blood test to find certain “markers” associated with the genetic condition and sonograms, which doctors can use to measure the fluid in the neck of the baby, or nuchal translucency, which also can indicate that the developing baby has Down syndrome.

If the results of these screenings indicate there is a higher risk that an unborn child might have Down syndrome, doctors offer the mother additional diagnostic tests, including amniocentesis, which requires inserting a needle into the womb to draw amniotic fluid so the chromosomes of fetal cells can be examined.

Another test, Chorionic villus sampling, or CVS, collects fetal cells from the placenta via the cervix. Both tests are almost 100 percent accurate in detecting Down syndrome in an unborn child.

Because they are invasive, however, both tests can cause a miscarriage. According to ACOG and the federal Centers for Disease Control and Prevention, for example, between one in 400 and one in 200 women have a miscarraige after amniocentesis. Other complications that can arise from amniocentesis include injury to the developing baby and infection.

The risk of miscarriage after first-trimester amniocentesis may be three times higher than the risk after second-trimester amniocentesis, according to the results of the Canadian Early and Mid-Trimester Amniocentesis Trial Group, which were published in The Lancet in 1998.

Results of a 2004 study published in Obstetrics and Gynecology suggested that early amniocentesis may also increase the risk of the deformity called clubfoot.

According to the Royal College of Obstetricians and Gynecologists (RCOG) in London, the additional overall risk of miscarriage from amniocentesis is approximately one percent. In other words, about one in every 100 women who have amniocentesis under ultrasound guidance after 15 weeks will miscarry.

RCOG also claims that the additional overall risk of miscarriage from CVS is approximately two percent. In other words, about two in every 100 women who have CVS under ultrasound guidance after 10 weeks will miscarry.

Dr. Lewis B. Holmes, a geneticist at Massachusetts General Hospital who participated in the 1998 study on pre-natal testing at Brigham and Women’s Hospital, said that some patients refuse pre-natal screening.

“The (patients) who have strong religious or cultural leaning … don’t take the test,” Holmes told CNSNews.com. “So they make their choice very easily.”

But many, Holmes said, use the pre-natal diagnosis of Down syndrome as a reason to end the pregnancy.

“Even though you encourage, ‘take your time, take your time,’ they usually display a real sense of urgency,” Holmes said.
Post-Test Resources

Some parents of children with Down syndrome told CNSNews.com that when they got their diagnostic test results, they did not get the information they needed about the condition and the resources that are available to them and their children.

Lucy Talbot, the mother of a Down syndrome child, is president of Families Exploring Down Syndrome, a support group of some 200 families in Michigan that have children with the genetic condition.

Talbot said her group’s Changing Lives program, developed by the National Down Syndrome Society, is designed to teach medical professionals how to give a compassionate diagnosis and provide the resources and support that parents need.

“(The doctor) says, ‘Your baby has these characteristics, we think your baby has Down syndrome,’” Talbot said. “They say, ‘We’re going to do some blood work,’ and they walk out of the room.”

“You’ve just changed a person’s life forever,” she said.

Dr. Holmes said he offers detailed information about Down syndrome to parents, as well as giving them the option of speaking with parents who have children with the genetic condition.

But Brian Skotko, a resident physician at Children’s Boston Hospital, said Holmes is the exception, not the rule. Skotko cited the results of a questionnaire sent out to 1,105 ACOG fellows and junior fellows in 2004.

Among the 60 percent that were returned, 80 percent said they felt qualified to counsel patients about genetic issues and pregnancy, but 45 percent rated their residency training regarding prenatal diagnosis as “barely adequate” or “non-existent.”

Skotko, who has a sister with Down syndrome and serves on several boards of Down syndrome advocacy groups, said pre-natal testing has put the fate of unborn children in their parents’ hands.

“Current testing affords couples to learn, if they so desire, pre-natally whether or not their fetus has Down syndrome,” Skotko said.

“I encourage all parents to think about and answer two essential questions, which I think can be their guideposts through all pre-natal testing that’s available during pregnancy. One, they need to answer for themselves when does life begin and then answer the question, what forms of human life are valuable?” he added.

“The first question will determine for them when life starts,” he said, “so what testing done at certain times may determine for them whether or not termination is allowable in their own moral compass.”

“And then once life begins, they then need to answer the other question, what forms of human life are valuable?” said Skotko. “Some people say, once life begins, all forms of human life are valuable--others say, once life begins, only certain characteristics are valuable.”

New tests Could Increase Abortions

Now, a new pre-natal blood test that could check a baby’s DNA has been developed by researcher Dr. Stephen Quake and his team at Stanford University. Quake said a broader test is needed.

Carol Boys, chief executive of the Down’s (sic) Syndrome Association in Great Britain, told the BBC that the less invasive blood test will make pre-natal testing safer and more common.

“There is no question that these non-invasive tests will be introduced in the next few years,” Boys said. “It’s therefore incredibly important that potential parents are given accurate information on Down’s (sic) syndrome before they make a choice about whether to terminate or not.”

But Alison Davis of the No Less Human group that is a part of the British Society for the Protection of Unborn Children said in an article on lifenews.com that the new test wasn’t a positive development.

“"The new non-invasive test for Down's syndrome will inevitably mean more pre-natal testing, leading to more abortions of babies with the condition. Describing this as a 'breakthrough' is offensive to people who live with Down's syndrome, and to all who recognize the equal right to life of disabled people,” she said.

Posted byDoc Junhel at 5:21 PM 0 comments  

SEMINAR: Faces of Autism
Monday, August 25, 2008

You are cordially invited to the SWU's seminar on Faces of Autism: Early Intervention & Developmental Evaluation. Please see attached image for details.

