Transcript Title: OCD
Obsessive Compulsive Disorder The doubting disease What is OCD? Definition of OCD: Obsessive Compulsive Disorder is a brain and behavior disorder. In OCD, there are issues with communication, from the front of the brain to the deeper sections. The issues involve a chemical that acts as a messenger, known as serotonin. In a brain with OCD, certain sections are overactive, causing the patient to experience very bad anxiety. It affects their everyday lives tremendously, in both children and adults. The Obsessive Compulsive Brain As you can see from the picture above, the OCD patient’s brain is much more active than the normal person’s brain. When triggered, certain parts of the brain are overactive, causing the brain to “skip” like a scratched CD. The human brain Here is a diagram of the human brain. In OCD, the front part of the brain (here, frontal lobe) and some structures deeper into the brain are affected. Symptoms of OCD In OCD, the person experiences obsessions and compulsions. OBSESSIONS COMPULSIONS • Aggressive obsessions • Repeating rituals • Contamination obsessions • Washing/cleaning compulsions • Saving/hoarding obsessions • Checking compulsions • Religious obsessions (scrupulosity) • Collecting/hoarding compulsions • Exactness or symmetry obsessions • Ordering or arranging compulsions • Somatic obsessions (hypochondriasis) • Counting compulsions An additional branch: Emotional Contamination Emotional contamination is another form of OCD. This is the same idea as the other contamination obsessions, but in emotional contamination, the person with OCD is afraid of “catching” the negative personality traits of another person, like one would catch a contagious illness. More information on OCD symptoms • The need to ritualize is unique to OCD, whereas worrying is not. • OCD can range from being mild to very severe. • OCD is chronic. There is no cure yet. However, with treatment, many people can go on to lead normal lives, even with the OCD. • OCD isn’t fatal in the literal sense; however, in a few cases, it can be so severe that the patient may want to commit suicide. Causes of OCD • • • OCD can be caused partially by genetics. It often runs in families, so if a parent has OCD, their child is genetically at risk for getting OCD as well. The diathesis-stress model describes the development of OCD. A person has a biological vulnerability for OCD and then experiences a stressful life event, such as leaving home for college, or having a baby, and then develops symptoms of OCD. PANDAS is another cause of OCD, in which a child can develop OCD symptoms overnight while infected with streptococcus (strep throat).* Three parts of the brain are overactive in OCD, and that causes the person to doubt and feel a need to find 100% certainty about things, which they then attempt to do through ritualizing. So, brain tissue (nervous tissue) is affected by OCD. Serotonin is a chemical that theses brain structures use, and so OCD can sometimes be treated with serotonin medications. *For more information on PANDAS, see the next slide. P.A.N.D.A.S PANDAS, short for “Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus” is when a child suddenly gets OCD symptoms during or immediately following a strep throat infection. (It can occur whether the child already had mild OCD or has never had it at all.) PANDAS can occur in children from age 3 to around the time of puberty. PANDAS is caused by the way the child’s body reacts to the streptococcus bacteria (not by the bacteria itself). In PANDAS, the body makes a specific protein and antibodies, and then the strep spreads to the brain. The antibodies then attach to the base of the brain and cause OCD. To treat PANDAS, the patient receives blood transfusions every month and then goes through behavior therapy. Which Human Body Systems Does OCD Affect? OCD primarily (and always) affects the nervous system, but the different obsessions and compulsion s affect other specific body systems. For example: • PANDAS, as a cause, is associated with the body’s immune system parts, such as the lymphatic system. • When a person has trichotillomania (which is often associated with OCD), they pull out their hair or pick at their skin excessively. That affects the integumentary system (skin, hair, and nails). Transmission and Prevention of OCD • OCD cannot be transferred; it is a disorder of the brain, not a virus or bacteria that one can catch. Living with a person with OCD won’t give you OCD. • There is no specific way to prevent OCD, as it is often genetic. However, if a child is genetically at risk to get OCD ( for example, if a close relative has it, like a parent), the family can take certain precautions to make it less probable that the child will get OCD. The child should be taught to be able to tolerate being uncertain about things, and should be encouraged to not fear germs. (One way to do this is to have the child eat a cookie or other food item even after it has fallen on the floor, showing them that germs are not that big a deal.) Perfection should not be a main focus either, and overall, the child shouldn’t be taught that the world is a dangerous place for them. By preventing certain behaviors, such as the fear of germs, the child’s vulnerability to OCD can be lessened, regardless of any genetics. Epidemiology: OCD Timeline • • • 1600s – Intrusive thoughts and repeating behaviors were considered to be indicating the presence of melancholia, a really bad form of depression where the person no longer takes any joy in anything in life. Church leaders also often thought that these behaviors meant that the person didn’t pray to God enough. 