1 / 48

OCD MANAGEMENT

Obsessive-Compulsive Disorder (OCD) is a mental health condition marked by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) performed to reduce anxiety or distress. This presentation explains what OCD is, how it develops, and why obsessions feel so powerful and uncontrollable. It highlights common OCD themes such as contamination, checking, intrusive thoughts, harm fears, doubt, and mental rituals.

Emotion
Télécharger la présentation

OCD MANAGEMENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Obsessive-compulsive disorder

  2. Shyam Gupta OCD Specialist Therapist Emotion of Life OCD Treatment Research and Training Institute, Agra, India

  3. What this presentation covers Background Epidemiology Neurobiology Stepped care Pharmacological treatments

  4. Background OCD is a potentially life-long disabling disorder and is poorly recognised and under-treated People in some studies report waiting an average of 17 years before the correct management is started

  5. What is OCD? Obsessive-compulsive disorder (OCD) Characterised by the presence of either obsessions (repetitive, distressing, unwanted thoughts) or compulsions (repetitive, distressing, unproductive behaviours) – commonly both. Symptoms cause significant functional impairment/distress Diagnostic criteria ICD-10/DSM-IV – must include the presence of either compulsions or obsessions

  6. Epidemiology • The lifetime prevalence of OCD in general population in 2-3%, that means 2-3 persons in every hundred persons have OCD in their lifetime • It affects men and women equally. • Fourth most common mental disorder after depression, alcohol and substance abuse, and social phobia

  7. •Incidence • Male predominance in childhood, probably attributed to earlier age of onset in males but this eventually equalizes with age. • Onset: Before the age of 25years (50–65% of the patients). • Peak incidence: Around the age of 20years. • Over 85% of patients will have developed the illness before the age of 35years.

  8. Practical approach to the treatment would be as follows- 1.Early screening for the illness —identify juvenile onset or adolescent onset OCD 2.Considering a differential diagnosis if required 3.Maximisingthe effectiveness of the first trials of either pharmacotherapy or behaviourtherapy or both 4.Identifyingco-morbidities 5.Addressing the psychosocial issues 6.Better utilisation of the available non-drug treatments (multimodal CBT, Intensive individual and/or group therapy)

  9. Stepped care model The model provides a framework in which to organise the provision of services in order to identify and access the most effective interventions Stepped care attempts to provide the most effective but least intrusive treatments appropriate to a person’s needs The recommendations in the NICE guidance are structured around the stepped-care model

  10. Differentiate from OCD: Major depression: depressive rumination vs. obsessive rumination(repetitive thoughts in Obsessive rumination are irrational, intrusive and of neutral content while that of depressive rumination usually involve day to day experience and events). • Bipolar disorders: racing of thoughts vs. repeated intrusive thoughts of OCD,(Racing thoughts, flight of ideas and prolixity have some lively embellishment and differ from repetitive intrusive ego-dystonic thoughts of OCD).

  11. Severity rating scales Yale‐Brown Obsessive‐Compulsive Scale (YBOCS): symptom checklist and severity rating scale (adult and child versions) -. Use in both children and adult. Gold standard tool • Scales to assess insight in OCD • Yale‐Brown Obsessive‐Compulsive Scale (YBOCS) • Brown‐Assessment of Beliefs Scale (BABS) • Overvalued Ideas scale (OVIS)

  12. Anxiety disorders (have more autonomic arousal than in OCD), including PTSD-flashbacks vs. obsessive images and thoughts (the flashbacks of PTSD are reliving experience of past traumatic event and have to be differentiated). • Phobia: vs. obsessive fear. Psychotic disorders: delusions vs lack of insight in OCD. • Organic mental disorders -intrusive thoughts vs. forced thinking. • Habit disorders, Impulse control disorders • OCPD • Schizotypal disorder: obsessive ruminations and magical thinking.

