neal c m hattersley lynne m drummond - ocd action

Supporting the Person with OCDLynne M DrummondCopyright L M DrummondWhat 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 byCopyright L M DrummondIndividual seeks relief from horrible intrusive thoughts by:- Performing anxiety reducing compulsions (rituals)Eg washing; counting; undoing; cancelling et c. Asking for reassuranceFrom family; friends even health professionalsCopyright L M DrummondCompulsions/Rituals/ReassuranceCopyright L M DrummondEducation about the role of Compulsions/ Reassurance/ Rituals (Adapted from Stern and Drummond, 1991)Copyright Lynne M DrummondTheoretically 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” Copyright L M DrummondWhat 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 involvedCopyright L M DrummondYour 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 Sufferers interests too!Copyright L M DrummondWhat can you do if your loved-one does not want treatment at this point? Be encouraging and supportive but not over-involved (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 Copyright L M DrummondWhat 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! Copyright L M DrummondWhat 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)Copyright L M DrummondWhat 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 supportCopyright L M DrummondWhat are the treatments? Drug Treatments (generally starting with SRIs) Cognitive Behaviour Therapy involving Exposure and Response PreventionCopyright L M DrummondDrug Treatments for OCDACTION OF THE SRIsFronto-Septo-Hippocampal CircuitsLACK of SEROTONIN IN OCDCopyright L M DrummondSerotonin Reuptake Inhibiting (SRI) drugs CLOMIPRAMINE (225mg/day) FLUVOXAMINE (300mg/day) PAROXETINE (60mg) FLUOXETINE (60mg) SERTRALINE (200mg) (CITALOPRAM and ESCITALOPRAM)Copyright L M DrummondResponse to SRI Drugs Needs to be higher doses than those used for depressiongenerally 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 yearsCopyright L M DrummondSide-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 supervisionCopyright L M DrummondDespite this some people still do not respond to SRIs or ERPFronto-Septo-Hippocampal CircuitsLACK of SEROTONIN IN OCDBasal ganglia circuits. Mediated by DOPAMINECopyright L M DrummondEfficacy 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 DrummondCBT Treatment for OCDPsychological Treatment of OCD.Gold Standard = ERPProlonged graduated exposure in real life to the feared situation with self-imposed response preventionCopyright L M DrummondCompulsions/Rituals/ReassuranceCopyright L M DrummondExposure and Response Prevention (Adapted from Stern and Drummond, 1991)Copyright Lynne M DrummondWhen 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 withCopyri