MENTAL ILLNESS AWARENESS WEEK (OCT. 1-7)

Ocotber 1st through the 7th is marked as Mental Illness Awareness Week. Mental illnesses include ADHD, Anxiety Disorders, Autism, Bipolar Disorder, Borderline Personality Disorder, Depression, Eating Disorders, Obsessive-Compulsive Disorder, PTSD, Schizophrenia and many others.

The National Alliance of Mental Illness provides statistics behind mental illness and the numbers are truly shocking. Approximately 1 in 5 adults in the U.S.—43.8 million—experiences mental illness in a given year.

Many of these adults turn to medication to curb the effects of the symptoms associated with carious mental illnesses. Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.

Although the entire month of May is dedicated to Mental Illness Awareness, some things can be exceptionally difficult during the fall and winter months. There is always help to those that may need it through a phone call, text or email with the contact information below.

 

To learn more about mental illnesses, the signs, ways to get involved or donate visit: www.nami.org

 

CALL THE NAMI HELPLINE
800-950-NAMI; 
M-F, 10 AM – 6 PM ET
info@nami.org
FIND HELP IN A CRISIS OR TEXT “NAMI” TO 741741
National Suicide Prevention Lifeline – 1‑800‑273‑TALK (8255)  24 hours a day, 7 days a week
Veterans Crisis Line – 1-800-273-8255, Press 1

Addressing animal psycho-pathologies

Dr. Abrar Ul Haq Wani

Psychiatry is the branch of medicine devoted to the diagnosis, treatment and prevention of mental, emotional and behavioural disorders. There are cornucopias of abnormalities that are affective, behavioural, cognitive and perceptual.
Psychiatry treats mental disorders which are conventionally divided into three tiers that is mental illness, severe learning disabilities and personality disorders. Talking about the animal psychopathology, it is the study of mental or behavioural disorders in animals.
Historically there has been an anthropocentric inclination to emphasize the study of animal psychopathologies as models for human mental illness. If we talk about the behavioural disorders in animals or pets its very much similar to human psychiatric disorders.
So, one of the newest additions to the field of psychiatry is directed at working with our furry friends.
Nowadays, pet psychiatry is a growing field in which professionals are tasked in dealing with pets showing troublesome behaviours which have become so extreme that they are now impacting upon their owner’s happiness and welfare.
The example of such behaviours includes aggression towards humans or other animals, compulsive behaviours, inappropriate elimination, soiling, hyperactivity or symptoms of fears and phobias. Pet psychiatry looks towards medical as well as behavioural interventions.
It is quite widely accepted now that domestic pets can suffer from mental health issues that are very similar in nature to that of humans. There are varieties of animal psychopathologies like eating disorders (for example Activity anorexia, Thin sow syndrome, pica) studied in domestic, farm, lab and pet animals. Activity anorexia is one of the eating disorders seen in primates and rats which are very much similar to human anorexia nervosa or hyper gymnasia.
In this condition, rats begin to exercise excessively while simultaneously cutting down on their food resulting in excessive weight loss, and ultimately death. Dogs have been shown to display similar rates of depression to humans.
The most common anxiety disorders studied in pets include Generalized anxiety disorder (GAD), Separation anxiety disorder (SAD), Obsessive compulsive disorder (OCD) and Post traumatic stress disorder (PTSD).
In GAD the animal shows constant and crescent reactivity, alertness and exploration and a great motor activity that interferes with a normal social interaction.
The Obsessive compulsive disorder (OCD) is a recognized disorder by animal psychiatry and one of the most disabling. In animals OCD is divided into three categories, first is the conflict behaviour like (cannibalism, urine suction) followed by empty behaviours (for example licking, self mutilation) and stereotyped behaviours (licking nose and lips, yawning, circling, tail chasing, snapping at the air etc). Scientists have located chromosome 7 in dogs that confers a high risk of susceptibility to OCD.
Canine chromosome 7 expresses in the hippocampus of the brain, the same area where OCD is expressed in human patients. Similar pathways are involved in drug treatment responses for both humans and dogs, offering more research that the two creatures exhibit symptoms and respond to treatment in similar ways.
This data can help scientists to discover more effective and efficient ways to treat OCD in humans through information they find by studying obsessive compulsive disorder in dogs.
As far as aggressiveness is concerned the American psychiatric association doesn’t consider aggressiveness in humans as a separate diagnostic category but it’s one of the most frequent problems in dogs.
Aggressiveness also studied due to some medical problems like intracranial neoplasm, cerebral hypoxia, endocrine disorders, rabies, canine distemper, hydrocephaly, intoxication due to metals.
Medication in pet psychiatry is accompanied by behavioural teaching, counselling and modification with an ultimate aim to wean the pet off the medication. Pet psychiatrists usually get involved after a pet has been thoroughly assessed by a veterinarian to ensure there is no medical reason for such behaviours.
The work of a pet psychiatrist involves extremely close working with owners and often involves team working techniques to achieve best outcome.
For the discovery of psychiatric medicaments animal models have been central since 1950 for the discovery of such drugs in order to treat the serious disorders such as depression, anxiety disorders, and schizophrenia. Brain being one of the most complex organs contains thousands of distinct types of neurons which put up the challenges to brain research.
So, for this a new technique called optogenetics which permits us to manipulate individual types of cells and circuits is now introduced which is having a powerful implication for understanding brain disorders. This technology involves the insertion of genes into particular neurons in the brains of mice.
This new technology has already contributed to the analysis of many circuits that play a role in normal thought and emotions, as well as in brain disorders. There are laundry lists of drugs used to treat psychiatric disorders in animals like Tricyclic antidepressants, selective serotonin reuptake inhibitor (Fluoxetine, Paroxetine), Benzodiazepines (Diazepam, Lorazepam etc) and atypical antidepressant.

