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Never Just Right: Solving the Puzzle of Obsessive-Compulsive Disorder
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Diagnosis of somatic symptom disorder may be given to people who are overly anxious about their medical problems (page 257). Clinicians no longer need to distin- guish hysteri- cal symptoms from medical symptoms. People with a serious medi- cal disease, such as cancer, may receive a psychiatric di- agnosis. Diagnosis of major depressive disorder may be given to recently bereaved people (page 196). Clinicians can more quickly spot and treat clini- cal depression among griev- ing people. People experi- encing normal grief reactions may receive a psychiatric di- agnosis. Previous category of Asperger’s disorder has been eliminated (page 486). Better alterna- tive diagnoses may now be assigned to people with severe social impairments. Individu- als may no longer qual- ify for special educational services if they lose the As- perger’s label. The new category substance use disorder combines substance abuse and substance dependence into one disorder (page 314). Patterns of sub- stance abuse and substance dependence were often indistinguish- able. Sub- stance abuse and sub- stance depen- dence may re- quire different treatments. Top DSM-5 DebaTeS Many of the DSM-5 changes have provoked debate. Several have been particularly controversial in some clinical circles. Who DevelopeD DSM-5? * World Health Organization ** National Institute of Mental Health Field Testing DSM-5 From 2010 to 2012, DSM-5 researchers conducted field studies to see how well clinicians could apply the new criteria. Disorders tested: 23 Clinical participants: 3,646 Clinicians: 879 (APA, 2013; Clarke et al., 2013; Regier et al., 2013) Two-thirds of the DSM-5 work group members were psychiatrists and one-third were psychologists. (APA, 2013) Work groups (pathology groups) 13 160 persons 12 persons per group Task force (oversight committee) 30 persons New Categories Hoarding disorder (page 143) Excoriation disorder (page 143) Persistent depressive disorder (page 187) Premenstrual dysphoric disorder (page 209) Disruptive mood dysregulation disorder (page 472) Somatic symptom disorder (page 255) Binge eating disorder (page 288) Mild neurocognitive disorder (page 511) WhaT’S NeW iN DSM-5? DSM-5 features a number of changes, new categories, and eliminations. Many of the changes have been controversial. Name Changes OLD NEW Mental Retardation Intellectual Disability (page 489) Dementia Major Neurocognitive Disorder (page 511) Hypochondriasis Illness Anxiety Disorder (page 261) Male Orgasmic Disorder Delayed Ejaculation (page 355) Gender Identity Disorder Gender Dysphoria (page 376) Dropped Categories Dissociative fugue (page 168) Asperger’s disorder (page 486) Sexual aversion disorder (page 348) Substance abuse (page 314) Substance dependence (page 314) CoMpeTiTorS Both within North America and around the world, the DSM faces competition from 2 other dia.
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This session included information on the collaborative work being done between The Royal’s Sexual Behaviours Clinic (SBC) and Ottawa Police Service’s High Risk Offender Unit (HROU). Dr. Paul Fedoroff was the moderator and began the presentations with an overview of innovative work being done within the SBC and the common goals of the Clinic and the HROU. Staff Sargent Dana Reynolds and Det. Mark Horton discussed the role of their team in the community based management of high risk sexual offenders. More specifically they discussed the role of the Unit and common legal designations utilized for high risk sexual offenders. Lisa Murphy, M.C.A. provided an overview of sex offender registries (SORs) and public notification and made comparisons between the approaches used in Canada and the United States. A discussion period followed the panel presentations.
Aiming for Zero: Sexual Behaviours Clinic at The Royal
Aiming for Zero: Sexual Behaviours Clinic at The Royal
The Royal Mental Health Centre
Presented by Dr. Jakov Shlik, Clinical Director, Mood and Anxiety, and Operational Stress Injuries Clinic at our monthly Conversations lecture series.
Living with Anxiety: How to move ahead
Living with Anxiety: How to move ahead
The Royal Mental Health Centre
As presented by Dr. Mathieu Dufour, Psychiatrist at The Royal, at a special Men's Mental Health Awareness event hosted by The Men's D.E.N. (Depression Education Network).
Depression and Men
Depression and Men
The Royal Mental Health Centre
Presented by Dr. Atwood, Carlo Verdicchio, and Heather Masson of The Royal's Recovery Program.
Recovery from Mental Illness: Offering hope through your personal journey
Recovery from Mental Illness: Offering hope through your personal journey
The Royal Mental Health Centre
Dr. Andrew Wiens, Head, Division of Geriatric Psychiatry at The Royal, talks about behaviour issues in dementia at our monthly lecture series, Conversations.
