The topic is Obsessive Compulsive Disorder (OCD) in Adults.
Detailed Paper (18 Pages double-spaced in APA Format. Page requirement includes title page, abstract, and reference page)
The paper sections:
1) the development and course of the disorder,
2) cerebral localization,
3) neurotransmitters involved,
4) genetics,
5) treatment (including pharmacotherapy),
6) current controversies about the biology of
the disorder and the appropriate next steps
for researchers to take to resolve them.
Obsessive Compulsive Disorder (OCD) in Adults
The majority of psychological conditions that are observed in clinical cases are known to mainly affect adults. People in age extremities such as the too young or the too old do not often suffer from these diseases due to their dormant lifestyle. Adults are the main targets of psychological conditions because they have a very active lifestyle, are fully developed and have many responsibilities that they are required to accomplish. Obsessive Compulsive Disorder or OCD is one of the most common psychological diseases that affects most adults. This disorder is often characterized by thoughts that are intrusive, leading to constant worry, anxiety and obsession. The affect adult will exhibit behaviors that are repetitive, so that he or she can try to reduce the anxiety or obsession being felt. This paper is a comprehensive essay that focuses on Obsessive Compulsive Disorder in adults. The essay will address the causes of this disorder, the treatment and the controversies that surround the biology of this disease.
The development and cause of Obsessive Compulsive Disorder
Obsessive Compulsive Disorder or OCD is defined as an anxiety and apprehension disorder that is mostly characterized by repetitive behaviors that compel a person to behave in a bizzzare manner (Dell’Osso et al, 2013). These behaviors are often caused by unwanted thoughts that make the actions being done to be uncontrollable (Thomsen, 2013). Most adults who suffer from OCD have obsessive thoughts and compulsive behaviors which other people will define as being irrational, since they do not make sense at all (Weber et al, 2014). For example, it is very normal for a person to counter check if they have unplugged the iron box from the socket after they have finished an ironing session. It is also normal to go back and check if the car is locked after packing it outside a shopping mall.
However, for a person suffering from OCD, their behaviors become too compulsive and obsessive such that they interfere with their normal daily life (Thomsen, 2013). For instance, a person with Obsessive Compulsive Disorder will check the cooker twenty times just to make sure that they have switched it off. Another person will opt to wash their hands by thoroughly scrubbing them to a point of almost peeling the skin just to ensure that the hands are clean (Vakili and Gharraee, 2014). In fact, OCD is so serious that if a person happens to be driving and comes across a bump, they will go round the same road fifty times just to confirm to themselves that they did not run over a person.
The main cause of Obsessive Compulsive Disorder has been linked to both psychological and biological factors in a person’s body that lead to the development of the disease (Tucci et al, 2014). Nonetheless, these factors will differ from one individual to the next depending on the degree of emphasis on either one of the two factors. The psychological cause of OCD is brought about by overly obsessive behaviors that make a person to become pre-occupied with a certain habit or activity (Gordon et al, 2013). For example, the constant washing of hands as a way of affirming hygiene, hoarding of personal belongings, even if they are no longer useful or even making the bed after every five minutes even if no one has laid on it. On the other hand, the biological cause of OCD is linked to abnormal functioning of certain neurotransmitters in the brain (Dittrich and Johansen, 2013).
Neurotransmitters are chemicals that are involved in the transmission of a synapse or chemical message from one neuron to another target nerve cell (Gordon et al, 2013). In the case of OCD, the defective neurotransmitter is usually serotonin, which is very important in the regulation of anxiety in the body (Dittrich and Johansen, 2013). Therefore, a person or adult who suffers from OCD will always be in constant fear that something is not right and will go ahead to try and make it well by performing a given task infinite times (Gellatly and Molloy, 2014). Common Obsessive Compulsive Disorder symptoms can include the fear of being contaminated with dirt or germs or even passing these contaminants to others. This is why most patients with OCD will wash their hands so seriously that they can even cause them to have sores (Gellatly and Molloy, 2014). Other people will have excessive thoughts on morally upright or pious issues that they will often regard other people as impure, sinners or evil. Obsessive Compulsive Disorder becomes a problem because it interferes with the daily life and normal relationships, causes immense distress and takes up a lot of useful time.
b) Cerebral localization of the disorder
Obsessive Compulsive Disorder is a disease that is capable of afflicting a person throughout their entire lifetime. The brain of people suffering from OCD is somewhat different from their normal counterparts. People with OCD have significantly less white matter in their brain as compared to normal subjects. This was evidenced through a preliminary study that was conducted in parts of the brain of people with OCD using Magnetic Resonance Imaging or MRI (Souza et al, 2014). The white matter is an important component of the central nervous system within the brain and the spinal cord as well. It contains important cells, such as the glial cells and axons that contain the myelin sheath. It is through the white matter that signals are transmitted from one end of the cerebrum to other places within the brain center (Fairfax et al, 2014).