  13. There are 3 main modes of management of OCD- • PHARMACOTHERAPY • BEHAVIOUR THERAPY • EXPERIMENTAL

  14. Stepped care model Who is responsible for care? STEP 6Inpatient care or intensive treatment programmes. CAMHS Tier 4 STEP 5Multidisciplinary teams with specific expertise in management of OCD. CAMHS Tiers 3 and 4 STEP 4Multidisciplinary care in primary or secondary care. CAMHS Tiers 2 and 3 STEP 3GPs and primary care team, primary care mental health worker, family support team. CAMHS Tiers 1 and 2 STEP 2GPs, practice nurses, school health advisors, general health settings. CAMHS Tier 1 STEP 1Individuals, public organisations, NHS

  15. STEP 1 Awareness and recognition • Mental healthcare trusts and children’s trusts that provide mental health services should: • Have access to a specialist OCD multidisciplinary team offering age-appropriate care • Specialist mental healthcare professionals/teams in OCD should: • collaborate with local and national voluntary organisations to increase awareness and understanding of the disorders and improve access to high quality information about them • collaborate with people with the disorders and their family/carers to provide training for all mental health professionals

  16. Step 2 Recognition and assessment of OCD: 1 Routinely consider and explore the possibility of comorbid OCD for people: • at higher risk of OCD, such as those with symptoms of: - depression - anxiety - alcohol or substance misuse - BDD - an eating disorder • attending dermatology clinics Ask direct questions about possible symptoms

  17. Step 2 Recognition and assessment of OCD: 2 For any person diagnosed with OCD: • assess risk of self-harm and suicide (particularly if depression already diagnosed) • include impact of compulsive behaviours on patient and others in risk assessment • consider other comorbid conditions or psychosocial factors that may contribute to risk • consult mental health professional with specific expertise in OCD if uncertain about risks associated with intrusive sexual, aggressive or death-related thoughts. (These themes are common in OCD and are often misinterpreted as indicating risk.)

  18. Steps 3 to 5 treatment options for adults with OCD : 1 Mild functional Moderate functional Severe functional impairment impairment impairment Inadequate response at 12 weeks Brief CBT (+ERP) < 10 therapist hours (individual or group formats) Offer choice of: more intensive CBT (+ERP) >10 therapist hours or course of an SSRI Multidisciplinary review Offer combined treatment of CBT (+ERP) and an SSRI Patient cannot engage in/CBT (+ERP) is inadequate Next slide See the QRG for full overview of treatment pathway

  19. Steps 3 to 5 treatment options for adults with OCD : 2 Severe functional impairment: • offer combined treatment with CBT (including ERP) and an SSRI inadequate response or the patient cannot engage Offer either: a different SSRI or clomipramine inadequate response or the patient cannot engage Refer to multidisciplinary team with expertise in OCD inadequate response or the patient cannot engage Consider: • additional CBT (including ERP), or cognitive therapy • adding an antipsychotic to an SSRI or clomipramine • combining clomipramine and citalopram

  20. Steps 3 to 5 for children and young people with OCD : 1 Mild functional Moderate to severe impairment functional impairment Consider guided self-help support and information for family/carers Offer CBT (+ERP) involve family/ carers (individual or group formats) Consider an SSRI (with careful monitoring) Ineffective or refused Ineffective or refused Next slide Please refer to QRG for full overview of treatment pathway

  21. Steps 3 to 5 for children and young people with OCD : 2 Consider an SSRIand carefully monitor for adverse events inadequate response or the patient cannot engage Multidisciplinary review inadequate response or the patient cannot engage SSRI + ongoing CBT (including CBT) • Consider use in 8-11 year age group • Offer to 12-18 year age group • Carefully monitor for adverse events, especially at start of treatment inadequate response or the patient cannot engage Consider either (especially if previous good response to): • a different SSRI • clomipramine

  22. Adults with OCD For OCD with moderate functional impairment offer: • a course of an SSRI, or • more intensive CBT For BDD with moderate functional impairment offer: • a course of an SSRI, or • more intensive individual CBT (including ERP) that addresses key features of BDD

  23. Children and young people with OCD For OCD with moderate to severe functional impairment, or mild functional impairment for which guided self-help has been ineffective or refused, offer CBT (including ERP) that involves the family or carers and is adapted to the developmental age of the child Offer group or individual formats depending on the preference of the child or young person and their family or carers

  24. Children and young people with OCD For moderate to severe functional impairment and an adequate response to CBT, carry out multidisciplinary review, then: • for a young person (aged 12-18 years) offer to add an SSRI to ongoing psychological treatment • for a child (aged 8-11 years) consider adding an SSRI to ongoing psychological treatment Monitor carefully, particularly at the beginning of treatment

  25. PHARMACOTHERAPY

  26. Pharmacological treatmentsadults: starting treatment Address common concerns about taking medication with the patient, such as potential side effects including worsening anxiety Explain that OCD responds to drug treatment in a slow and gradual way and that improvements may take weeks or months