Conversations at The Royal: Behaviour Issues in Dementia
Conversations at The Royal: Behaviour Issues in Dementia
The Royal Mental Health Centre
As presented at our Conversations at The Royal on March 20, 2014 by speakers Karen James, Cynthia DuBaie, and Richard Cottingham. More at www.theroyal.ca
Taking Responsibility for our Mental Health
Taking Responsibility for our Mental Health
The Royal Mental Health Centre
By Dr. Georg Northoff, Canada Research Chair and Director of the Brain Imaging, Mind, and Neuroethics Clinical Research Unit at The Royal
What is the brain?
What is the brain?
The Royal Mental Health Centre
“Love Sense” (written by Dr. Sue Johnson): the revolutionary new science of romantic relationships offers the reader a ground breaking guide to the new science of love and loving that has emerged in the last 15 years. The science allows us not just to “fall” in love but to make sense of and shape our most precious relationships.
Conversations at The Royal: Love Sense
Conversations at The Royal: Love Sense
The Royal Mental Health Centre
By Dr. Elliott Lee, Sleep Specialist at The Royal as presented at our monthly lecture series, Conversations at The Royal.
Good Night, Sleep Tight: Understanding the Importance of Sleep
Good Night, Sleep Tight: Understanding the Importance of Sleep
The Royal Mental Health Centre
Mais de The Royal Mental Health Centre
(20)
The Changing Face of Mental Health
The Changing Face of Mental Health
Using Technology for Mental Health Treatments
Using Technology for Mental Health Treatments
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
Conversations at The Royal - Alcohol: How much is too much?
Conversations at The Royal - Alcohol: How much is too much?
Extremism, Terrorism: Mad, Bad, or Both?
Extremism, Terrorism: Mad, Bad, or Both?
The Cost of ADHD in Adults
The Cost of ADHD in Adults
Demystifying Electroconvulsive Therapy (ECT)
Demystifying Electroconvulsive Therapy (ECT)
Strengths-Focused Cognitive Behavioural Therapy for Psychosis and Schizophrenia
Strengths-Focused Cognitive Behavioural Therapy for Psychosis and Schizophrenia
Dealing with Fear and Anxiety in the Wake of Traumatic Events - #OttawaStrong
Dealing with Fear and Anxiety in the Wake of Traumatic Events - #OttawaStrong
Conversations at the royal october 2014 women and prescription opioid addicti...
Conversations at the royal october 2014 women and prescription opioid addicti...
Conversations at The Royal: Women and Prescription Opioid Addiction - A Growi...
Conversations at The Royal: Women and Prescription Opioid Addiction - A Growi...
Aiming for Zero: Sexual Behaviours Clinic at The Royal
Aiming for Zero: Sexual Behaviours Clinic at The Royal
Living with Anxiety: How to move ahead
Living with Anxiety: How to move ahead
Depression and Men
Depression and Men
Recovery from Mental Illness: Offering hope through your personal journey
Recovery from Mental Illness: Offering hope through your personal journey
Conversations at The Royal: Behaviour Issues in Dementia
Conversations at The Royal: Behaviour Issues in Dementia
Taking Responsibility for our Mental Health
Taking Responsibility for our Mental Health
What is the brain?
What is the brain?
Conversations at The Royal: Love Sense
Conversations at The Royal: Love Sense
Good Night, Sleep Tight: Understanding the Importance of Sleep
Good Night, Sleep Tight: Understanding the Importance of Sleep
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Never Just Right: Solving the Puzzle of Obsessive-Compulsive Disorder
1.
Never Just Right: Solving the Puzzle of Obsessive‐Compulsive Disorder Andrew Jacobs, Psy.D., C.Psych. Psychologist, Anxiety Disorders Program Jakov Shlik, MD, FRCPC Psychiatrist and Clinical Director, Anxiety Disorders Program
2.
Overview • OCD: Impact • What is OCD – and What Isn’t? •
OCD Treatment • GePng Help in ORawa • Online Resources
3.
Rates of OCD • ORawa Metro Area, 2011: 1,236,324 people • LifeZme prevalence of OCD: 2.3% – 28,435 people in ORawa will have diagnosable OCD in their lifeZme •
One‐year prevalence of OCD: 1.2% – 14,836 people in ORawa have diagnosable OCD this year Based on data from NaZonal Comorbidity Survey (Ruscio et al, 2010) and StaZsZcs Canada (2012)
4.
OCD & Other Mental Health Concerns • Over the course of a lifeZme, individuals with OCD oben experience the following: – Other anxiety disorders: 76% –
Mood disorders: 63% – Substance use disorders: 39% – ANY disorder: 90% Ruscio, Stein, Chiu, & Kessler, 2010
5.
