Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Phillipa on August 28, 2009, at 23:34:33
Never realized OCD had so many variations. Also Many treatments and requires higher doses of meds Phillipa
From Medscape Medical News
Best Practices for Treating Obsessive-Compulsive Disorder in Primary Care Setting
Laurie Barclay, MD
August 24, 2009 Recommendations for diagnosing and treating obsessive-compulsive disorder (OCD) in the primary care setting are reviewed in the August 1 issue of American Family Physician."...OCD is a neuropsychiatric disorder characterized by recurrent distressing thoughts and repetitive behaviors or mental rituals performed to reduce anxiety," write Jill N. Fenske, MD, and Thomas L. Schwenk, MD, from the University of Michigan Medical School in Ann Arbor.
"Symptoms are often accompanied by feelings of shame and secrecy because patients realize the thoughts and behaviors are excessive or unreasonable. This secrecy, along with a lack of recognition of OCD symptoms by health care professionals, often leads to a long delay in diagnosis and treatment. OCD has a reputation of being difficult to treat, but there are many effective treatments available."
Despite the considerable distress and disability accompanying OCD, it is often unrecognized and undertreated. Primary care physicians should be able to recognize various presentations of OCD as well as clues regarding the presence of obsessions or compulsions. Children with OCD and adults who are refractory to treatment should be referred to a specialist.
Subtypes of OCD
Various subtypes of OCD, and their typical presenting features, are as follows:
Early-onset OCD: This subtype typically manifests symptoms before puberty, with higher frequency of tics and other psychiatric comorbidities vs the other OCD subtypes. Compulsions, which are often severe and frequent, usually are evident before obsessions develop. Early-onset OCD is less responsive to first-line therapy than the other subtypes, and there is a strong familial predisposition, with incidence of 17% among first-degree relatives.
Hoarding OCD: Patients with this subtype usually have less insight vs other OCD subtypes and may be less responsive to psychological therapy. Symptoms are often more severe, with a greater degree of global impairment, and rates of psychiatric comorbidities are higher, especially for social phobia.
"Just right" OCD: In this subtype, the primary manifestation is a desire for circumstances or things to be "perfect," "certain," or "under control," resulting in a need to repeat certain actions to alleviate the uncomfortable feeling.
Primary obsessional OCD: This subtype occurs in one quarter of patients, with common themes including sex, violence, and religion. Although overt compulsions are absent, patients are not free from rituals, which may be mental, such as praying, counting, or reciting "good words." Although this subtype has been considered to be less responsive to treatment, patients do respond to medication and exposure and response prevention.
Scrupulosity OCD: This subtype, which is characterized by religious or moral obsessions, can be devastating for patients in whom faith or religious affiliation is important. The obsessions may involve blasphemous thoughts or focus on whether the patient has committed a sin, and the accompanying compulsions may include prayer, seeking reassurance from clergy, or excessive confession.
Tic-related OCD: This subtype overlaps significantly with early-onset OCD, and many patients meet criteria for Tourette's syndrome. Comorbid conditions often occur, such as, attention-deficit/hyperactivity disorder, body dysmorphic disorder, trichotillomania, social anxiety, and/or mood disorders. Hoarding and somatic obsessions typically occur. This subtype often requires combination treatment including a selective serotonin reuptake inhibitor (SSRI) and an atypical antipsychotic.
Initial OCD Treatment StepsImportant initial steps in facilitating recovery include correct diagnosis and educating the patient concerning the nature of OCD. Treatment is indicated when OCD symptoms cause impaired function or significant distress for the patient. Although treatment rarely cures the patient with OCD, significant symptomatic relief is achievable. Reasonable goals for treatment would be to spend less than 1 hour per day on obsessive-compulsive behaviors, causing minimal interference with daily activities.
First-line therapy should consist of cognitive behavioral therapy with exposure and response prevention, or pharmacotherapy with an SSRI, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. Physicians should be aware that medication dosages required in OCD often exceed those needed for other indications, and there is also usually a longer duration of treatment needed before response becomes apparent.