The white matter in OCD patients is usually much less and that is why it interferes with functioning, cognition and processing. What’s more, the white matter acts as a relay that passes on information from the brain’s cerebrum to different areas of the body (Fairfax et al, 2014).
The white matter lies beneath the cerebral cortex and contains nerve cells that connect other neurons within different areas in the brain. People suffering from OCD often have abnormal rates of cerebral activity that directly affects their metabolic rates. The severity of this disorder attacks the frontal lobe and the basal ganglia within the orbital cortex, which then stimulates a worry circuit or signal (Fairfax et al, 2014). This is what is seen as the obsessive disorder that makes most OCD patients worry a lot about their hygiene, safety or even property. The orbital cortex is able to stimulate and ignite a worry circuit because is contains a caudate nucleus that helps it to switch from one line of thought to another (Moradi et al, 2014). This process is then enhaced by the thalamus which processes the body’s sensory inputs. Researchers have also postulated that Obsessive Compulsive Disorder can result from lower levels of neurotransmitters in the brain.
c) Neurotransmitters involved in OCD
It is clear that Obsessive Compulsive Disorder is caused by certain biological disorders that affect the functioning of the brain (Moradi et al, 2014). In particular, these disorders affect the neurotransmitters in the brain and cause them to transmit the wrong information. Neurotransmitters or NTs are chemicals that are involved in the relaying of information or signals across a synapse (Moradi et al, 2014). They do this through the use of nerve cells or neurons that are located within the brain. Once they are released from the brain, NTs are packaged in the form of a synaptic vesicle that is then clustered under the membrane in the axon terminal. From here, they are able to bind to receptors in the synaptic cleft and they can then pass across the opposite side of the synapse (Souza et al, 2014).
The most common neurotransmitter is acetylcholine which is involved in controlling most of the body’s synapses. In healthy or normal people, information is usually transmitted through the central nervous system through the combination of chemical and electrical signals (Souza et al, 2014). The neurotransmitters are able to travel from one neuron to the next and in the process, they relay information relating to moods, emotions and feelings. There are special receptor chemicals that are prepared to receive these messages from the neurotransmitters (Souza et al, 2014). This process continues from one nerve cell to the other until the relevant signal is relayed. In adults with Obsessive Compulsive Disorder, the neurotransmitters are defective and are not able to function as they should. The main neurotransmitter involved is usually serotonin, which is usually under some form of chemical imbalance. It is capable of cutting of the normal sequence of signal communication within the brain so that comminucation failure results.
This is because serotonin is reabsorbed or sucked into the nerve cells before it is able to cross over to the synapse. This then causes chemical signals and messages to be lost due to the sucking back of the serotonin neurotransmitter. This is what causes the symptoms of OCD to develop due to the malfunctioning of the transmission of a synapse. The brain scans of people who suffer from Obsessive Compulsive Disorder show varied patterns of brain activity when compared to their normal counterparts. In OCD patients, there is a very different form of neurotransmitter circulation within specific parts of the brain. In other cases, the neurotransmitter dopamine has been linked to the cause and development of OCD. Research has also shown that people with OCD can have inconsistent levels of dopamine and serotonin in certain parts of the brain’s cerebrum. Scientifically, these conditions are termed as hypofunctioning of the serotonergic activity within the basal ganglia and the hyperfuctioning of dopaminergic activity in the frontal cortex.