What is OCD? (and what isn’t…)
6.
What are Obsessions? • Intrusive, recurring, persistent thoughts, mental images, or urges that cause marked anxiety or distress • More than “excessive worry” •
A person tries very hard to get rid of the obesssion with another thought or behaviour • A person knows the obsession comes from his/her own mind Based on DSM‐IV‐TR (2000)
7.
Some Common Obsessions • Excessive, intrusive thoughts about dirt, germs, illness, or contaminaZon • Fears of having accidentally caused harm •
Excessive doubZng of whether tasks were complete or accurate • UpsePng, “nonsensical” need for specific order or exactness • UpsePng aggressive, sexual, or religious thoughts that are out of character
8.
What Aren’t Obsessions? • InfatuaZon • Fantasies •
Over‐thinking • UpsePng memories • Worrying • Intrusive thoughts*
9.
Intrusive Thoughts are NORMAL • 90% of people report experiencing intrusive thoughts (Salkovskis, 1998) • It is not the intrusion that makes an obsession or OCD; it is our anxiety, distress, and reacZon to it
10.
So Why Not Just Stop Thinking About It? An Experiment
11.
What are Compulsions? • RepeZZve behaviours or mental tasks a person must perform according to very set rules and/or in response to an obsession • Compulsions aim to bring down distress or prevent a bad thing from happening, although they are either very excessive or wouldn’t realisZcally work
Based on DSM‐IV‐TR (2000)
12.
Some Common Compulsions • Checking doors, windows, locks, appliances many Zmes • Washing and cleaning a great deal •
CounZng objects, words, etc • Arranging and rearranging objects • Following very specific “rituals” • Looking for reassurance excessively
13.
What Aren’t Compulsions? • Tidiness / orderliness • Habits •
Impulses • AddicZons • SupersZZous behaviours (usually)
14.
Avoidance • Triggers become linked with obsessions and are avoided – Avoid due to fear of intrusive thoughts –
Avoid to prevent need to do compulsions
15.
The Cycle & Growth of OCD • Obsessions are never saZsfied • Compulsions are never complete •
Avoidance expands
16.
What Makes it a Disorder? • Impact – Very upsePng –
Quality of life – Time‐consuming
17.
Treatment of OCD Exposure & Response PrevenZon (ERP) MedicaZons
18.
Exposure & Response PrevenZon • Behavioural change‐based therapy • Learning through new experiences •
EssenZally a process of reversing what the OCD is telling a person to think, feel, and do – IdenZfy OCD cycle in acZon – Face feared situaZons / triggers – Carry through without compulsions – Allow the anxiety to change and fade on its own
19.
Exposure • Targets oben on a hierarchy of difficulty • Gradually confront avoided items, situaZons, and thoughts •
Stay in the situaZon – Anxiety gradually declines • Repeat
20.
Response PrevenZon • Stop compulsive behaviour – Very challenging –
Leads to high anxiety at first • Declines with Zme • Alternate: “ruin” compulsion – Example – touch something “contaminated” aber washing hands
21.
Gains from ERP • Learn new things – Feared outcome doesn’t happen –
Ability to cope is beRer than expected • Fear and anxiety gradually decrease • Avoidance gradually decreases • Urge to do compulsions decreases • Thoughts become less upsePng
22.
A Course of ERP • Typically 10‐20 sessions, 60‐120 minutes • Exposures are done both in session and on own •
Client is never forced to do anything
23.
ERP: The BoRom Line • Very challenging, but it works – Extremely well‐researched, established, and effecZve treatment for OCD –
ERP and similar therapies are effecZve for approximately 2/3 to 3/4 of individuals
24.
MedicaZons Used to Treat OCD • Used to treat OCD: – SSRIs / SNRIs – Serotonin Reuptake Inhibitors –
Tricyclic anZdepressants • To help treatment – Atypical anZpsychoZcs / mood stabilizers
25.
GePng Help for OCD in ORawa
26.
At The Royal • Physician referral to The Royal • Assessment by psychiatrist or psychologist –
Treatment is done both through medicaZons and through ERP – ERP is usually done in a group
27.
In the Community • Look for therapists with the following: – Professionally qualified / licensed –
OCD‐specific experience – Behavioural or cogniZve‐behavioural treatment approach • Unless the pracZZoner is a physician, his/her services will likely not be covered by OHIP / RAMQ; however, private insurance may assist
28.
Online Resources • InternaZonal OCD FoundaZon – www.ocfoundaZon.org •
Anxiety & Depression AssociaZon of America – www.adaa.org • Anxiety Disorders AssociaZon of Ontario – www.anxietydisordersontario.ca • The Royal – www.theroyal.ca
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