Alyssa’s Medical Station: How the Brain Affects the Body

The brain of the human body is impeccably prominent in the process of the body’s many physical functions.

Most college students incoherently add massive amounts of work, events, and activities on our to-do list every week. Likewise, in today’s society our minds can become cluttered with the struggle between school and personal life. Students who attend high school or college are subject to losing tenacity in their daily thought processes when participating in multiple forms of activities at once. The very idea of a deadline can become overwhelming for most students.

When neglected, the brain can activate a negative effect on our mental and physical health. When treated, the mind has a positive effect on the mental health and physical health of humans.

The human brain is responsible for the control of the body’s basic functions, such as emotions, behavior, response and interpretation, as briefly described by the National Institution on Drug Abuse. The “cerebral cortex” of the brain is divided into four distinctive parts which carry out different tasks: frontal, occipital, parietal, and temporal lobes. The “limbic system” controls the human “pleasure” circuit.

According to the National Geographic website, the human brain is composed of neurons that transmit and chemical information, and send messages through neuron fibers called axons and dendrites. When we touch something of a certain temperature (like touching a hot stove) neurotransmitters send a message to the brain’s neurons so the human brain identifies the danger. The same effect is responsible for cold, sharp, smooth objects; utilizing different senses necessary for survival.

The negative aspects that can formulate are anxiety disorders, depression, and forms of memory loss (such as Alzheimer’s disease). According to the Anxiety and Depression Association of America, over 40 million adults are affected by anxiety disorders, and 18.1% of the total population is affected in the United States. Many forms of disorders stem from depression and anxiety such as PTSD (Post Traumatic Stress Disorder), Panic Disorder, OCD (obsessive compulsive disorder), etc.

According to Dr. Amy R. Pearce, Ph.D., Professor of Psychology, “The brain stem region is comprised of the structures of the midbrain pons and medulla. The brainstem is responsible for our vital signs-breathing, heart rate, blood pressure, awaking, so damage to this area (trauma, aneurysm) typically results in death.”