Posted byDoc Junhel at 5:34 PM 611 comments  

How to Download from Youtube?
Sunday, August 17, 2008

Lecture presentations or report works are best presented with animation or video clips to liven up the discussion. As such, the need for video files is imminent. How do we do it?



There are different ways. You can check these sites for details:

• TechCrunch
• DownloadFromYouTube
• KeepVid

Or you could download these softwares:

• YouTube Downloader
• Orbit Downloader
  

Posted byDoc Junhel at 5:57 PM 0 comments  

SWU DSPED 08 List of Requirements

I. SPED 101 - Introduction

• (2) Reports
• (1) Portfolio containing:

1. Class Reflections
2. Others

II. SPED 102 - Arts & Crafts

• (1) Portfolio containing:

1. (10) Paper Art
2. (10) Crayon Art
3. (10) Water Color Art
4. (10) Craft Art

• Art Demo

III. SPED 103 - Current Trends

• (1) Report
• (1) Portfolio containing:

1. Given Hand-outs
2. DSWD Visit
3. Adam Jennie's SPED Center Visit
4. Ideal School Organization
5. Written Report
6. (2) Movie Reaction Paper

IV. SPED 104 - Methods & Materials

• Lesson Plan Criticizing
• Nursery Rhymes
• Visual Aides
• Teaching Demo

V. SPED 105 - Dynamics

• Movie Reaction Paper
• Report

VI. SPED 106 - Remediation

• Report
• Demo

VII. SPED 107 - Hearing & Visually Impaired

• ASL Book or Photocopy
• (3) ASL Songs - Slow, Average, Fast
• (1) ASL Poem - 3, 4, 6 Stanzas (Filipino / English)
• (1) Describe a thing or tell a story

VIII. SPED 108 - Assessment

• (1) Case Study
• (1) Movie Reaction Paper
• (1) Report
• (1) Psycho-Educational Assessment
• (1) IEP

NOTE: This information is correct as of Monday, August 18, 2008 pending further changes. Please keep up-to-date with the requirements and frequently update with this website.

Posted byDoc Junhel at 4:26 PM 0 comments  

Hearing Impairment
Thursday, August 7, 2008

A hearing impairment or hearing loss is a full or partial decrease in the ability to detect or understand sounds. Caused by a wide range of biological and environmental factors, loss of hearing can happen to any organism that perceives sound.

Sound waves vary in amplitude and in frequency. Amplitude is the sound wave's peak pressure variation. Frequency is the number of cycles per second of a sinusoidal component of a sound wave. Loss of the ability to detect some frequencies, or to detect low-amplitude sounds that an organism naturally detects, is a hearing impairment.

Loudness, frequency, and discrimination deficiencies

Hearing sensitivity is indicated by the quietest sound that an individual can detect, called the hearing threshold. In the case of people and some animals, this threshold can be accurately measured by a behavioral audiogram. A record is made of the quietest sound that consistently prompts a response from the listener. The test is carried out for sounds of different frequencies. There are also electro-physiological tests that can be performed without requiring a behavioral response.

Normal hearing thresholds are not the same for all frequencies in any species of animal. If different frequencies of sound are played at the same amplitude, some will be loud, and others quiet or even completely inaudible. Generally, if the gain or amplitude is increased, a sound is more likely to be perceived. Ordinarily, when animals use sound to communicate, hearing in that type of animal is most sensitive for the frequencies produced by calls, or, in the case of humans, speech. This tuning of hearing exists at many levels of the auditory system, all the way from the physical characteristics of the ear to the nerves and tracts that convey the nerve impulses of the auditory portion of the brain.

A hearing impairment exists when an individual is not sensitive to the sounds normally heard by its kind. In human beings, the term hearing impairment is usually reserved for people who have relative insensitivity to sound in the speech frequencies. The severity of a hearing impairment is categorized according to how much louder a sound must be made over the usual levels before the listener can detect it. In profound deafness, even the loudest sounds that can be produced by the instrument used to measure hearing (audiometer) may not be detected.

There is another aspect to hearing that involves the quality of a sound rather than amplitude. In people, that aspect is usually measured by tests of speech discrimination. Basically, these tests require that the sound is not only detected but understood. There are very rare types of hearing impairments which affect discrimination alone.

Types and causes of hearing impairment

Hearing impairment comes from different biologic causes. Most commonly, the ear is the affected part of the body.

Conductive

Conductive hearing loss occurs when sound is not normally conducted through the outer or middle ear or both. Since sound can be picked up by a normally sensitive inner ear even if the ear canal, ear drum, and ear ossicles are not working, conductive hearing loss is often only mild and is never worse than a moderate impairment. Hearing thresholds will not rise above 55-60 dB from outer or middle ear problems alone. Generally, with pure conductive hearing loss, the quality of hearing (speech discrimination) is good, as long as the sound is amplified loud enough to be easily heard.

A conductive loss can be caused by any of the following: Ear canal obstruction Middle ear abnormalities: Tympanic membrane Ossicles Inner ear abnormalities: Superior canal dehiscence syndrome

Sensorineural hearing loss

A sensorineural hearing loss is due to insensitivity of the inner ear, the cochlea, or to impairment of function in the auditory nervous system. It can be mild, moderate, severe, or profound, to the point of total deafness. This is classified as a disability under the ADA and if unable to work is eligible for disability payments.

