Hopp til hovedinnhold

Tvangslidelse, OCD

Sist revidert:
Sist revidert av:

Definisjon:
Tvangslidelse eller obsessiv-kompulsiv lidelse (OCD) kjennetegnes ved tilbakevende og påtrengende tvangstanker og/eller gjentatte tvangshandlinger som er tidkrevende eller forårsaker betydelig ubehag eller svekket fungeringsevne
Forekomst:
Livstidsprevalensen angis til 1-3%
Symptomer:
Tvangstanker eller obsesjoner er påtrengende og ubehagelige tanker, impulser eller bilder. Selv om pasienten opplever dette som irrasjonelt utløser det ubehag og trang til å utføre tvangshandlinger. Tvangshandlinger eller kompulsjoner er gjentatte fysiske eller mentale handlinger som utføres for å dempe ubehaget eller forhindre de fryktede hendelsene
Funn:
Klinisk undersøkelse er normal bortsett fra symptomene på tvangslidelse
Diagnostikk:
Tilleggsundersøkelser er vanligvis ikke påkrevd
Behandling:
Ubehandlet vil tilstanden typisk vedvare, men det finnes effektive psykologisk og farmakologiske behandlinger. Kognitiv atferdsterapi (KAT) med eksponering og responsprevensjon (ERP) er førstevalg. Oppstart av behandling er ofte sterkt forsinket
  1. Stein DJ, Costa DLC, Lochner C, et al. Obsessive-compulsive disorder. Nat Rev Dis Primers. 2019 Aug 1;5(1):52. PMID: 31371720. PubMed  
  2. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010 Jan;15(1):53-63. Epub 2008 Aug 26. PMID: 18725912. PubMed  
  3. Thorsen AL, Hagland P, Radua J, et al. Emotional Processing in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis of 25 Functional Neuroimaging Studies. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Jun;3(6):563-571. Epub 2018 Feb 3. PMID: 29550459. PubMed  
  4. Boedhoe PSW, van Rooij D, Hoogman M, et al. Subcortical Brain Volume, Regional Cortical Thickness, and Cortical Surface Area Across Disorders: Findings From the ENIGMA ADHD, ASD, and OCD Working Groups. Am J Psychiatry. 2020 Sep 1;177(9):834-843. Epub 2020 Jun 16. Erratum in: Am J Psychiatry. 2020 Sep 1;177(9):843. PMID: 32539527. PubMed  
  5. Picó-Pérez M, Moreira PS, de Melo Ferreira V, et al. Modality-specific overlaps in brain structure and function in obsessive-compulsive disorder: Multimodal meta-analysis of case-control MRI studies. Neurosci Biobehav Rev. 2020 May;112:83-94. Epub 2020 Jan 30. PMID: 32006553. PubMed  
  6. Thorsen AL, van den Heuvel OA, Hansen B, Kvale G. Neuroimaging of psychotherapy for obsessive-compulsive disorder: A systematic review. Psychiatry Res. 2015 Sep 30;233(3):306-13. Epub 2015 May 16. PMID: 26228566. PubMed  
  7. Mataix-Cols D, Boman M, Monzani B, Rück C, et al. Population-based, multigenerational family clustering study of obsessive-compulsive disorder. JAMA Psychiatry. 2013 Jul;70(7):709-17. PMID: 23699935. PubMed  
  8. Eilertsen T, Hansen B, Kvale G, Abramowitz JS, Holm SEH, Solem S. The Dimensional Obsessive-Compulsive Scale: Development and Validation of a Short Form (DOCS-SF). Front Psychol. 2017 Sep 5;8:1503. PMID: 28928693. PubMed  
  9. Öst LG, Riise EN, Wergeland GJ, Hansen B, Kvale G. Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. J Anxiety Disord. 2016 Oct;43:58-69. Epub 2016 Aug 13. PMID: 27632568. PubMed  
  10. Öst LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. Clin Psychol Rev. 2015 Aug;40:156-69. Epub 2015 Jun 14. PMID: 26117062. PubMed  
  11. Zhou DD, Zhou XX, Lv Z, et al. Comparative efficacy and tolerability of antipsychotics as augmentations in adults with treatment-resistant obsessive-compulsive disorder: A network meta-analysis. J Psychiatr Res. 2019 Apr;111:51-58. Epub 2019 Jan 14. PMID: 30677645. PubMed  
  12. Thorsen AL, Kvale G, Hansen B, van den Heuvel OA. Symptom dimensions in obsessive-compulsive disorder as predictors of neurobiology and treatment response. Curr Treat Options Psychiatry. 2018 Mar;5(1):182-194. Epub 2018 Feb 23. PMID: 30237966. PubMed  
  13. Knopp J, Knowles S, Bee P, Lovell K, Bower P. A systematic review of predictors and moderators of response to psychological therapies in OCD: do we have enough empirical evidence to target treatment? Clin Psychol Rev. 2013 Dec;33(8):1067-81. Epub 2013 Sep 5. PMID: 24077387. PubMed  