However, when the mind is treated the body exuberates confidence and superior health status.  Managing your time wisely in school and social life can have a positive effect on your overall state of mind. When stress clouds our judgment we tend to think unclearly, resulting in actions that can be damaging to our health and mind. Topics such as suicide awareness have helped encourage people to manage their mindfulness and overcome obstacles. Preventing depression or anxiety can seem too difficult to accomplish, but it is not impossible.

Some methods for relieving stress, anxiety, or depression are meditation techniques lasting a minimum of 10 minutes, yoga, adequate sleep, hydration, nutrition foods, and moderate exercise as encouraged by WebMD. It is only logical that in order to be mindful and accomplish tasks in life, that you must first provide ways to avoid negative intake.

Devin Nelson, Education specialist, Student Life Counselor here at A-State describes that, “We hear our own voices more than we hear anyone else’s. If we are focusing on what we cannot do, or doubting ourselves, this will negatively impact our performance. However, by challenging those thoughts and replacing them with positive affirmations, performance will be improved as will our overall mental well-being.”

A body cannot function without being prepared for the task at hand. Products such as alcohol or drugs are the most common forms of negative intake. Alcohol and drugs are an example of negatively intake. The fundamental purpose of alcohol and drugs is to damage brain cells and limit brain functionality. When we begin to prioritize our friends, family, school and work over our health, our bodies take a tremendous toll. However, as our brain cells die in response to the foreign substance within the body. When excessive alcohol and drug use take place in the body, the repercussions can be hazardous to all of the body’s systems, and often can lead to death.

Our bodies are not to be taken for granted. We only have one body– treat it with respect. When you are concerned about a test, take a moment of meditation. If you need assistance in facing a challenge, ask for help. Do not stay silent. When treated, the mind has a positive effect on our overall physical health as well as mental health. Negative thoughts or stress-induced episodes can have a withering effect on the body’s ability to function.

However, if cared for the mind and body can work in harmony, bringing peace to human lives around the country. Take care of your mind, body and livelihood.

 

Multiple Births group hosts free workshop Saturday

TEMISKAMING SHORES – 

Temiskaming Multiple Births is addressing the growing issue of anxiety by hosting a free workshop Saturday at Temiskaming District Secondary School led by nationally recognized psychologist, Eva de Gosztonyi.

The topic and presenter were chosen after local TMB executive travelled to Montreal to participate in a similar workshop earlier this year.

“Anxiety is a common mental health concern in Temiskaming, yet few resources are available locally to support children and adults who struggle with it,” organizers say.

“The topics covered during the Anxiety- Alarm workshop were so powerful TMB wanted to share it with everyone in Temiskaming. After the Frog’s Breath Foundation agreed to support the initiative, TMB booked the Small Gym at TDSS hoping to fill the venue by making it a free event. The Montreal fee for the full accredited workshop was $295 per participant. To eliminate barriers to attendance,”

TMB is also offering free transportation from Kirkland Lake and Temagami with stops along the route, free day care, and a free lunch making it essential for participants to pre-register.

There are seven main anxiety disorders in children/youth. These include: Social Anxiety Disorder, Post- Traumatic Stress Disorder, Panic Disorder with or without Agoraphobia, Obsessive-Compulsive Disorder, Specific Phobia, Generalized Anxiety Disorder, and Separation Anxiety. The goal of the Anxiety-Alarm workshop is to provide informed strategies on how to manage these challenges. In her presentation, Eva will weave together theory and practice; learning and behaviour, to help parents and those working with children put into practice the Neufeld Institute paradigm so they can most effectively help children and youth become the “best that they can be”.

“Every time we talk to people about anxiety, they nod their head,” said Temiskaming Multiple Births treasurer Gail Moore. “Families are dealing with the challenge in private silos. Many need this workshop but do not realize it is available, and if they do – most cannot afford to go to a major city to attend it elsewhere. We speak as parents who want to help make a difference for all families in Timiskaming, this workshop is well worth attending.”

Details on the workshop and topics are posted online at www.temiskamingmultiplebirths.com.