The great majority of human sensorineural hearing loss is caused by abnormalities in the hair cells of the organ of Corti in the cochlea. There are also very unusual sensorineural hearing impairments that involve the VIIIth cranial nerve, the Vestibulocochlear nerve or the auditory portions of the brain. In the rarest of these sorts of hearing loss, only the auditory centers of the brain are affected. In this situation, central hearing loss, sounds may be heard at normal thresholds, but the quality of the sound perceived is so poor that speech can not be understood.

Most sensory hearing loss is due to poor hair cell function. The hair cells may be abnormal at birth, or damaged during the lifetime of an individual. There are both external causes of damage, like noise trauma and infection, and intrinsic abnormalities, like deafness genes.

Sensorineural hearing loss that results from abnormalities of the central auditory system in the brain is called Central Hearing Impairment. Since the auditory pathways cross back and forth on both sides of the brain, deafness from a central cause is unusual.

Typical causes are discussed in following subsections.

Long-term exposure to environmental noise

Populations of people living near airports or freeways are exposed to levels of noise typically in the 65 to 75 dB(A) range. If lifestyles include significant outdoor or open window conditions, these exposures over time can degrade hearing. The U.S. EPA and various states have set noise standards to protect people from these adverse health risks. The EPA has identified the level of 70 dB(A) for 24 hour exposure as the level necessary to protect the public from hearing loss and other disruptive effects from noise, such as sleep disturbance, stress-related problems, learning detriment, etc. (EPA, 1974).

Noise-Induced Hearing Loss (NIHL) typically is centered at 3000, 4000, or 6000 Hz. As noise damage progresses, damage starts affecting lower and higher frequencies. On an audiogram, the resulting configuration has a distinctive notch, sometimes referred to as a "noise notch." As aging and other effects contribute to higher frequency loss (6-8 kHz on an audiogram), this notch may be obscured and entirely disappear.

Louder sounds cause damage in a shorter period of time. Estimation of a "safe" duration of exposure is possible using an exchange rate of 3 dB. As 3 dB represents a doubling of intensity of sound, duration of exposure must be cut in half to maintain the same energy dose. For example, the "safe" daily exposure amount at 85 dB A, known as an exposure action value, is 8 hours, while the "safe" exposure at 91 dB(A) is only 2 hours (National Institute for Occupational Safety and Health, 1998). Note that for some people, sound may be damaging at even lower levels than 85 dB A. Exposures to other ototoxins (such as pesticides, some medications including chemotherapy, solvents, etc.) can lead to greater susceptibility to noise damage, as well as causing their own damage. This is called a synergistic interaction.

Some American health and safety agencies (such as OSHA and MSHA), use an exchange rate of 5 dB. While this exchange rate is simpler to use, it drastically underestimates the damage caused by very loud noise. For example, at 115 dB, a 3 dB exchange rate would limit exposure to about half a minute; the 5 dB exchange rate allows 15 minutes.

While OSHA, MSHA, and FRA provide guidelines to limit noise exposure on the job, there is essentially no regulation or enforcement of sound output for recreational sources and environments, such as sports arenas, musical venues, bars, etc. This lack of regulation resulted from the defunding of ONAC, the EPA's Office of Noise Abatement and Control, in the early 1980s. ONAC was established in 1972 by the Noise Control Act and charged with working to assess and reduce environmental noise. Although the Office still exists, it has not been assigned new funding.

Most people in the United States are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, transportation, crowds, lawn and maintenance equipment, power tools, gun use, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. If one is exposed to loud sound (including music) at high levels or for extended durations (85 dB A or greater), then hearing impairment will occur. Sound levels increase with proximity; as the source is brought closer to the ear, the sound level increases. This is why music is more likely to cause damage at the same output when listened to through headphones, as the headphones are in closer proximity to the ear drum than a loudspeaker. With the invention of in-ear headphones, these dangers are increased.

Genetic

Hearing loss can be inherited. Both dominant gene and recessive genes exist which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generations because it will manifest itself in the offspring even if it is inherited from only one parent. If a family had genetic hearing impairment caused by a recessive gene it will not always be apparent as it will have to be passed onto offspring from both parents. Dominant and recessive hearing impairment can be syndromic or nonsyndromic. Recent gene mapping has identified dozens of nonsyndromic dominant (DFNA#) and recessive (DFNB#) forms of deafness.

• The most common type of congenital hearing impairment in developed countries is DFNB1, also known as Connexin 26 deafness or GJB2-related deafness.
• The most common dominant syndromic forms of hearing impairment include Stickler syndrome and Waardenburg syndrome.
• The most common recessive syndromic forms of hearing impairment are Pendred syndrome, Large vestibular aqueduct syndrome and Usher syndrome.

Disease or illness

• Measles may result in auditory nerve damage
• Meningitis may damage the auditory nerve or the cochlea
• Autoimmune disease has only recently been recognized as a potential cause for cochlear damage. Although probably rare, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs.Wegener's granulomatosis is one of the autoimmune conditions that may precipitate hearing loss.
• Mumps (Epidemic parotitis) may result in profound sensorineural hearing loss(90 Decibel|dB or more), unilateral (one ear) or bilateral (both ears).
• Presbycusis is a progressive hearing impairment accompanying age, typically affecting sensitivity to higher frequencies (above about 2 kHz).
• Adenoids that do not disappear by adolescence may continue to grow and may obstruct the Eustachian tube, causing conductive hearing impairment and nasal infections that can spread to the middle ear.
• AIDS and AIDS-related complex|ARC patients frequently experience auditory system anomalies.
• HIV (and subsequent opportunistic infections) may directly affect the cochlea and central auditory system.
• Chlamydia may cause hearing loss in newborns to whom the disease has been passed at birth.
• Fetal alcohol syndrome is reported to cause hearing loss in up to 64% of infants born to alcoholism|alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess ethanol|alcohol intake.
• Premature birth results in sensorineural hearing loss approximately 5% of the time.
• Syphilis is commonly transmitted from pregnant women to their fetuses, and about a third of the infected children will eventually become deaf.
• Otosclerosis is a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.
• Superior canal dehiscence, a gap in the bone cover above the inner ear, can lead to low-frequency conductive hearing loss, autophony and vertigo

Medications

Some medications cause irreversible damage to the ear, and are limited in their use for this reason. The most important group is the aminoglycosides (main member gentamicin).

