Fanatical Compulsive Disorder Lecture Overview

Presentation Transcript

Fanatical Compulsive Disorder Lecture Overview Nature and the study of disease transmission Etiology Empirically-upheld medicines Efficacy information Moderator factors Class dialog

Epidemiology of OCD Defining highlights Prevalence Onset and course Associated highlights/comorbidity

Associated Disorders Depression Other nervousness issue Sleep unsettling influence Eating issue Tourette's issue and engine tics

Classification of Obsessions (Jenike et al. 1986) Contamination (55%) Concerns of hurting self or others (half) Sexual concerns (32%) Somatic concerns (35%) Symmetry concerns (37%)

Classification of Compulsions Cleaning or washing Checking Counting Repeating Neutralizing contemplations Obsessional Slowness* Touching* Phobic avoidance*

Functional Classification (Foa et al, 1985) Internal dread signals External dread prompts Fears of damage or terrible outcomes

Pharmacological Treatments for OCD Clomipramine* SSRIs Fluoxetine Fluvoxamine* Sertraline

Multicenter Trial of Fluoxetine Data taken from Tollefson et al (1994). Files of General Psychiatry , 51 , 559-567 *NOTE: Response was characterized as a 35% or more lessening in Y-BOCS scores.

Multicenter Trial of Fluoxetine Data taken from Tollefson et al (1994). Chronicles of General Psychiatry , 51 , 559-567.

Empirically-Supported Psychosocial Treatments Psychosocial Treatments Exposure and Response Prevention (ERP) Cognitive Therapy Combined Medications + ERP

Rationale for Investigating Non-Drug Alternatives Limited extent of patients who demonstrate clinical advantage Level of lingering indications among treatment responders Troublesome reactions Extremely high backslide rates Role of mental considers OCD

Psychological Factors Implicated in OCD Cognitive evaluation of meddlesome considerations (Salkovskis, 1985; Rachman, 1997) Overestimation of risk Inflated moral obligation Thought-activity combination Thought-concealment (Wegner et al, 1987) Cognitive shortages in specific consideration Deficits in restraining immaterial jolts (especially inside ones, for example, nosy contemplations) (Clayton et al, 1999)

Procedural Overview of Foa ERP Treatment Protocol Information Gathering Phase (2 sessions) Session 1 (2 hrs.) Obtaining data on OCD side effects History of the issue Defining the turmoil Rationale for treatment Overview of treatment Program Teaching patients to Monitor side effects Taking a general history

Procedural Overview of Foa ERP Treatment Protocol Cont. Data Gathering Phase (2 sessions) Session (2 hrs.) Inspection of patient's self-observing Collecting data about fixations and impulses Generating the treatment arrange Rules for determination of presentation circumstances Develop clear contract amongst specialist and patient Teaching patients to Monitor manifestations Homework task

Important Areas of OC Assessment Obsessions outer dread signals inside prompts outcomes of outside and interior signs Avoidance Patterns Passive shirking Rituals Relationship between evasion examples and dread signals

Procedural Overview of Foa ERP Treatment Protocol Cont. Treatment Phase (15 day by day sessions, 120 min. each) Format of presentation session Implementation of introduction Homework assignments Comments amid presentation sessions Response aversion Rules Return to ordinary conduct Common challenges amid sessions

Examples of In Vivo Exposure Component For Washer Session 1: stroll with advisor through the building touching doorknobs, holding each for a few minutes Session 2: Repeat above and include contact with sweat by having understanding touch armpit and within shoe Session 3: Repeat above yet present having tolerant touch latrine seats Session 4: Repeat above yet present pee by having persistent hold a paper towel hosed in his own particular pee Session 5: Repeat above yet present fecal material by having quiet hold tissue gently grimy with his own particular fecal material Sessions 6-15 Daily introduction to the three most dread inciting exercises are rehashed.

Examples of In Vivo Exposure Component For Checker Session 1: kill the lights on and once, turn stove on and off once, open and close entryways once (leave room quickly without checking) Session 2: Repeat above and include flushing of latrine without looking in the bowl Session 3: Repeat above yet acquaint opening door with the storm cellar and permitting little girl to play close to the entryway Session 4: Repeat above however present conveying little girl on solid floor Session 5: Repeat above yet present driving on interstate without remembering course Sessions 6-15 Daily introduction to the three most dread inciting exercises are rehashed.

Rules for Response Prevention Washer Patients not allowed to utilize water on their body Bath powder and antiperspirants are allowed unless they decrease defilement concerns Shaving is finished by electric shaver Supervised showers happen like clockwork for 10-min. Formal washing of specific regions of the body is precluded Family individuals administer adherence to rules while patient is home Violations are accounted for to specialist In the last couple of sessions, reaction counteractive action prerequisites are casual to allow ordinary washing

Rules for Response Prevention Checker No ceremonial checking is allowed One check (typical checking) is allowed Designated relative or companion oversees reaction anticipation adherence at home Therapist/chief is to remain with patient until desire to check reduces Violations of home practice are accounted for to advisor

Guidelines for Constructing Imaginal Exposure Scenes Imaginal sessions ought to be roughly 45 min. in span; Present roughly six scenes of bit by bit expanding uneasiness bringing out potential; Include outer boosts and interior/psychological or physiological reactions in the dreaded scene.

Common Difficulties During ERP Non-consistence with reaction aversion guidelines Continued inactive shirking Arguing/recoiling about presentation/reaction counteractive action necessities Emotional over-burden Family responses

Summary of Outcome for ERP (Foa et al, in press) Reviewed 18 investigations of ERP 83% reaction rate at posttreatment 76% reaction rate at development (Mean 9 months) Mean indication decrease was 46% at posttreatment

Limitations of Exposure-Response Prevention for OCD Substantial treatment refusal rate Difficulty in transporting ERP to focuses that don't work in OCD (low generalizability); Low validity of ERP among specialists

Limitations of Combined Treatment Studies for OCD Fails to give a decisive correlation of the relative short and long haul impacts of the individual monotherapies; Fail to enough look at whether joined treatment is better than either medication or ERP controlled alone Fail to sufficiently analyze backslide and the potential for ERP to diminish backslide

NIMH Multicenter Study Sites Design Strengths Results

NIMH Multicenter Study Results

Moderators of Treatment Outcome Personality issue Pretreatment OCD seriousness Pretreatment wretchedness Outcome anticipations Compliance with treatment Strength of faith in mischief Comorbid tic disorders*

Cognitive Therapy of OCD

Cognitive Factors in OCD Overestimation of the significance of musings Distorted thinking Thought-activity combination Magical considering

Cognitive Factors in OCD Responsibility Perfectionism Need for assurance Need to know Need for control

Cognitive Factors in OCD Overinterpretation of risk Consequences of tension Anxiety is perilous Anxiety will keep me from working

Empirical Support for Cognitive Interventions LaDouceur et al (1996) Van Oppen et al (1995)

Comparison Trial of ERP and Cognitive Therapy Data taken from Van Oppen et al (1995) Behavior Research and Therapy , 33, 379-390.