Transcript Neal C M Hattersley Lynne M Drummond

Supporting the Person with OCD
Lynne M Drummond
Copyright L M Drummond
What is OCD?
• A condition where the individual is
plagued by nasty, horrible, frightening
intrusive thoughts
• These thoughts cause the individual
distress and often anxiety
• To overcome this anxiety/distress the
individual seeks some relief by…..
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Individual seeks relief from horrible
intrusive thoughts by:• Performing anxiety reducing
compulsions (rituals)
– Eg washing; counting; undoing; cancelling
et c.
• Asking for reassurance
– From family; friends even health
professionals
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Compulsions/Rituals/Reassurance
Anxiety
Anx iety
rises
Feeling
‘c ont aminated’
Rit ualis ation
Anx iety reduc es
- only a lit tle
- not f or long
Time
Copyright L M Drummond
Education about the role of Compulsions/ Reassurance/
Rituals (Adapted from Stern and Drummond, 1991)
Anxiety
Anx iet y
init ially
rises
Breaking t he c y c le s elf -imposed res pons e prev ention
Copyright Lynne M Drummond
Anx iet y ev entually reduc es it f alls higher than when rit ualisation oc curs
Time
Theoretically then treatment is easy!!!!
Hang on!!! First things first!!
Does the OCD Sufferer want
Treatment?
• Remember it is their problem (and should
not be yours)
• They need to be ready to undergo treatment
– Psychological treatment require commitment and
also is TOUGH as involves facing up to fear
– Drug treatment may lead to some side-effects and
again needs commitment
• Sometimes an individual has not reached
their own “rock bottom”
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What can you do if your loved-one does
not want treatment at this point??
What can you do if your loved-one does
not want treatment at this point??
• Consider your own health and that of
other family members first
–
–
–
–
You are the “healthy people” and need to set the “house rules” of
what you will or will not tolerate
You may need to consider asking sufferer to leave. You have a
right to your own life!!
Consider any children first and foremost. They need protection
from OCD!!! They need to not be subjected to OCD restrictions
and involvement in rituals. If there is any doubt then need to
request a Child Safeguarding Assessment
Your safety is vitally important and must be protected at all times!!
In some cases Police need to be involved
Copyright L M Drummond
Your own health and safety
• Can be very difficult as it may feel you are
being unpleasant to the OCD sufferer
• Remember it is the OCD you abhor and NOT
the OCD sufferer
• Looking after yourself and other family
members is in the OCD Sufferer’s interests
too!!!!!
Copyright L M Drummond
What can you do if your loved-one does
not want treatment at this point??
• Be encouraging and supportive but not overinvolved (which may lead them to “dig in their
heels”
– People with OCD may have restricted lives and
live in a way normally see with a much younger
individual
– They may rebel
– Some OCD Sufferers are desperate to have
control and vehemently resent anyone seen as
trying to restrict this
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What can you do if your loved-one does
not want treatment at this point??
• Try not to get swept up with performing more
and more OCD compulsions and rituals for
them
– It will often seem easier and better to do things in
an OCD way or give repeated reassurance. It will
stop the distress in the short-term but will
undoubtedly escalate and lead to increasing
requests in time
• Try to get support and help for yourself. YOU
NEED TO REMAIN STRONG!!
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What can you do if your loved-one does
not want treatment at this point??
• Set out “ground rules” of what is and what is
not acceptable to you and discuss these with
the OCD Sufferer
– Make these clear and simple and STICK BY
THESE RULES (just as you would with a child,
this establishes the boundaries of the relationship)
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What can you do if your loved-one does
not want treatment at this point??
• Learn what you can about OCD so that you
understand what is going on.
– It can be useful to know about both the drugs and
also about ERP so that you can help and support
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What are the treatments??
• Drug Treatments (generally starting with
SRIs)
• Cognitive Behaviour Therapy involving
Exposure and Response Prevention
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Drug Treatments for OCD
ACTION OF THE SRIs
Fronto-SeptoHippocampal
Circuits
LACK of
SEROTONIN IN OCD
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Serotonin Reuptake Inhibiting (SRI)
drugs
• CLOMIPRAMINE (225mg/day)
•
•
•
•
•
FLUVOXAMINE (300mg/day)
PAROXETINE (60mg)
FLUOXETINE (60mg)
SERTRALINE (200mg)
(CITALOPRAM and ESCITALOPRAM)
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Response to SRI Drugs
• Needs to be higher doses than those used for
depression....generally low dose has little/no
effect whereas high dose does.
• Can take up to 3 months to see benefit
• Benefits can continue to grow up to 2 years
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Side-effects and SRI drugs
• The older drug, Clomipramine, has more side-effects
than the newer ones (dry mouth; tiredness et c.)
• Newer SSRIs have fewer side-effects and most of
these will settle after a short while (Energising so
need to be taken in morning; can occasionally have
minor GI effects)
• None are addictive BUT if you stop them then need
to come off slowly and under medical supervision
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Despite this some people still do
not respond to SRIs or ERP
Fronto-SeptoHippocampal
Circuits
LACK of
SEROTONIN IN
OCD
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Basal
ganglia
circuits.