Various other medications may reversibly affect hearing. This includes some diuretics, aspirin and NSAIDs, and macrolide antibiotics.

Extremely heavy hydrocodone (Vicodin) abuse is known to cause hearing impairment. There has been speculation that radio talk show host Rush Limbaugh's hearing loss was at least in part caused by his admitted addiction to narcotic pain killers, in particular Vicodin and OxyContin.

Physical trauma

• There can be damage either to the ear itself or to the brain centers that process the aural information conveyed by the ears.
• People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent.
• Exposure to very loud noise (90 Decibel|dB or more, such as jet engines at close range) can cause progressive hearing loss. Exposure to a single event of extremely loud noise (such as explosions) can also cause temporary or permanent hearing loss. A typical source of acoustic trauma is an excessively loud music concert.

Categories of hearing impairment

Hearing loss is categorized by its severity and by the age of onset. Two persons with the same severity of hearing loss will experience it quite differently if it occurs early or late in life. Furthermore, a loss can occur on only one side (unilateral) or on both (bilateral).

Types

As discussed above, there are three major types of hearing loss: neural/sensorineural, conductive, or a combination of both. Treatment depends upon the type of hearing loss that is present.

Quantification of hearing loss

The severity of hearing loss is measured by the degree of loudness, as measured in decibels, a sound must attain before being detected by an individual. Hearing loss may be ranked as mild, moderate, severe or profound. It is quite common for someone to have more than one degree of hearing loss (i.e. mild sloping to severe). The following list shows the rankings and their corresponding decibel ranges:

• Mild:
  • for adults: between 25 and 40 dB
  • for children: between 20 and 40 dB
• Moderate: between 41 and 55 dB
• Moderately severe: between 56 and 70 dB
• Severe: between 71 and 90 dB
• Profound: 90 dB or greater

The quietest sound one can hear at different frequencies is plotted on an audiogram to reflect one's ability to hear at different frequencies. The range of normal human hearing (from the softest audible sound to the loudest comfortable sound) is so great that the audiogram must be plotted using a logarithmic scale. This large normal range, and the different amounts of hearing loss at different frequencies, make it virtually impossible to accurately describe the amount of hearing loss in simple terms such as percentages or the rankings above.

Measuring hearing loss in terms of a percentage is debatable in terms of effectiveness, and has been compared to measuring weight in inches. Though in specific legal situations, where decibels of loss are converted via a recognized legal formula, one can infer a standardized "percentage of hearing loss" which is suitable for legal purposes only.

Another method for determining hearing loss, is the Hearing in Noise Test (HINT). HINT technology was developed by the House Ear Institute, and is intended to measure an ability to understand speech in quiet and noisy environments. Unlike pure-tone tests, where only one ear is tested at a time, HINT evaluates hearing using both ears simultaneously (binaural), as binaural hearing is essential for communication in noisy environments, and for sound localization.

Age of onset of hearing impairment

The age at which the hearing impairment develops is crucial to spoken language acquisition. Post-lingual hearing impairments are far more common than pre-lingual impairments.

If the hearing loss occurs at a young age, interference with the acquisition of spoken language and social skills may occur. Hearing aids, which amplify the incoming sound, may alleviate some of the problems caused by hearing impairment, but are often insufficient. Cochlear implants artificially stimulate the VIIIth Nerve by providing an electric impulse substitution for the firing of hair cells. Cochlear implants are not only expensive, but require sophisticated programming in conjunction with patient training for effectiveness. People who have hearing impairments, especially those who develop a hearing problem in childhood or old age, require support and technical adaptations as part of the rehabilitation process.

Pre-lingual deafness

Main article: Prelingual deafness

Prelingual hearing impairment exists when the impairment is congenital or otherwise acquired before the individual has acquired speech and language, thus rendering the disadvantages more difficult to treat because the child is unable to access audible /spoken communication from the outset. It is important to note that those children born into signing families have no delay in language development and communication. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma; therefore, families commonly have no prior knowledge of deafness.

Post-lingual hearing impairment

Main article: Post-lingual hearing impairment

Post-lingual hearing impairment where hearing loss is adventitious after the acquisition of speech and language, usually after the age of six. It may develop due to disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual, and often detected by family and friends of the people so affected long before the patients themselves will acknowledge the disability. Common treatments includes hearing aids and learning lip reading. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability.^{[citation needed]}

Hard-of-hearing

People who are hard of hearing have varying amounts of hearing loss but usually not enough to be considered deaf. Many people who are deaf consider spoken language their primary language and consider themselves "hard of hearing".^{[citation needed]} How one classifies themselves relative to hearing loss or deafness is a very personal decision and reflects much more than just their ability to hear.

The phrase hard of hearing, normally used as an adjective or adverb, can also be used as a noun, referring to people with hearing impairment as the hard of hearing. People who consider themselves culturally deaf, prefer the term "hard of hearing" or "deaf", and perceive "hearing impaired" as an insult.