  14. Pearcy CP, Anderson RA, Egan SJ, Rees CS. A systematic review and meta-analysis of self-help therapeutic interventions for obsessive-compulsive disorder: Is therapeutic contact key to overall improvement? J Behav Ther Exp Psychiatry. 2016 Jun;51:74-83. Epub 2015 Dec 30. PMID: 26794856. PubMed  
  15. Vogel PA, Solem S, Hagen K, Moen EM, Launes G, Håland ÅT, Hansen B, Himle JA. A pilot randomized controlled trial of videoconference-assisted treatment for obsessive-compulsive disorder. Behav Res Ther. 2014 Dec;63:162-8. Epub 2014 Oct 30. PMID: 25461792. PubMed  
  16. Launes G, Hagen K, Sunde T, Öst LG, Klovning I, Laukvik IL, Himle JA, Solem S, Hystad SW, Hansen B, Kvale G. A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disorder: The Bergen 4-Day Treatment. Front Psychol. 2019 Nov 15;10:2500. PMID: 31803089. PubMed  
  17. Wootton BM. Remote cognitive-behavior therapy for obsessive-compulsive symptoms: A meta-analysis. Clin Psychol Rev. 2016 Feb;43:103-13. Epub 2015 Oct 20. PMID: 26494179. PubMed  
  18. Simpson HB. Pharmacotherapy for obsessive-compulsive disorder in adults. UpToDate. 2015. www.uptodate.com  
  19. Simpson HB, Huppert JD, Petkova E, et al. Response versus remission in obsessive-compulsive disorder. J Clin Psychiatry. 2006 Feb;67(2):269-76. PMID: 16566623. PubMed  
  20. Issari Y, Jakubovski E, Bartley CA, et al. Early onset of response with selective serotonin reuptake inhibitors in obsessive-compulsive disorder: a meta-analysis. J Clin Psychiatry. 2016 May;77(5):e605-11. PMID: 27249090. PubMed  
  21. Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic Augmentation of Serotonin Reuptake Inhibitors in Treatment-Resistant Obsessive-Compulsive Disorder: An Update Meta-Analysis of Double-Blind, Randomized, Placebo-Controlled Trials. Int J Neuropsychopharmacol. 2015 May 4;18(9):pyv047. PMID: 25939614. PubMed  
  22. Piacentini J, Woods DW, Scahill L, et al. Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA. 2010 May 19;303(19):1929-37. PMID: 20483969. PubMed  
  23. Skarphedinsson G, Compton S, Thomsen PH, et al. Tics Moderate Sertraline, but Not Cognitive-Behavior Therapy Response in Pediatric Obsessive-Compulsive Disorder Patients Who Do Not Respond to Cognitive-Behavior Therapy. J Child Adolesc Psychopharmacol. 2015 Jun;25(5):432-9. PMID: 26091197. PubMed  
  24. Zhou DD, Wang W, Wang GM, Li DQ, Kuang L. An updated meta-analysis: Short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorder. J Affect Disord. 2017 Jun;215:187-196. doi: 10.1016/j.jad.2017.03.033. Epub 2017 Mar 18. PMID: 28340445. PubMed  
  25. Visser HA, van Oppen P, van Megen HJ, et al. Obsessive-compulsive disorder; chronic versus non-chronic symptoms. J Affect Disord. 2014 Jan;152-154:169-74. Epub 2013 Sep 13. PMID: 24084621. PubMed  
  26. Wheaton MG, Galfalvy H, Steinman SA, et al. Patient adherence and treatment outcome with exposure and response prevention for OCD: Which components of adherence matter and who becomes well? Behav Res Ther. 2016 Oct;85:6-12. Epub 2016 Jul 29. PMID: 27497840. PubMed  
  27. Visser H, Megen H, Oppen P, et.al. The impact of poor insight on the course of Obsessive-Compulsive Disorder in patients receiving naturalistic treatment. J Obsessive Compuls Relat Disord 2017; 13: 42-8. doi:10.1016/j.jocrd.2017.03.003 DOI  
  28. Hansen B, Kvale G, Hagen K, Havnen A, Öst LG. The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting. Cogn Behav Ther. 2019 Mar;48(2):89-105. Epub 2018 Aug 8. PMID: 30088441. PubMed  
  29. Batelaan NM, Bosman RC, Muntingh A, et al. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017 Sep 13;358:j3927. Erratum in: BMJ. 2017 Sep 25;358:j4461. PMID: 28903922. PubMed  
  • Anders Lillevik Thorsen, psykolog og PhD, Haukeland universitetssykehus og Universitet i Bergen, Bergen
  • Marte Jürgensen, overlege og PhD, Haukeland universitetssykehus, Bergen
  • Bjarne Hansen, professor, psykologspesialist og PhD, Haukeland universitetssykehus og Universitet i Bergen, Bergen

Tidligere fagmedarbeidere

  • Olav Thorsen, spesialist allmennmedisin, Klubbgaten legesenter, Stavanger
  • K Gunnar Götestam, professor, Psykiatrisk institutt, Norges teknisk-naturvitenskapelige universitet, Trondheim