Serotonin is a neurotransmitter that is responsible for the regulation of anxiety. This chemical is normally found in the platelets of the blood, the brain and nervous system as well as the gastrointestinal tract or GIT (Peterson, 2012). In addition to anxiety, serotonin is believed to be responsible for making people feel happy and excited with themselves. However, most of the serotonin is located in the brain where it regulates other activities such as sleep, appetite, mood and happiness. The depletion of serotonin is what is responsible for the Obsessive Compulsive Disorder. Some researchers in an Italian university have linked the depletion of serotonin in people who have recently fallen in love (Peterson, 2012). Such people normally exhibit symptoms of obsessive behavior in the early stages of love. For instance, some people will call their partner every five minutes, send them text messages in an overly frequent manner or keep checking on them if they work or study in the same place.
On the other hand, dopamine is responsible for a number of functions within the human body. For instance, dopamine regulations the activity of most hormones so that people can behave in a normal manner. For people with Obsessive Compulsive Disorder, the neurotransmitter dopamine is not well produced and these results to abnormal functioning of most hormone dependant activities. This then translates to the patient feeling bad about themselves, insecure and even unclean (Peterson, 2012). This is what becomes visible as the obsessive habit of trying to make themselves feel good about themselves by washing excessively, counter checking on people and even confirming if things are in the right place in an excess manner.
d) Diagnosis and Treatment of Obsessive Compulsive Disorder
(including pharmacotherapy)
The treatment for Obsessive Compulsive Disorder can only be done if the clinical psychologist or clinician understands the symptoms very well. The signs of this disorder include both the compulsive and obsessive symptoms. In general, the symptoms of OCD are normally persistent, repetitive and highly unwarranted. The person suffering from OCD often thinks that getting rid of the obsession is the best way to solve the issue. Instead, this becomes a problem because it becomes an intrusion, especially when other things have to be done. Obsessive symptoms can include the fear of being contaminated with dirt, having horrific and aggressive thoughts that can lead to some people harming themselves, wanting things to be always perfect, symmetrical and orderly and even having unwanted thoughts on religious and sexual issues. These signs are what makes OCD patients to fear shaking other people’s hands because they will be contaminated. It is also the reason why some people will doubt they have switched of the kettle or shut the windows at night.
For the perfectionists, they are obsessed that their things must face a certain way. Some people will want their clothes to be arranged facing a certain direction in the wardrobe. When it comes to foods, they will want the canned or bottled goods to face the same way. Interestingly, most adults with Obsessive Compulsive Disorder think that their behaviors make a lot of sense.
The most effective treatment for Obsessive Compulsive Disorder is cognitive behavioural therapy. This mode of treatment involves two main components which are the cognitive therapy bit and the second part is exposure and response prevention. Cognitive therapy focuses its efforts on the distractive and horrific thoughts that most OCD patients normally have.
This mode of therapy aims at helping the patient to fill their minds and thoughts with more positive content so that they can avoid resorting to compulsive behavior. On the other hand, exposure and response prevention involves the constant exposure of the person to the source of a given obsession. For example, if a person has the obsession of hygiene and they are always cleaning their hands, the person can be made to touch a dirty surface then be prevented from washing their hands. Next, the patient can be made to sit somewhere for a while and with time, the urge to wash their hands will gradually fade away. With time, the person will realize that their compulsive behavior can be controlled without employing any obsessive or compulsive behaviors.
Pharmacotherapy is also another mode of treatment for adults with obsessive or compulsive behaviors. The modern approach used in pharmacotherapy began in the late 1960’s when some drugs such as clomipramine was shown to be effective in treating OCD (Klein et al, 2013). This mode of treatment was later adopted to involve the mechanism of drug action of clomipramine (Lihua et al, 2014). This is a non-selective chemical that enhances the re-uptake of serotonin during a synapse. Pharmacotherapy can also involve selective serotonin reuptake inhibitors or SSRIs such as paroxetine, fluoxetine and citalopram (Jacob and Storch, 2013).
Both the selective and the selective re-uptake inhibitors where developed due to the deficiency in the functioning of serotonin among OCD patients (Lihua et al, 2014). Therefore, these drugs normally function by blocking the uptake of serotonin during the pre-synaptic stage. In turn, this increases the availability of serotonin at the postsynaptic receptors.