Hearing impaired persons with partial loss of hearing may find that the quality of their hearing varies from day to day, or from one situation to another or not at all. They may also, to a greater or lesser extent, depend on both hearing-aids and lip-reading. They may perhaps not always be aware of it, but they do admit to it being important to see the speaker's face in conversation.

Many people with hearing loss have better hearing in the lower frequency ranges (low tones), and cannot hear as well or at all in the higher frequencies. Some people may merely find it difficult to differentiate between words that begin with consonantal sounds such as the fricatives or sibilants, z, or th, or the plosives d, t, b, or p. They may be unable to hear thin, high-pitched or metallic noises, such as birds chirping or singing, clocks ticking, etc. Often, they are able to hear and understand men's voices better than women's.

Others will find their condition so much worse if circumstances in their immediate environment affect the way they are able to use their hearing aids, or prevent them from employing their speech reading skills. A room with a high ceiling and a lot of reverberation will affect the sound of a speaker's voice adversely. The position of the listener, too, sitting at a right angle to the speaker at a long seminar table, thus being able to hear only with one, maybe the ineffectual ear, can make a difference. Difficulties can also arise for the listener trying to lip-read, if the speaker is sitting with his back against the light-source and is in this way obscuring his face. A rule of thumb is that bright lighting is to the hearing-impaired what noise is to the hearing; a source of distraction.

The speaker's accent; the topic under discussion, possibly with many unfamiliar words; the softness of his voice; possibly his having a speech impediment; a habit of holding a hand in front of his mouth or turning his face away at times: all these tendencies cause problems to the hard-of-hearing, especially when they have to rely on lip-reading. The rustling of papers, and notebook pages being turned are precisely the noises that will be the first thing hearing-aids pick up.

Noisy situations are especially difficult, because hearing loss affects not only the ability to hear sounds, but also the ability to localize and filter out background noise.

Unilateral hearing loss

People with unilateral hearing loss (single sided deafness/SSD) can hear normally (or better) in one ear, but have trouble hearing out of the other ear. Problems with this type of deficit is inability to localize sounds (ie. unable to tell where traffic is coming from) and inability to process out background noise in a noisy environment, such as in a restaurant.

Social impact

Pre-lingual impairment

See also: Prelingual deafness

In children, hearing loss can lead to social isolation for several reasons. First, the child experiences delayed social development that is in large part tied to delayed language acquisition. It is also directly tied to their inability to pick up auditory social cues. This can result in a deaf person becoming generally irritable. A child who uses sign language, or identifies with the deaf sub-culture does not generally experience this isolation, particularly if he/she attends a school for the deaf, but may conversely experience isolation from his parents if they do not know sign language. A child who is exclusively or predominantly oral (using speech for communication) can experience social isolation from his or her hearing peers, particularly if no one takes the time to explicitly teach her social skills that other children acquire independently by virtue of having normal hearing. Finally, a child who has a severe impairment and uses some sign language may be rejected by his or her deaf peers, because of an understandable hesitation in abandoning the use of existent verbal and speech-reading skills. Some in the deaf community can view this as a rejection of their own culture and its mores, and therefore will reject the individual preemptively.

Post-lingual impairment

Those who lose their hearing later in life, such as in late adolescence or adulthood, face their own challenges. For example, they must adjust to living with the adaptations that make it possible for them to live independently. They may have to adapt to using hearing aids or a cochlear implant, develop speech-reading skills, and/or learn sign language. The affected person may need to use a TTY (teletype), interpreter, or relay service to communicate over the telephone. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability. The challenge is made greater by the need for those around them to adapt to the person's hearing loss.

Many relationships have suffered because of the anger that occurs when there is general miscommunication between family members. Generally, it's not only the person with a hearing disability that feels isolated, but others around them who feel they are not being "heard" or paid attention to, especially when the hearing loss has been gradual. Many people opt not to choose hearing aids for fear of looking old, since hearing loss is usually associated with old age, which equals ineffectiveness in some societies. Family members then feel as if their hearing loss partner doesn't care about them enough to make changes to reduce their disability and make it easier to communicate.

Medical treatments

Approaches

In addition to hearing aids there exist cochlear implants of increasing complexity and effectiveness. These are useful in treating the mild to profound hearing impairment when the onset follows the acquisitions of language and in some cases in children whose hearing loss came before language was acquired. Recent research shows variations in efficacy but some promising studies ^[4]show that if implanted at a very young age, some profoundly impaired children can acquire effective hearing and speech.

Views of treatments

There is controversy in the culturally deaf community as to whether cochlear implants address wellness concerns, the overall health and psycho-emotional well-being of prelingually deaf children at all.

Gene therapy

In 2005, there was success of the regrowth of cochlea cells in test subjects by a research team led by Dr. Yehoash Raphael from the University of Michigan. This study was conducted using guinea pigs as test subjects.^[5] It is important to note however, that the regrowth of cochlear hair cells does not imply the restoration of hearing sensitivity as the sensory cells may or may not make connections with neurons that carry the signals from hair cells to the brain.

A team led by Dr. Stefan Heller from Stanford University are pioneering stem cell research in the prospect of regrowth in cochlea cells.^[6]....

Adaptations to hearing impairment

Many hearing impaired individuals use certain assistive devices in their daily lives. Individuals can communicate by telephone using telecommunications devices for the deaf (TDD). This device looks like a typewriter or word processor and transmits typed text over the telephone. Other names in common use are textphone and minicom. A videophone can be used for distance communication using sign language. In 2004, mobile textphone devices came onto the market for the first time allowing simultaneous two way text communication. In the U.S., the UK, the Netherlands and many other western countries there are Telecommunications Relay Services so that a hearing impaired person can communicate over the phone with a hearing person via a human translator. Wireless, internet and mobile phone/SMS text messaging are beginning to take over the role of the TDD. Other assistive devices include those that use flashing lights to signal events such as a ringing telephone, a doorbell, or a fire alarm. Video conferencing is also a new technology that permits signed conversations as well as permitting an ASL-English interpreter to voice and sign conversations between a hearing impaired and hearing person, negating the need to use a TTY or computer keyboard. In addition, there are many new Telecommunications Relay Service technologies including IP Relay and captioned telephone.