 

With Anxiety Common in Depression, DSM-5 Specifier Aids Screening


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Major depressive disorder (MDD) frequently appears with other disorders and comorbidities; experts say it’s more the rule than the exception. But before the Diagnostic and Statistical Manual for Mental Health Disorders, Fifth Edition (DSM-5) was published in 2013, the presence of anxiety in some patients may have been missed.
 
The addition of the anxiety distress specifier in the DSM-5 has simplified the task of identifying those patients whose anxiety must be considered in their treatment plan, said Mark Zimmerman, MD, director of outpatient psychiatry and the Partial Hospital Program at Rhode Island Hospital, and a professor of psychiatry at Brown Medical School.
 
During a presentation at the US Psychiatric and Mental Health Congress in New Orleans, Louisiana, Zimmerman said studies show that the presence of a comorbid disorder or specific symptom were the most important factors driving treatment decisions when clinicians picked an antidepressant, and anxiety was the symptom they cited most frequently (19.9%).1
 
For patients to meet the criteria of the anxious distress specifier, they must have 2 of the following 5 symptoms across an episode: 1) feeling keyed up or tense, 2) feeling unusually restless, 3) difficulty concentrating because of worry, 4) fear that something awful might happen, and 5) a feeling that one might lose control of himself/herself.2
 
In reality, anxiety affects about 50% of patients with depression, Zimmerman said. That covers a lot ground: he led a study of 373 depressed patients that found 17.1% had panic disorder, 33% had social phobia, 13.4% had posttraumatic stress disorder (PTSD), and 15% had general anxiety disorder.3 Despite the numbers, social phobia was frequently overlooked, he said. This means that many patients with anxiety are missed. “It’s just the reality of a busy clinical practice,” Zimmerman said.
 
But finding better ways to screen patients for anxiety is important, because Zimmerman said studies show more than three-fourths of patients with anxiety say they want to be treated. “When we ask patients do they want treatment, they say ‘yes,’” he said.

Zimmerman took the audience through a 2-stage screening process; the first stage screens for general distress, and if the patient tests positive, a second, more in-depth stage hones in on the precise diagnosis.

Next, he reviewed clinical trial data involving patients with anxious depression. Zimmerman explained there have been fewer studies involving patients with depression and anxiety, because they have often been excluded from trials. These patients have greater psychosocial impairment, and poorer, slower response to treatment. A literature review involving 31 studies concluded that:

·         Selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors, and tricyclic antidepressants are effective in treating anxious depression.
·         Patients with anxious depression have poorer outcomes and greater side effects.
·         Patients with anxious depression often do not have sustained outcomes after initial success with a new drug.4

Guidelines from different countries have varied on which antidepressants are recommended. British guidelines did not find much difference among different antidepressants, but the American Psychiatric Association made several specific recommendations for SSRIs (good for social anxiety disorder with depression, PTSD, and obsessive compulsive disorder [OCD]), bupropion (comparable to SSRIs for low to moderate levels of anxiety), and clomipramine (effective for OCD with depression).

Testing the Anxious Distress Specifier
So far, some studies of the anxious distress specifier don’t actually measure all 5 criteria because databases didn’t have information on all 5 measures. Zimmerman’s research group came up with ways to measure all 5. His group tested a scale for the new anxious distress specifier, called CUDOS (Clinically Useful Depression Outcome Scale); the study with 793 depressed outpatients found the scale to have high retest reliability, and good discriminant and convergent validity.5 Because the specifier is supposed to measure symptoms across an episode, Zimmerman’s group also came up with an interview measure; once again, the specifier held up to clinician and self-reported assessments of anxiety and depression.

Some of their work suggests that the new specifier may produce different results than older scales that measured anxiety; this is an area for future research, Zimmerman said. “Hopefully the anxious distress specifier is as good if not better at [assessing] impairment, functioning, and predicting outcomes,” because it’s so much easier to administer. “Hopefully, it’s a more clinically useful way of assessing anxiety.”

Clinical guidelines, however, say there is no best or worst antidepressant for highly anxious depressed patients, which can leave much to the individual prescribing practices of the psychiatrist.
The DSM-5 anxious distress specifier does represent a step forward, Zimmerman said. “Screening can improve detection. It can improve the efficiency of the diagnostic process.”
 