For patients with OCD who are resistant to treatment, feasible options for therapy may include augmentation of an SSRI with an atypical antipsychotic. Because OCD is a chronic condition with a high rate of relapse, treatment should be discontinued only with caution. Patients with OCD should be carefully monitored to detect possible comorbid depression and suicidal ideation.
OCD Clinical Recommendations
Specific key clinical recommendations for practice, and their accompanying level of evidence rating, are as follows:
Cognitive behavioral therapy including exposure and response prevention is an effective modality for OCD treatment (level of evidence, A).
Recommended first-line pharmacotherapy for OCD is SSRIs, which have been shown to be effective (level of evidence, A).
In some patients with treatment-resistant OCD, augmentation of SSRI therapy with atypical antipsychotic agents is effective (level of evidence, B).
Optimal duration for a trial of SSRI treatment is 8 to 12 weeks, with at least 4 to 6 weeks at the maximal tolerable dosage (level of evidence, C).
Before attempting discontinuation of SSRIs, patients should take these drugs for at least 1 to 2 years. To help prevent relapse when SSRIs are discontinued, the treating physician should consider exposure and response prevention "booster" sessions (level of evidence, C).
Patients with OCD should be monitored for psychiatric comorbidities and suicide risk (level of evidence, C).
"Patients with treatment-resistant OCD should be referred to a subspecialist," the study authors conclude. "There are a variety of treatment options for these patients, but the evidence for most therapies is based on small preliminary studies or expert opinion. Partial hospitalization and residential treatment facilities are options for patients with severe, treatment-resistant OCD."
Posted by Garnet71 on August 29, 2009, at 0:22:14
In reply to Subtypes Of OCD and Treatments, posted by Phillipa on August 28, 2009, at 23:34:33
I never knew all that either, Phillipa.
My son had tics when he was very young; always had real bad ADHD now ADD..and has some signs of OCD with the way he keeps his room, etc...I worry about him....
Stuff on the unconscious causes of OCD:
"The underlying dynamic of obsessive or compulsive behavior is usually the unconscious attempt to neutralize feelings of anger, which are perceived by the afflicted person as objectionable and shameful. (In contrast, a disorder of impulse control often involves blatant acts of hostility, destructiveness, danger, or risk.)
OCD should not be confused with Obsessive-Compulsive Personality Disorder, which is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control. Such a personality can be inflexible, rigid, stubborn, and miserly."
http://www.guidetopsychology.com/reasons.htm
Oh-you gotta read about anger and how it manifests into all our symptoms:
..."In fact, the proof of all this can be found in Obsessive-Compulsive Disorder where a person who feels overwhelmingly ashamed of these fantasies of revenge will construct elaborate rituals to neutralizeor undothese bad thoughts."
http://www.guidetopsychology.com/anger.htm
Interesting stuff.
Posted by yxibow on August 29, 2009, at 1:18:16
In reply to Subtypes Of OCD and Treatments, posted by Phillipa on August 28, 2009, at 23:34:33
Yes, there are numerous and endless varieties of these subtypes of OCD.
The OC Spectrum Disorder includes OCD, Trichotillomania, Tourette's, Tic disorders among others, and possibly gambling/compulsive shopping, although I'm not sure if it quite fits the same realm.
OCPD as noted is an Axis II disorder, different from OCD, it is a personality disorder.
It is biologically based and a lifetime illness, but triggered/awakened by some organic change (puberty is very common) and/or psychological reason.
In treatment for my OCD, which was a 39/40 on the YBOCS scale, I encountered probably most of these types of OCD in the support group and program I was in.
As for my own OCD... Things waxed and waned through different phases, some being on top of each other, most separate... I had pretty much the gamut of what is commonly seen in OCD.
Puberty and knowing I was gay just shortly afterward was the biggest contributor.
I had "magical thinking" that people would know at school that I was... let's say pleasing myself because I was thinking of males.