Clomipramine is the most intensively studied drug for the treatment of Obsessive Compulsive Disorder (Lihua et al, 2014). This drug has a couple of chemical properties that give it the ability to enhance the functioning of serotonin within the body. Apart from clomipramine, several other selective re-uptake inhibitors have been tested and proven effective in treating OCD. For instance, celexa has shown to be highly effective in treating Obsessive Compulsive Disorders in adults (Lihua et al, 2014). Pharmacotherapy can also involve the use of anti depressants although not all of them are effective in treating this disorder. Desipramine is a very effective antidepressant that has been used to treat symptoms related to compulsive and obsessive disorders.The rate of success of this drug has led to most psychologists recommending this drug to people with OCD related symptoms. However, the use of any drug is bound to have its own adverse drug reactions that differ depending on the efficacy of the drug and the lethal dose.
Clomipramine is the most effective selective re-uptake inhibitor for serotonin, but it has its own share of side effects. For example, this drug is known to cause seizures and some forms of heart conductivity problems. The risk of clomipramine related seizures increases if the lethal dose of the drug exceeds 250 milligrams. On the other hand, antidepressants such as desipramine have been known to cause nausea, constipation and dryness of the mouth. Therefore, the preferential drug to be used for pharmacotherapy should be evaluated based on the adverse drug reactions of each medication as well as the body metabolism of a patient. The common denominator for all of these drugs is to enhance the activity of serotonin in the nervous system. Since most neurons are normally separated from each other by a synapse, a neurotransmitter has to be released into this synapse so that a signal is passed across it. Therefore, when this process is blocked or restricted, it results in a number of disorders one of which is OCD.
As such, both selective and non-selective re-uptake inhibitors have the mechanism of inhibiting serotonin being drawn back into the pre-synaptic membrane. Ultimately, these drugs have been shown to be effective in the treatment of Obsessive Compulsive Disorder. There are other alternative methods that are used in the treatment of Obsessive Compulsive Disorder in adults. Most psychologists as well as psychiatrists recommend a number of activities that can help a person to overcome OCD. First, they should relabel themselves by recognizing that the intrusive actions and obsessive thoughts are being caused by the disorder. Therefore, such a person should try telling himself or herself the opposite of what they always feel compelled to do. For instance, a patient with OCD can train their minds to say that their hands are not dirty and they should not have the urge to wash them.
Secondly, the Obsessive Compulsive Disorder patients should reattribute themselves and realize that the severity of the thoughts or urges they have are actually caused by a chemical imbalance in the brain. In such a case, the person should confront the disease by saying that the obsessive thoughts are not being caused by themselves. Instead, they are being caused by false messages being transmitted from the brain, making them act in a bizarre manner. It is also important for OCD patients not to take the thoughts caused by the disorder at face value and instead focus on things that are more productive. They should regard these thoughts as senseless obsessions that have no meaning at all. Therefore, they should ignore them and pay no attention to them. Clinical psychologists have also developed different forms of family therapy, since this disease usually affects families and societies.
The symptoms that are exhibited by OCD are known to cause heart aching problems that affect the life of the individual, the immediate family members and society as a whole. Consequently, family therapy can be helpful in promoting the understanding of this disorder and help affected family members to reduce conflicts with the affected person. Psychologists encourage family members to treat the sick member in a lovable way, motivate them to become better and heal from the disorder. There are also self-help tips that can be applied in combination with pharmacotherapy or cognitive therapy. Patients with OCD should divert their attention from the strong urges and obsessions to other helpful activities. For instance, they can listen to music, read, go for a walk or jog or even prepare a favorite dish. The importance of doing this is to delay the response to that particular compulsive though that the patient can have.
The outcome of this delay is that the urges become less intense than it was in the first place. Therefore, the longer this urge is delayed, the easier it becomes to forget and eventually refrain from engaging in the habit. Since the disorder is often caused by problems of anxiety, a healthy lifestyle should be adopted to try to reduce this fear and anxiousness. Patients with Obsessive Compulsive Disorder should exercise regularly, have ample rest and observe a healthy balanced diet. Cognitive behavioral therapy is a form of cognitive therapy that can be used to regain the control of the behavior of OCD patients. This mode of treatment works under the principle that thoughts are responsible for causing anxiety. Therefore, these thoughts can be altered by using a number of behavioral responses that will eliminate anxiety. Different forms of therapy will work at varying levels depending on the patient. Some patients will respond successfully to one mode of treatment will others may show no change at all. The first step in successful treatment of this disorder is accepting that one has the disease. This will then be followed by searching for the appropriate mode of treatment that will be effective in the end.
e) Genetics of Obsessive Compulsive Disorders
The psychological condition of Obsessive Compulsive Disorder has been shown to be hereditary and can be passed down from a parent to the progeny. Genetically speaking, OCD is caused by a mutation in the gene that is responsible for anxiety and worry. This mutation has been located in the human serotonin transporter gene, which is known as hSERT and occurs in families with OCD. Identical twins can also be at risk of developing OCD because they contain a hereditary factor that controls neurological anxiety. Patients with ICD are much more likely to have their firstborns developing the disorder since they are the first progeny in the hereditary tree. If Obsessive Compulsive Disorder develops during the childhood stage, the genetic links become much stronger than if the disorder was to develop during adulthood.