Resources

Many different assistive technologies, such as hearing aids, are available to people who are hearing impaired. People with cochlear implants, hearing aids, or neither of these two devices also use additional communication devices to reduce the interference of background sounds, or to mediate the problems of distance from sound and poor sound quality caused by reverberation and poor acoustic materials of walls, floors and hard furniture. Three types of wireless, one-way wireless exist along with hard-wired devices. A wireless device used by people who use their residual hearing has two main components. One component sends the sound out to the listener, but is not directly connected to the listener with the hearing loss. The second component of the wireless system, the receiver, detects the sound and sends the sound to the ear of the person with the hearing loss. The three types of wireless devices are the FM system, the audio induction loop and the infra red system. Each system has advantages and benefits for particular uses. The FM system can easily operate in many environments with battery power. It is thus mobile and does not usually require a sound expert for it to work properly. The listener with the hearing loss carries a receiver and an earpiece. Another wireless system is the audio induction loop which permits the listener with hearing loss to be free of wearing a receiver provided that the listener has a hearing aid or cochlear implant processor with an accessory called a "telecoil". If the listener doesn't have a t-coil or telecoil, then she must carry a receiver with an earpiece. The third kind of wireless device for people with hearing loss is the infra red (IR) device which also requires a receiver to be worn by the listener. Usually the emitter for the IR device, that is, the component that sends out the signal, uses an AC adaptor. The advantage of the IR wireless system, is that people in adjoining rooms cannot listen in on conversations, and thus it is confidential and necessary for situations where privacy and confidentiality are required or chosen. Another way to achieve confidentiality is to use a hardwired amplifier which sends out no signal beyond the earpiece that is plugged directly into the amplifier. That amplifier of the hardwired device also has a microphone inside of it or plugged into it.

• Hearing dogs, a category of assistance dogs, are trained to help those with hearing impairments.
• The advent of the internet's World Wide Web and closed captioning has given the hearing impaired unprecedented access to information. Electronic mail and online chat have reduced the need for deaf and hard of hearing people to use a third-party Telecommunications Relay Service in order to communicate with the hearing and other hearing impaired people.

Posted byDoc Junhel at 9:45 PM 0 comments  

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions. OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life. The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.^[1] Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive-compulsive personality disorder (OCPD) or some other condition. Some symptoms of OCD and OCPD are consistent with what Sigmund Freud called an anal retentive personality type, although this is rarely diagnosed as a clinical condition by non-psychoanalytic therapists.

Diagnostic criteria

To be diagnosed with OCD, a person must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) states several characteristics of obsessions and compulsions:^[2]

Obsessions

1. Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress.
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions

1. Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
2. The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviours or mental acts are not actually connected to the issue, or they are excessive.

In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.^[2] OCD often causes feelings similar to those of depression.

Symptoms and prevalence

OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically-recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed.^[3] The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that they have the condition.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain amount of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as tics or Parkinson's disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.

However, the general idea of a person with OCD (washing hands, checking doors etc.) is not always the case. There are OCD sufferers who are convinced that reality is non-existent, that they are destroying people's souls merely by looking at them, that people are being possessed and many more.

There are many other possible symptoms, and it is not necessary to display those described in the lists below to be considered as suffering from OCD. Formal diagnosis should be performed by a psychologist, a psychiatrist or psychoanalyst. OCD sufferers are aware that their thoughts and behavior are not rational,^[4] but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time.^[5]For people with OCD, the thoughts are intrusive and persistent, and cause them great anxiety and distress. ^[6]

Contamination

A major subtype of the fear category is the fear of contamination:(see mysophobia); some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine or feces. Some OCD sufferers even fear that the soap they are using is contaminated.^[7] As with the other anxieties, these fears may cause a person to have significant distress, and they may make it hard for a person with OCD to work or go to school or interfere with social relationships.

Performing tasks

Symptoms related to performing tasks may include repeated hand washing or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions -- more generally, this can involve an obsession with numbers or types of numbers (e.g., odd numbers). These obsessive behaviours can cause individuals to feel psychological distress, because they are very concerned about having "made mistakes" in the number of steps that they have taken, or the number of stairs on a staircase. For some people with OCD, these obsessive counting and re-counting tasks, along with the attendant anxiety and fear, can take hours of each day, which can make it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviours can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.

Intrusive thoughts and fears

Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.^[8] Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts.^[9] Most people experience these thoughts; when they are associated with OCD or depression, they may become paralyzing, anxiety-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts.^[8] When intrusive thoughts co-occur with OCD, patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.^[8]

Violent or aggressive thoughts

Intrusive thoughts may involve violent obsessions about hurting others or one's self.^[10] They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile.^[9] A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including ^[11] imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent. A person with OCD may meet up with their best friend, to whom they bear no ill will, and an image of them stabbing their friend may "pop" into their head.