References
1.       Zimmerman M, Posternak M, Friedman M, et al. Which factors influence psychiatrists’ selection of antidepressants? Am J Psychiatry. 2004;161(7):1285-1289. DOI: 10.1176/appi.ajp.161.7.1285.
2.       American Psychiatric Association. Diagnostics and Statistical Manual, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
3.       Zimmerman M, McDermut W, Mattia JI. Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. Am J Psychiatry. 2000;157(8):1337-1340. https://doi.org/10.1176/appi.ajp.157.8.1337 .
4. Ionescu DF, Niciu MJ, Richards EM, Zarate CA. Pharmacological treatment of dimensional anxious depression: a review. Prim Care Companion CNS Disord. 2014;16(3). doi:  10.4088/PCC.13r01621.
5.       Zimmerman M, Chelminski I, Young D, Dalyrymple K, Walsh E, Rosenstein L. A clinically useful self-report measures of the DSM-5 anxious distress specifier for major depressive disorder. J Clin Psychiatry. 2014;75(6):601-607.
 
 

 


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Families, NDP call for funding to open mental health unit

Lucy Mauerhoff still feels anguish over how her adult son was treated when he sought help for mental illness at Royal University Hospital in Saskatoon. Now, she’s hoping to call attention to a funding shortfall that has delayed the opening of a mental health unit in the city.

“Every time I came to visit him, I could hear him sobbing down the hallway. Every time I went in he said, ‘Mom, I’m going crazier in here,’” she said.

Mauerhoff explained her 33-year-old son, Sean, suffers from Obsessive Compulsive Disorder and an anxiety disorder, which intensified in July. Having no other option, Mauerhoff said Sean went to  the ER for help and was admitted to RUH for two days.

Sean was allegedly placed into what Mauerhoff described as a jail cell and was given medication to take.

The cell consisted of a bed secured to the floor, a toilet out in the open and a security guard outside who would kept the lights on in the room at all times. Mauerhoff said Sean was put in the room because he was a flight risk due to confusion caused by his illness.

“I left visiting my son in the cell, I would cry all the way to the car. It was heart wrenching to see him sobbing day and night,” Mauerhoff said. “Saying, ‘Mom get me out of here, get me out of here, get me out of here.’”

Mauerhoff was joined Monday by others whose family members have faced barriers when seeking treatment, along with members of Saskatchewan’s New Democratic Party to push for answers on a mental health unit at RUH.

The proposed seven-bed unit already received $1 million in funding from the Dubé family earlier this year and was supposed to open this fall.

At present, the opening of the unit has been delayed indefinitely.

NDP Health Critic Danielle Chartier said she’s heard numerous stories like Mauerhoff’s, and noted the delay on the unit comes down to funding for a few nurses.

Chartier said the mental health emergency unit would ensure proper care for people living with mental challenges, and would relieve some of the broader pressure emergency rooms face.

OCD: Cognitive behavioral therapy improves brain connectivity

MRI scans show that people diagnosed with OCD who have undergone CBT have intensified connectivity between key brain networks.

Researchers have used brain scans to measure changes in the cerebral activity of people with obsessive-compulsive disorder after undergoing a type of cognitive behavioral therapy. They found that the connectivity of key brain networks is improved, suggesting new targets for therapy.

Obsessive-compulsive disorder (OCD) is a condition marked by inescapable, intrusive thoughts that cause anxiety (hence “obsessive”), and repetitive, ritualistic behaviors aimed at reducing that feeling (hence “compulsive”).

OCD can be a debilitating condition and can severely impair daily functioning. The National Institutes of Mental Health estimate that, in the United States, the yearly prevalence of OCD amounts to 1 percent of the total adult population. Around half of these cases are deemed “severe.”

Treatments for OCD include the administration of selective serotonin reuptake inhibitors and cognitive behavioral therapy (CBT), a type of therapy that aims to improve damaging mind associations.