Mediated by
DOPAMINE
Efficacy of augmentation for OCD
with Dopamine Blockers
• Overall only 1/3 of SRI refractory patients improve
with addition of Dopamine Blockade (Bloch et al
2010).
• These drugs are sometimes named “anti-psychotics”.
This is because they are same drugs as used in
psychosis BUT IN MUCH LOWER DOSES ( e.g I
may use 2.5-5mg Aripiprazole as opposed to up to
30mg!!)
Copyright L M Drummond
CBT Treatment for OCD
Psychological Treatment of OCD.
Gold Standard = ERP
– Prolonged graduated exposure in real life
to the feared situation with self-imposed
response prevention
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Compulsions/Rituals/Reassurance
Anxiety
Anx iety
rises
Feeling
‘c ont aminated’
Rit ualis ation
Anx iety reduc es
- only a lit tle
- not f or long
Time
Copyright L M Drummond
Exposure and Response Prevention (Adapted from Stern and Drummond,
1991)
Anxiety
Anx iet y
init ially
rises
Breaking t he c y c le s elf -imposed res pons e prev ention
Anx iet y ev entually reduc es it f alls higher than when rit ualisation oc curs
Time
Copyright Lynne M Drummond
When undergoing ERP, the OCD Sufferer
will be:
• Anxious++
– The treatment works by the patient
becoming anxious and taking the risk. This
is the way to overcome the OCD fear
•
•
•
•
Maybe agitated
Maybe more preoccupied than usual
Maybe very tired
Maybe depressed to begin with
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What is it like to be the Carer in
these situations?
• Difficult to accept your “loss of role”
• Difficult to watch your loved one
undergoing stress and not step in
• You may be the person who receives
the “brunt” of the stress
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What can you do to help?
• Ask the OCD Sufferer what they need you to
do TO ASSIST THERAPY
– This is likely to mean NOT helping them perform
OCD Compulsions et c. And letting them “get on”
themselves.
• Ask the OCD Sufferer about REASSURANCE
and how to respond
– May agree a form of words such as “The hospital
has advised me not to answer questions like that
in order to help you overcome your OCD”
Copyright L M Drummond
What can you do to help?
• Be helpful and supportive without performing
“OCD tasks”
– Can be difficult as:
• “Old Habits Die Hard”
• It is difficult to watch someone struggling (remember that
you are not intervening as a way to help them overcome
their OCD)
• Aggression and violence are TOTALLY
UNACCEPTABLE and you must always look after
yourself first and foremost !!
Copyright L M Drummond
Your own health and safety
• Can be very difficult as it may feel you are
being unpleasant to the OCD sufferer
• Remember it is the OCD you abhor and NOT
the OCD sufferer
• Looking after yourself and other family
members is in the OCD Sufferer’s interests
too!!!!!
Copyright L M Drummond
What about other Psychological
Therapies??
• Psychotherapy
– This is the more “old-fashioned” talking therapy. IT
IS NOT USEFUL FOR OCD
• Family Therapy
– Not generally useful for OCD but may help in the
problems which develop as a result of the OCD
• Cognitive Therapy
• Mindfulness
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What about other Psychological
Therapies??
• Cognitive Therapy
– Not useful on it’s own and only in
combination with ERP.
• Mindfulness
– A more recent therapy. This can be used to
reduce general stress levels HOWEVER IT
IS NOT A TREATMENT FOR OCD
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What happens to the Family and
Carers AFTER OCD???
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What happens to the Family and
Carers AFTER OCD???
• Readjustment of roles within the
family/relationship
– Carers lose their role as carer which can be difficult
– There needs to be adjustment in family members
responsibilities
– This can lead to resentment and even depression in the
carer
• Learn or relearn what the loved one is
actually like as a person
– Previously the OCD has been masking the personality
– Can lead to relationship difficulties and even divorce
Copyright L M Drummond
What happens to the Family and
Carers AFTER OCD???
• Parents can lose their “child”
– The OCD sufferer may have been living in the parental home
and being cared for when they are well into adulthood
– After all these years can be difficult to see your offspring “fly
the nest”
• One of the partners in a relationship may
have assumed most of the roles in eg ChildCare; Housework and Employment
– Can be hugely difficult to relinquish some of these roles
Copyright L M Drummond
In Summary:
Summary
• There are effective treatments for OCD
• The OCD Sufferer needs to take control of when and
how they do their treatment
• Carers may be asked to assist (or may not!!)
• At all times Carers need to ensure their own safety
and wellbeing (and that of family members)
• Carers can help by being supportive and
understanding
• Life after OCD treatment may require considerable
adaptation too!!
Copyright L M Drummond
In other words........
.......it is a journey when we know the
desired destination but when we get
there.... it may not look exactly as we
imagined!!
Copyright L M Drummond