While some individuals with OCD who have these unwanted images pop into their minds are able to dismiss the images as random "static" generated by the mind, others are tormented by the thoughts, and they may worry that they are actual desires that they may act on, or that they are "going crazy." In some cases, the person struggling with these horrible images may try to deal with them by developing compulsions. For example, a person who is tormented by unwanted thoughts of them stabbing their mother with a kitchen knife may ensure that all kitchen knives are kept locked away, to prevent the perceived danger that they may "act upon" the horrible thoughts.

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won't act upon the thoughts. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn't feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don't see; or feels uncontrollable irresistible anger.^[12]

Inappropriate sexual thoughts

Sexual obsessions involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age.^[13] Like other intrusive, unpleasant thoughts or images, most people have some inappropriate sexual thoughts at times^{[citation needed]}, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing.^[13]

One of the more common sexual intrusive thoughts occurs when an obsessive person doubts his or her sexual identity, a symptom of OCD called homosexuality anxiety or HOCD.^[14] As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity.^[15] A person experiencing sexual intrusive thoughts may feel shame, "embarrassment, guilt, distress, torment, fear that you may act on the thought or perceived impulse and, doubt about whether you have already acted in such a way." Depression may be a result of the self-loathing that can occur, depending on how much the OCD interferes with daily functioning or causes distress.^[13] The possibility that most patients suffering from intrusive thoughts to sexually assault people will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts.

Related conditions

OCD is often confused with the separate condition obsessive-compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic — marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.^[16] This is a significant difference between these disorders.

Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not.

OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.

Related disorders

People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, asperger's syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive-compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD suffer also from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.^[17]

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal antibodies become involved in an autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it.^[18]

Causes

Psychological

Scientists studying obsessive-compulsive disorder are split into two factions disagreeing over the illness's cause. One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin.

From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil. Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.^[19] In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms.^[19] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".^[20]

The cognitive-behavioral model suggests that the behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).

Biological

There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality with the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's response to OCD, and not its cause. Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. This neurotransmitter travels from one nerve cell to the next via synapses. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This suggestion is supported by the fact that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs) — a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells.^[21] For more about this class of drugs, see the section about potential treatments for OCD.

The Stanford University School of Medicine OCD webpage states, "Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to Group A streptococcal infection promises to bring increased understanding of the disorder's pathogenesis."^[22]

Recent research has revealed a possible genetic mutation that could help to cause OCD. Researchers funded by the National Institutes of Health have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, in his study of identical twins, Rasmussen (1994) produced data that supported the idea that there is a "heritable factor for neurotic anxiety".^[23] In addition, he noted that environmental factors also play a role in how these anxiety symptoms are expressed. However, various studies on this topic are still being conducted and the presence of a genetic link is not yet definitely established.

Another possible genetic cause of OCD was discovered in August 2007 by scientists at Duke University Medical Center in North Carolina. They genetically engineered mice that lacked a gene called SAPAP3. This protein is highly expressed in the striatum, an area of the brain linked to planning and the initiation of appropriate actions. The mice spent three times as much time grooming themselves as ordinary mice, to the point that their fur fell off.^[24]

Using tools like positron emission tomography (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder.^[25] This suggests that brain functioning in those with OCD may be impaired in some way. A popular explanation for OCD is that offered in the book Brain Lock by Jeffrey Schwartz, which suggests that OCD is caused by the part of the brain that is responsible for translating complex intentions (e.g., "I will pick up this cup") into fundamental actions (e.g., "move arm forward, rotate hand 15 degrees, etc.") failing to correctly communicate the chemical message that an action has been completed. This is perceived as a feeling of doubt and incompleteness, which then leads the individual to attempt to consciously deconstruct their own prior behavior — a process which induces anxiety in most people, even those without OCD^{[citation needed]}.

It has been theorized that a miscommunication between the orbitofrontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong.^[vague] When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to interpret the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension.^[21] This overactivity of the OFC is shown to be attenuated in patients who have successfully responded to SSRI medication. The increased stimulation of the serotonin receptors 5-HT2A and 5-HT2C in the OFC is believed to cause this inhibition. ^[26]

Some research has discovered an association between a type of size abnormality in different brain structures and the predisposition to develop OCD. Through the use of magnetic resonance imaging (MRI), researchers at Cambridge's Brain Mapping Unit were able to discover distinctive patterns in the brain structure of individuals with OCD and their close family members. ^[27] This is the first instance in which it has been demonstrated that those with a familial risk of developing OCD have anatomical differences when compared with ordinary individuals. The discovery of these structural differences in the area of the brain associated with stopping motor response may ultimately aid researchers who seek to determine which genes contribute to the development of OCD.

Demographics and other statistics

In a 1980 study of 20,000 adults from New Haven, Baltimore, St. Louis, Durham, and Los Angeles, the lifetime prevalence rate of OCD for both sexes was recorded at 2.5 percent. Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9 percent versus 3.4 percent). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1 percent) than it is for those who have only some college background (2.4 percent). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-20s in both sexes, but the age of onset tends to be slightly younger in males than in females.^[28]

Violence is very rare among OCD sufferers, but the disorder is often debilitating to their quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.

Treatment

According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), medications, or any combination of the three, are first-line treatments for OCD. Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD.^[29]

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking.

Exposure and ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.^[30]

Medication

Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious. There has been controversy of efficacy with this class of drugs, recent studies of SSRIs have suggested a low profile for efficacy and high profile for dangerous side effects.