The genetic factors of OCD account for approximately seventy percent of the symptoms that are observed among adults. The genetic factors of OCD are also affected by environmental parameters, which interfere with how the signs of this disorder are expressed. There is a genetic link between this disease and its occurrence in different environments (Gomes et al, 2014).
OCD has also been shown to affect close relatives of people who previously suffered from this disease. The genes that are of great intrest in OCD are those that control and regulate the serotonin and dopamine neurotransmitters in the brain. The genes behind these neurotransmitters can be linked to the strong inheritance of this disorder (Gomes et al, 2014). There is also a group of researchers who have identified a genetic marker that is responsible for causing Obsessive Compulsive Disorder.
The cause and mechanisms of OCD are poorly understood despite the disorder being the fifth common psychological condition in the world. A genome related study has been conducted where the genomes linked to OCD have been scanned and compared to those of healthy people (Gomes et al, 2014). The findings revealed that there is a deletion mutation in the genes of people with OCD that caused them to have obsessive and anxious moments. OCD as a psychological disorder has a genetic architecture that has many different genes and they can be as many as one hundred in one individual. The identification of the specific genes that predispose a person to the risk of inheriting OCD are still being researched on to date. These studies involve a genome wide research that endeavors to find the specific target genes and compare them to the controls. In addition, there is also the genome wide trait analysis that compares genetic variation across the entire OCD genome. This method is able to test multiple OCD sites at one go and can also estimate the proportion of heredity of this disorder. The preliminary results of this study have showed that the level of heredity of this disorder is as close as what was predicted in the families of people with a history of OCD .
f) Current controversies about the biology of the disorder and the appropriate next steps for researchers to take to resolve them.
The biggest controversy behind the biology of OCD lays the medical approaches that have been used to treat the condition. While some researchers believe that the re-uptake inhibitors are highly successful, others believe that the chemicals only worsen an already serious condition. Obsessive Compulsive is a condition that has had numerous clinical explorations in an exponential manner. However, the research in the biological factors of the disease continues to witness disagreements in the advances that have already been made. The recent findings concerning the heredity of this disorder and the identification of certain presumed subtypes continues to elicit different reactions. In addition. The development of sophisticated theoretical models to help understand OCD has until recently been the topic of discussion.
Despite these controversies, the efforts research has put into understanding the nature of the disease should be appreciated. The advances in its treatment now range from medical attention to changes in cognitive behavior. However, these modes of treatment are not always effective to every OCD patient and that is why they have brought a lot of controversy.
There are a couple of steps that researchers are taking to ensure this disorder is transformed from the unmanageable condition it is to a problem that can be managed. Psychologists now view OCD as a disease that can be treated and help increase the quality of life of the affected individual. The disciplinary lines between cognitive behavior and biology of OCD remain the most common areas that are researched on when it comes to this disease.
Scientists are aware that medical approaches have been highly valuable in explaining the biological processes of OCD. In addition, the psychological formulations of OCD only emphasize the vital role of dysfuctional and learning cognitions. Regardless of these facts, the empirical findings from each theoretical speculation are gaining a diverse range of perspectives.
There have also been controversies surrounding some of the symptoms that come with OCD in adults. Compulsive hoarding is one of the serious signs of this disorder and involves the storage of unnecessary items. This usually results in cluttering and untidiness of the living area and is brought about by distress or impairment by the OCD patient. This symptom causes a lot of controversy since there are many people who have the habit of hoarding their items and yet do not suffer from OCD.