  27. Pharmacological treatments adults: choice of drug Initial pharmacological treatment should be an SSRI If drug treatment effective, consider continuing for 12 months to prevent relapse and then review with the patient Consider prescribing a different SSRI if prolonged side effects

  28. Pharmacological treatments adults: monitoring risk Monitor closely on a regular basis particularly: • early stages and dose changes of SSRI treatment • adults younger than 30 • people who are depressed or considered to present an increased suicide risk Consider prescribing limited quantities of medication Consider enlisting others, for example carers, to contribute to monitoring until risk is no longer significant

  29. Pharmacological treatmentsadults: response to treatment • Symptoms not responded adequately within 12 weeks to SSRI or CBT (including ERP)? Conduct multidisciplinary review • Consider combined treatment of CBT (including ERP) and an SSRI • Not responded to combined treatment? Consider different SSRI or clomipramine • Still not responded? Consider referral to OCD multidisciplinary team for assessment and treatment planning

  30. Pharmacological treatments adults: discontinuing treatment Taper the dose gradually when stopping treatment in order to minimise potential discontinuation/withdrawal symptoms Encourage people to seek advice if they experience significant discontinuation/withdrawal symptoms

  31. Pharmacological treatments: children and young people CBT ineffective or refused, carry out multidisciplinary review and consider adding an SSRI Sertraline and fluvoxamine are the only SSRIs licensed for use in children and young people with OCD Monitor carefully and frequently If successful, continue for 6 months post remission Withdraw slowly with monitoring

  32. Step 6: intensive treatment and inpatient services People with severe/chronic problems should have continuing access to multidisciplinary teams with specialist expertise in OCD Inpatient services are appropriate for a small proportion of people with OCD A small minority of adults will need suitable accommodation in a supportive environment in addition to treatment

  33. Overall treatment outcome: About 40-60% patients respond well to SSRI therapy. About 30% appear to be resistant to first line of treatment.

  34. Discharge after recovery When in remission, review regularly for 12 months by a mental health professional – frequency to be agreed between the healthcare professional and person with OCD At the end of the 12-month period if recovery is maintained the person can be discharged to primary care If relapse – see as soon as possible

  35. Special issues for children and families Symptoms are similar in children, young people and adults and they respond to the same treatments Stress may worsen symptoms or cause relapse: • school transitions • examination times • relationship difficulties • transition from adolescence to adult life Parents may feel guilty and anxious Increase in severity if left untreated

  36. Needs of people with OCD Early recognition, diagnosis and effective treatment Information about the nature of OCD and treatment options Respect and understanding What to do in case of relapse Information about support groups Awareness of family/carer needs

  37. EXPERIMENTAL MODE OF TREATMENT 1. Intravenous SSRI (Clomipiramineand Citalopram) • 2. Electroconvulsive Therapy (ECT) • 3. r TMS • 4. Deep brain stimulation (DBS) • 5. Vagal nerve stimulation (VNS) • 6. Psychosurgery

  38. Deep brain stimulation

  39. Transcranial magnetic stimulation

  40. THANK YOU

  41. Behavioural Intervention

  42. Psychological interventions children and young people • Guided self-help, CBT (including ERP) recommended • Work collaboratively and engage the family or carers • Identify initial and subsequent treatment targets collaboratively with the patient • Consider the wider context including other professionals involved with the child • Maintain optimism in child and family or carers • Consider rewards to enhance motivation

  43. Psychological interventions adults: 1 CBT (including ERP) is the mainstay of psychological treatment Consider CBT (including ERP) for patients with obsessive thoughts without overt compulsions Consider cognitive therapy adapted for OCD: • as an addition to ERP to enhance long-term symptom reduction • for people who refuse or cannot engage with treatments that include ERP

  44. Psychological interventions adults: 2 If a family member/carer is involved in compulsive behaviours, avoidance or reassurance seeking, treatment plans should help them to reduce their involvement in a supportive way The intensity of intervention is dependent upon the degree of functional impairment and patient preference

  45. Thank You If you or your loved one is struggling with OCD and seeking recovery, please reach out to us by Call: 9368503416 WhatsApp: 9368503416 Visit our website at www.emotionoflifeindia.com E-mail at info@emotionoflife.in

More Related