Benzodiazepines are also used in treatment. It's not uncommon to administer this class of drugs during the "latency period" for SSRIs or as synergistic adjunct long-term. Although widely prescribed, benzodiazepines have not been demonstrated as an effective treatment for OCD and can be addictive.^[31]

Serotonergic antidepressants typically take longer to show benefit in OCD than with most other disorders which they are used to treat, as it is common for 2–3 months to elapse before any tangible improvement is noticed. In addition to this, the treatment usually requires high doses. Fluoxetine, for example, is usually prescribed in doses of 20 mg per day for clinical depression, whereas with OCD the dose will often range from 20 mg to 80 mg or higher, if necessary. In most cases antidepressant therapy alone will only provide a partial reduction in symptoms, even in cases that are not deemed treatment-resistant. Other medications such as riluzole, memantine, gabapentin (Neurontin), lamotrigine (Lamictal), and low doses of the newer atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) have also been found to be useful as adjuncts in the treatment of OCD.

The use of antipsychotics in OCD must be undertaken carefully, however, since, although there is very strong evidence that at low doses they are beneficial (most likely due to their dopamine receptor antagonism), at high doses these same antipsychotics have proven to cause dramatic obsessive-compulsive symptoms even in those patients who do not normally have OCD. This is most likely due to the antagonism of 5-HT2A receptors becoming very prominent at these doses and outweighing the benefits of dopamine antagonism. Another point that must be noted with antipsychotic treatment is that SSRIs inhibit the chief enzyme that is responsible for metabolising antipsychotics — CYP2D6 — so the dose will be effectively higher than expected when these are combined with SSRIs. Also, it must be noted that antipsychotic treatment should be considered as augmentation treatment when SSRI treatment does not bring positive results.

Alternative Drug Treatments

The naturally occurring sugar inositol may be an effective treatment for OCD. Inositol appears to modulate the actions of serotonin and has been found to reverse desensitisation of the neurotransmitter's receptors.^[32] St John's Wort has been claimed to be of benefit due to its (non-selective) serotonin re-uptake inhibiting qualities, and studies have emerged that have shown positive results. However, a double-blind study, using a flexible-dose schedule (600-1800 mg/day), found no difference between St John's Wort and the placebo.^[33] Studies have also been done that show nutrition deficiencies may also contribute to OCD and other mental disorders. Certain vitamin and mineral supplements may aid in such disorders and provide the nutrients necessary for proper mental functioning. ^[34]

Recent research has found increasing evidence that opioids may significantly reduce OCD symptoms, though the use of them is not sanctioned for treatment and considered an "off-label" use, factors being physical dependence and long term drug tolerance. Anecdotal reports suggest that some OCD sufferers have successfully self-medicated with opioids such as Ultram and Vicodin, though the off-label use of such painkillers is not widely accepted, research on this has been limited. Tramadol is an atypical opioid that may be a viable option as it has a low potential for abuse and addiction, mild side effects, and shows signs of rapid efficacy in OCD. Tramadol not only provides the anti-OCD effects of an opiate, but also inhibits the re-uptake of serotonin (in addition to norepinephrine). This may provide additional benefits, but should not be taken in combination with antidepressant medication unless under careful medical supervision due to potential serotonin syndrome.^[35]

Recent studies at the University of Arizona using the tryptamine alkaloid psilocybin have shown promising results.^[36] There are reports that other hallucinogens such as LSD and peyote have produced similar benefits. It has been hypothesised that this effect may be due to stimulation of 5-HT2A receptors and, less importantly, 5-HT2C receptors. This causes, among many other effects, an inhibitory effect on the orbitofrontal cortex, an area of the brain in which hyperactivity has been strongly associated with OCD.^[37]

Emerging evidence suggests that regular nicotine treatment may be helpful in improving symptoms of OCD, although the pharmacodynamical mechanism by which this improvement is achieved is not yet known, and more detailed studies are needed to fully confirm this hypothesis. Anecdotal reports suggest OCD can worsen when cigarettes are smoked as a way of obtaining nicotine.^[38]

Psychosurgery

For some, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure.^[6] Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

In the US, psychosurgery for OCD is a treatment of last resort and will not be performed until the patient has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive-behavioral therapy with exposure and ritual/response prevention.^[39] Likewise, in the UK, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive-behavioural therapist has been carried out.

Transcranial magnetic stimulation

Though in its early stages of research, Transcranial magnetic stimulation (TMS) has shown promising results. The magnetic pulses are focused on the brain's supplementary motor area (SMA), which plays a role in filtering out extraneous internal stimuli, such as ruminations, obsessions, and tics. The TMS treatment is an attempt to normalize the SMA's activity, so that it properly filters out thoughts and behaviors associated with OCD. ^[40][41]

Neuropsychiatry

OCD primarily involves the brain regions of the striatum, the orbitofrontal cortex and the cingulate cortex. OCD involves several different receptors, mostly H₂, M₄, NK₁, NMDA, and non-NMDA glutamate receptors. The receptors 5-HT_1D, 5-HT_2C, and the μ opioid receptor exert a secondary effect. The H₂, M₄, NK₁, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.

The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Correlations where activity is positively correlated to severity include the histamine receptor (H₂); the Muscarinic acetylcholine receptor(M₄); the Tachykinin receptor (NK₁); and non-NMDA glutamate receptors. Correlations where activity is negatively correlated to severity include the NMDA receptor (NMDA); the Mu opioid receptor (μ opioid); and two types of 5-HT receptors (5-HT_1D and 5-HT_2C) The central dysfunction of OCD may involve the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors could simply exert secondary modulatory effects.

Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). Also, the anti-Alzheimer's drug memantine is being studied by the OC Foundation in its efficacy in reducing OCD symptoms due to it being an NMDA antagonist. One case study published in The American Journal of Psychiatry suggests that "memantine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation."^[42] The drugs that are popularly used to fight OCD lack full efficacy because they do not act upon what are believed to be the core mechanisms.

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