Obsessive-Compulsive Disorder

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by intrusive thoughts accompanied by anxiety, persistent obsessive thinking, and/or compulsive behaviors with repetitive actions to relieve this distress. The lifetime prevalence is 0.8–3.0% worldwide. The China Mental Health Survey reported an annual prevalence of 1.63% for OCD. Medication and cognitive behavioral therapy (CBT) remain as predominant first-line therapies for OCD in clinical practice; however, patients with refractory OCD (40–60% of OCD patients) fail to respond to such interventions. In recent years, physiotherapy has been introduced in clinical practice and has produced certain therapeutic effects. Numerous studies have confirmed that functional and structural abnormalities of the cortico-striatal-thalamic-cortical (CSTC) circuit are leading etiologies of OCD. This circuit includes the dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), supplementary motor area (SMA), anterior cingulate cortex (ACC), caudate nucleus, putamen, pallidum, and multiple regions in the thalamus. These brain regions are involved in processing various information such as emotion, motivation, cognition, and movement, which are the key areas for individual behavioral control. Based on the research of the CSTC circuit, physical interventions for the treatment of OCD at this stage are mainly carried out on the aforementioned brain regions. The methods mainly include deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, modified electric convulsive therapy, focused ultrasound, and vagus nerve stimulation (Compiling group of the Guidelines for the Prevention and Treatment of OCD in China 2016).