Researchers from the University of California, Los Angeles – who were led by Dr. Jamie Feusner – have conducted a study aiming to find out whether and how CBT might change levels of activity and network connectivity in the brains of people diagnosed with OCD.

They explain that although the efficacy of CBT in treating OCD has been previously explored, this is likely the first study to use functional MRI (fMRI) to monitor what actually happens in the brains of people with OCD after exposure to this kind of therapy.

The researchers’ findings were recently published in the journal Translational Psychiatry.

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Changes in key brain regions following CBT

The team specifically targeted the effects of exposure and response prevention (ERP)-based CBT, which entails exposure to triggering stimuli and encouraging the individual to wilfully resist responding to those stimuli in the way that they normally would.

For the study, 43 people with OCD and 24 people without it were recruited. The results for the two groups were later compared, at which point the 24 individuals without OCD were taken as the control group.

All the participants diagnosed with OCD received intensive ERP-based CBT on an individual basis in 90-minute sessions on 5 days per week, for a total of 4 weeks.

Participants from both groups underwent fMRI. Those diagnosed with OCD, who had received CBT, were scanned both before the treatment period and after the 4 weeks of treatment. Participants from the control group, who did not undergo CBT, also had fMRI scans after 4 weeks.

When the scans of participants with OCD were compared, the results from before exposure to CBT and after it were found to be largely contrasting.

The researchers noticed that the brains of people with OCD exhibited a significant increase in connectivity between eight different brain networks, including the cerebellum, the caudate nucleus and putamen, and the dorsolateral and ventrolateral prefrontal cortices.

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The cerebellum is involved with processing information and determining voluntary movements, while the caudate nucleus and putamen are key in learning processes and controlling involuntary impulses.

The dorsolateral and ventrolateral prefrontal cortices are involved with planning action and movement, as well as regulating certain cognitive processes.

Dr. Feusner and team point out that an increased level of connectivity between these cerebral regions suggests that the brains of the people who underwent CBT were “learning” new non-compulsive behaviors and activating different thought patterns.

He suggests that these changes may be novel ways of coping with the cognitive and behavioral idiosyncrasies of OCD.

The changes appeared to compensate for, rather than correct, underlying brain dysfunction. The findings open the door for future research, new treatment targets, and new approaches.”

Dr. Jamie Feusner

First study author Dr. Teena Moody adds that being able to show that there are quantifiable positive changes in the brain following CBT may give people diagnosed with OCD more confidence in following suitable treatments.

“The results could give hope and encouragement to OCD patients,” says Dr. Moody, “showing them that CBT results in measurable changes in the brain that correlate with reduced symptoms.”

Stopping antidepressants tied to increased relapse risk

By Lisa Rapaport

(Reuters Health) – People taking antidepressants for anxiety,
obsessive-compulsive disorder (OCD) and post-traumatic stress
disorder (PTSD) are more likely to relapse when they stop using
these drugs than when they remain on medication, a research
review confirms.

Researchers analyzed the combined results from 28 previously
published studies with a total of 5,233 participants who had been
on antidepressants for up to one year. Patients were randomly
assigned to either continue medication or switch to placebo, or
dummy, pills.

Over the next year, patients who discontinued treatment were
roughly three times more likely to relapse than people who
remained on antidepressants, researchers report in The BMJ.

“Patients and their doctors should be aware that discontinuing
antidepressants within a year is associated with increased
relapse risk,” said lead study author Dr. Neeltje Batelaan of the
VU University Medical Center in Amsterdam.

“This should be taken into account when discussing
discontinuation,” Batelaan said by email. “It does not imply that
all patients should remain on antidepressants for the rest of
their lives.”

That’s because the majority of patients who discontinue
antidepressants do not relapse, and because relapse sometimes
occurs even when patients are still taking these medications,
Batelaan added.

Overall, relapse occurred in about 36 percent of people who
switched to placebo and 16 percent of those who remained on
antidepressants, the study found.

And among the patients who did relapse, this happened more than
three times faster for people switched to placebo than for
individuals kept on antidepressants.