19th century – At this point, these symptoms were viewed as real mental health problems. As the century progressed, more and more ideas about obsessions and compulsions arose and were studied. Beginning of 20th century – Many psychiatrists were finally pairing obsessions with compulsions, and this was the biggest point of advancement yet. Two particular people played a major role in bringing our understanding of OCD to the way it is today: Sigmund Freud and Pierre Janet. Freud compared obsessions and compulsions to “cause and effect”; the obsessions were the cause of the compulsions. Janet had the idea that the cause of the obsessions had to do with high mental levels and nervous energy. This led to the prospect of impulses. Statistics (More Epidemiology) • 1 in every 200 kids/teens have OCD • 1 in every 100 adults has OCD • 80% of OCD patients develop OCD before the age of 18 Additional Information: • Most people who have OCD are highly intelligent – and this makes sense, because OCD requires complex thought patterns. • The wealthy often cannot get the best treatment, believe it or not. Because they have so much money, they are able to pay people to help them ritualize. That does not help them get better, but most of the people will do anything for a large sum of money, or because the person is so famous. Famous Obsessive Compulsives • David Beckham – symmetry and exactness obsessions • Howie Mandel – contamination • Jessica Alba, too, has OCD. • And last but not least… Michael Jackson had both BDD (body dysmorphic disorder) and OCD. He had contamination obsessions. Treatment of OCD OCD does not have a cure, per say, but there are many treatments that can greatly improve people’s lives. The best treatments are as follows: • Help from a well-trained behavior therapist • Exposure and Response Prevention, or ERP • Medications ERP ERP, or Exposure and Response Prevention, is a type of behavior therapy that is frequently used to help treat OCD. In Exposure and Response Prevention, the patient is supposed to do the exact opposite of what their OCD tells them to do, and end up facing their fear, but without ritualizing. ERP triggers the person’s obsessions on purpose. Habituation is what happens when they get scared at first, and more anxious, but then the feeling subsides as they get used to it, much like how you feel after jumping into a cold swimming pool. Brain Surgery and Deep Brain Stimulation Brain surgery and Deep brain stimulation are two other forms of possible treatment for OCD. In brain surgery for OCD, specific small sections of the brain are removed to try to get rid of or subdue the OCD symptoms. In deep brain stimulation, a probe is put into the brain, and a power box (which communicates with the probe) must be located somewhere in or on the patient’s body. It sends electrical signals throughout the brain to stop the OCD. However, even after undergoing one of these two surgeries, the OCD patient must go back and do more behavior therapy. If they have brain surgery, but then do not put in any more effort at all, they will not get better despite the alterations to their brain. (Brain surgery does not completely rid the person of symptoms.) These surgeries are very rare and very new; they only started in the 1980s and only about 26 OCD patients have actually had these procedures done, with varied results. (Surgeries work better for some patients than others.) Overall, as a treatment option, surgery is still in its trial stage. Additional Information • There is no vaccine for OCD, because, again, it is not a virus or bacteria, it is a brain disorder. • Lots of kids have OCD, but after going through treatment, they can often lead normal lives, just like those of us who don’t have OCD. • Sometimes, without meaning to, families help their children with OCD to ritualize. This is known as “Family Accommodation Behavior”, and it does NOT help the person to get better. In fact, it is reinforcing the behavior, which only causes the OCD to worsen. So, when a family member has OCD, the family should learn more about OCD, to avoid further issues. References: Images Actual Brain: http://2.bp.blogspot.com/_0KMnzNqRq8Y/S8JFJP75x_I/AAAAAAAAClk/4hKWDQvCfOs/s1600/brain.jpg High Energy Use in the Brain: http://www.parentsofocd.org/2011/04/09/energy-use-in-the-ocd-brain-very-interesting/ Human Brain Diagram: http://apividori84.edublogs.org/files/2008/10/brain.gif Strep Throat Diagram: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19694.htm Strep Throat Test: Little Girl http://www.gerberlife.com/gl/view/newsletter/nov07/images/other2.jpg Jessica Alba: http://topnews.in/light/files/Jessica-Alba_6.jpg David Beckham: http://sportsvideo24.com/wp-content/uploads/2010/06/David-Beckham-3.jpg Howie Mandel: http://media1.podbean.com/pb/39041bdbd54f89baff781129ae962359/4dd06ab3/blogs/13755/uploads/howie-mandel-350.jpg Michael Jackson: http://www.rawkblog.net/wp-content/uploads/2009/06/thriller-michael-jackson.jpg Behavior therapist: http://64.244.7.164/Content/stk93908cor.jpg CBT logo: http://www.sfsmith-mft.com/images/cbtlogo.jpg Pills: http://www.synaesthete.net/ocd/gr/psychopharmacology.gif Water: http://www.freefoto.com/images/33/04/33_04_3---Water-Texture_web.jpg?&k=Water+Texture Kids in Swimming Pool: http://www.cen.eu/cen/News/Spotlight%20on%20standards/Archive/PublishingImages/Swimmingpool.jpg Worried Teenage Girl: http://www.irishhealth.com/content/image/13232/Worriedteengirl.jpg 2nd real brain: http://www.morphonix.com/software/education/science/brain/game/specimens/images/wet_brain.gif Deep brain stimulation: http://www.mc.vanderbilt.edu/root/sitebuilder/mcweb/images/neurological_surgery/dbs-poster-segment-2web.jpg References: Information Websites http://www.brighthub.com/mental-health/ocd/articles/84789.aspx http://www.ocfoundation.org Books When Once Is Not Enough –Help for Obsessive Compulsives– written by Gail Steketee, Ph.D. and Kerrin White, M.D. Reference Papers Y-BOCS Symptom Checklist (Arch Gen Psychiatry adaptation-copyright 1989 AMA) Professionals: (Speaking with) Carol Hevia, Psy.D. Behavior therapist, McLean Hospital, Belmont MA