There was hoarding, useless garbage hoarding which didn't last that long, newspaper hoarding which lasted longer and was hard to get rid of things, and finally the spread of "ick", which was first semen, and then everything you can think of toilet related.
And suddenly most everything was untouchable... washing hands scaled up to 30 minutes (so much that my hands turned bone white and were noticeable in school and I had to make up some excuse for that)... showers to 7 hours at the end before I chose hospitalization (which in today's economy, insurance, costs, etc is basically an impossibility for the more than two months I stayed.)
But while the hospitalization was no picnic, through the day treatment program I learned the tools to be able to fight OCD. I still have latent tendencies of that sort but nobody can completely erase it. Even a "control" group could have 9 or 10 on a YBOCS.
I never had religious based OCD or checking.
I heard other people's stories -- someone who had terrible sexual thoughts about their mother, someone who had comorbid bipolar I think, fears of germs (mine was the spreading 'ick' that everything had some human excretion on it rather than microbes), and countless other things I don't remember now -- I think someone with a checking story.
One variety of checking besides the common, did I turn off the stove and do all I need to do, ten times over, before leaving the house and maybe coming back to do it....
...is a type of checking where the individual is scared that they ran over someone just because they feel a bump in the road. They go back and maybe again to check whether a body is there.
Today my OCD manifests itself in really a semi-O disorder... garbage thoughts when my anxiety symptoms are triggered high, just really random things that come in my mind that are very hard to stop as those with "Pure O" can attest to."Pure O" usually involves a single thought, like that person with Oedipal thoughts that I mentioned, that goes like a single track. I don't know how it is conquered by some, but it may require augmentation of a low dose antipsychotic with an SSRI if a high dose of an SSRI does not work.
Using "STOP" and "replacement thoughts" for such conditions are questionable by some psychiatrists/psychologists. It doesn't always work. I know personally that when this phase comes on, "letting them stream anyhow" doesn't really do a lot and may make it worse because I focus on it.
In fact focusing on a task helps my multi-comorbid disorder better (somatic [pain, and a gamut of other things], O/OCD components, unknown Psychosis NOS possibly involving D2, GABA and other things with an unknown etiology or source.).
Being raised in a strict religious setting (I'm not saying that this happens to everyone who is), could trigger someone with OCD religious scrupulosity that is greater than whatever they were brought up with, in some psychological fashion.
Newspapers, who knows where that came from -- I had a "fear" that vital articles would never be saved, its hard to describe and I don't know where it came from.
Its ironic that I got a related degree in college.
About 99% of people with OCD know that they have OCD and that while they know that, they still have trouble trying to stop the compulsion (e.g. washing) because of the obsession (germs, et alia.).There's a small subset of people with OCD that may have comorbid Psychosis Spectrum disorders or may have simply a psychotic form of OCD where they do not realize this. This may require extra care, and antipsychotic therapy or other interventions.
Anyhow my point is, yes, there are many many ways the biological condition that is OCD becomes expressed in psychological ways.
-- tidings
Posted by Phillipa on August 29, 2009, at 12:18:01
In reply to Re: Subtypes Of OCD and Treatments » Phillipa, posted by Garnet71 on August 29, 2009, at 0:22:14
You know it's strange you don't often hear of people on these boards at least discussing this complicated process but I know that being in a dysfunctional childhood where I was blamed for my Mother's illness and death and being her caretaken left me feeling it was all my fault. I stuffed it and kept busy with school and dating and marrying and moving til now and now that I have no choice in whether I work or not. I know my problem it's lack of time left on this earth and knowing I can't change the past or the future. So after trying unsuccessfully with a threapist to come to terms with age and aging I was told well you aren't well and it's a year. I was basically given a time frame and life isn't like that. Like oh take tylenol and your headache will be gone. Jay I know how devastating your illness is for you and being so young. Is there really an answer? And yes I'm angry as I need more time which means a longer life. Honestly I feel cheated. I appreciate your well thought out replies and see what a complex topic it is. More threads by others would be helpful. Love to both Phillipa/Jan
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