It’s not exactly clear why some patients relapsed, but it’s
unlikely to have been caused by withdrawal symptoms among the
people who discontinued treatment, Batelaan said.

Many antidepressants work by altering the way certain chemicals
in the brain such as serotonin, dopamine and norepinephrine
transmit signals involved in controlling emotions and moods.
Stopping antidepressants is thought to change how these brain
chemicals function, which may lead to relapse in some people.

Side effects of antidepressants can include nausea, weight gain,
sexual dysfunction, insomnia, blurred vision and constipation.
One limitation of the study is that it included only patients who
had been taking these medications for up to a year, making it
likely that all or most of the participants didn’t need to halt
treatment due to side effects.

Another drawback of the study is its reliance primarily on
published studies funded by drug companies, which the authors
note might bias the results toward showing the benefits of
continuing antidepressant treatment.

Even so, the results add to a large body of evidence already
suggesting that patients on antidepressants may be more prone to
relapse when they discontinue treatment than when they remain on
medication, said Dr. Ronald Pies, a psychiatry researcher at SUNY
Upstate Medical University in Syracuse, New York, and Tufts
University School of Medicine in Boston.

“If the patient has a fairly severe or recurrent anxiety disorder
that has not responded to cognitive-behavioral therapy alone, the
use of an antidepressant for up to a year and possibly longer can
be justified, owing to the risk of relapse with medication – so
long as the patient is tolerating the treatment reasonably well,”
Pies, who wasn’t involved in the study, said by email.

“Not all patients will need long-term medication,” Pies added.
“In fact, the study found that most patients do well when
discontinuing treatment.”

SOURCE: http://bit.ly/2x0HP3o The BMJ, online September 13, 2017.

Family accommodation in adult obsessive–compulsive disorder: clinical perspectives

Back to Browse Journals » Psychology Research and Behavior Management » Volume 10

Authors Albert U, Baffa A, Maina G

Received 27 July 2017

Accepted for publication 30 August 2017

Published 20 September 2017
Volume 2017:10
Pages 293—304

DOI https://doi.org/10.2147/PRBM.S124359

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication:
Dr Igor Elman

Umberto Albert, Alessandra Baffa, Giuseppe Maina

Rita Levi Montalcini Department of Neuroscience, A.O.U. San Luigi Gonzaga, University of Turin, Turino, Italy

Abstract: The term accommodation has been used to refer to family responses specifically related to obsessive–compulsive (OC) symptoms: it encompasses behaviors such as directly participating in compulsions, assisting a relative with obsessive–compulsive disorder (OCD) when he/she is performing a ritual, or helping him/her to avoid triggers that may precipitate obsessions and compulsions. At the opposite side, family responses to OCD may also include interfering with the rituals or actively opposing them; stopping accommodating OC symptoms or actively interfering with their performance is usually associated with greater distress and sometimes even with aggressive behaviors from the patients. This article summarizes progress of the recent research concerning family accommodation in relatives of patients with OCD. Family accommodation is a prevalent phenomenon both among parents of children/adolescents with OCD and relatives/caregivers of adult patients. It can be measured with a specific instrument, the Family Accommodation Scale, of which there are several versions available for use in clinical practice. The vast majority of both parents of children/adolescents with OCD and family members of adult patients show at least some accommodation; providing reassurances to obsessive doubts, participating in rituals and assisting the patient in avoidance are the most frequent accommodating behaviors displayed by family members. Modification of routine and modification of activities specifically due to OC symptoms have been found to be equally prevalent. Specific characteristics of patients (such as contamination/washing symptoms) and of relatives (the presence of anxiety or depressive symptoms or a family history positive for another anxiety disorder) are associated with a higher degree of family accommodation; these family members may particularly benefit from family-based cognitive–behavioral interventions. In recent years, targeting family accommodation has been suggested as a fundamental component of treatment programs and several interventions have been tested. Clinicians should be aware that family-based cognitive–behavior therapy incorporating modules to target family accommodation is more effective in reducing OC symptoms. Targeting family accommodation may be as well relevant for patients treated pharmacologically.