It is this controversy that has led to a fresh line of new and exciting research so as to increase the understanding of this syndrome. This issue has since continued to be debated upon and has led to newer advances regarding compulsive hoarding. Researchers have concluded that this hoarding is usually brought about by the obsession to collect as much property and items as possible. People with OCD will often believe that throwing away their belongings makes them evil and inhuman. Therefore, their thoughts will always tell them that keeping these things is a sure way of showing the world that they are good people. However, this behavior should not be confused with people who often prefer to keep their belongings in the garage as a way to remember their valuables.
In another angle, controversies also exist in areas where literature concerning the disease remains unclear, under-developed and contradictory. For instance, it still remains unclear if OCD should be categorized purely as an anxiety disorder or it should be considered as a different type of disorder. Secondly, there are many controversies that surround the existence and understanding of paediatric OCD. In addition, psychologists are yet to agree on an optimal mode of treatment for this disorder since different patients will respond differently to all the various types of treatment. Some people are still in doubt when it comes to combining pharmacotherapy with other ways of psychological treatment (Melca et al, 2013). Researchers are of the view that this approach is highly successful as it combines both biological and psychological healing (Melca et al, 2013). It has already been shown that the use of chemical drugs to compensate for the failure of serotonin neurotransmitter aids in the reduction of OCD (Martinelli et al, 2014).
In addition, it is able to contain anxiety and feelings in OCD patients, which is the main cause of the disorder. Despite these disagreements, research is looking at how best to disseminate the results of the evidence-based treatments (Melca et al, 2013).
The potential role of autoimmune related disorders that are associated with certain bacterial infections has also been linked to OCD. This is quite contradicting since literature states that the only biological cause of this disease lies in the malfunctioning of the neurotransmitters (Melca et al, 2013). What’s more, the structure of the disorder as well as the subtypes are a source of disagreements among most psychiatrists. The relative contributions of genetics versus the environmental factors are well known to be risk factors for an individual to develop OCD. However, this knowledge is not entirely conclusive and it is still under close scrutiny (Thomsen, 2013).
g) Conclusion
Obsessive Compulsive Disorder is a serious psychological condition that affects mainly adults across the globe. The condition is mainly characterized by a severe obsession and compulsive behavior that makes people engage in weird behavior. In addition, this disorder causes the affected person to perform a certain habit or activity in a repetitive or persistent manner without getting any form of returns from it. For example, most OCD patients will wash their hands so thoroughly that they can end up getting blisters and serious scars. They wash their hands to a serious extent because they think that their hands are dirty and may contaminate their bodies or people around them. OCD usually begins as an obsession that simply refuses to go away. It arised from the need to eradicate a given urge that is brough about by inner feelings that the person wants to sustain. Obsessive Compulsive Disorder can be caused by psychological factors as well as biological problems. The psychological cause is brough about by the paerson feeling inadequate, dirty, insecure and threatened. That is why a person can counter check if they have switched off the kitchen cooker twenty times even if they stopped cooking more than six hours ago.
In terms of biological causes, OCD is attributed to the malfunctioning of certain neurotransmitters such as serotonin and dopamine. Neurotransmitters are important chemicals that relay information between the pre and post synapse. These chemicals are usually released from the cerebrum of the brain and their absence results in serious mood, feeling and emotion disorders. For the case of OCD, serotonin is the most common neurotransmitter that usually malfunctions in most people. It is released from the brain, but is not able to pass across the post synapse. Therefore, most treatment options focus on enhancing the role of serotonin in OCD patients. Selective and non-selective re-uptake inhibitors work by restricting serotonin from being drawn back to the pre-synaptic membrane. Instead, they ensure that this chemical messenger is able to pass through the fluid filled synapse into the postsynaptic area.
Several forms of therapy such as pharmacotherapy have been used to treat OCD. This form of treatment employs drugs that enhance the activity of serotonin and dopamine. However, these forms of treatment can only be effective if the patient adopts a healthy lifestyle. In addition, they can also engage in activities that will divert their attention from the obsessive habits. There are current controversies about the biology of this disorder that have made researchers focus their time in resolving them. For example, the genetic issues regarding OCD are yet to become fully conclusive. The genome for OCD is being sequenced so that the active genes responsible for the disease can be identified. However, it is clear that this disorder is hereditary and can be passed on from parent to offspring. What’s more, a close relative is at risk of developing this disease since they are within the family tree of the OCD patient. It is anticipated that ongoing research will bring a lasting solution to solve the fourth common psychiatric illness across the globe.
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