Keywords: obsessive–compulsive disorder, family accommodation, cognitive–behavior therapy, treatment response

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License.

By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Other article by this author:

Effects of maintenance lithium treatment on serum parathyroid hormone and calcium levels: a retrospective longitudinal naturalistic study

Albert U, De Cori D, Aguglia A, Barbaro F, Lanfranco F, Bogetto F, Maina G

Neuropsychiatric Disease and Treatment 2015, 11:1785-1791

Published Date: 20 July 2015

Treatment Options for Obsessive Compulsive Disorder

NEW ORLEANS — Up to 30% of patients with obsessive-compulsive disorder (OCD) are not helped at all or are inadequately helped by current pharmacotherapies, according to Jon Grant, MD, JD, MPH, professor of psychiatry and behavioral neuroscience at the University of Chicago, in his presentation at the 2017 US Psych Congress.

“Most people tend to think of OCD as an innocuous, silly problem based on television,” Dr. Grant said, “but it is an incredibly serious mental health problem.”

OCD is characterized by recurrent distressing ideas and recurring behaviors designed to reduce the anxiety caused by the obsessions. While onset occurs earlier in boys than in girls, OCD affects both genders equally. Additionally, the age of onset appears to be bimodal, occurring either during childhood (mean age 10 years) or during adolescence or young adulthood (mean age 21 years).

Dr. Grant highlighted the importance of screening and diagnosis, emphasizing that patients with OCD should be assessed regarding their conviction that their obsessive beliefs are accurate.

Without treatment, remission rates for OCD are low (approximately 20%), but higher response and remission rates are reported with appropriate treatment, with early diagnosis and treatment leading to improved outcomes.

The US Food and Drug Administration (FDA) has approved the serotonin reuptake inhibitor clomipramine, as well as the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline for the treatment of OCD. 

According to head-to-head comparisons, all SSRIs are equally effective. Dr. Grant also acknowledged that while some patients are uncomfortable with the fact that medication doses for OCD are higher than they are for depression, those higher doses are crucial for symptomatic improvement.

Nonpharmacologic treatments are also effective options for OCD. Cognitive-behavioral therapy (CBT) attempts to reduce patient anxiety by implementing experiments that will force the patient to confront fallacies in their thinking about cause and effect. 

Another treatment option for OCD is exposure and response prevention therapy (ERP), which consists of repeated, prolonged exposures to fear-eliciting stimuli or situations with instructions for the patient to refrain from his or her compulsive behaviors. 

The purpose of this practice is to allow the patient to experience a reduction in the fear response and to learn that the anxiety will reduce naturally if he or she does not make efforts to avoid it. As many as 60% to 85% of patients report substantial symptom reduction with ERP; the large amount of empirical data supporting ERP over CBT make it a first-line treatment for OCD.

Reference

Grant J. Obsessive-compulsive disorder: treatment with psychotherapy and pharmacotherapy. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.


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NDIS: people with severe mental health problems being denied access on ‘a daily basis’

Australians with severe mental health problems are being regularly barred from the national disability insurance scheme, prompting fears that under-resourcing and a lack of expertise are compromising decision-making.

Peak mental health bodies say they are receiving “alarming” reports “on a daily basis” of people with diagnosed psychosocial disabilities being denied access to the NDIS.

A list of 16 recent cases, obtained by Guardian Australia, shows packages have been refused to people with decades-long histories of schizophrenia, major depressive disorders, bipolar and severe anxiety.

In one case, access was refused to a person with a 40-year diagnosed history of paranoid schizophrenia, who experiences delusional thoughts and visual and auditory hallucinations, has been admitted to hospital at least five times, and given regular depot injections.

In another, funding was denied to an individual with a three-decade long diagnosis of major depression, anxiety disorder, and obsessive compulsive disorder, because the NDIS could not be satisfied the person was permanently impaired.

The peak body representing Victoria’s community mental health services, Vicserv, has seen 50 rejection cases in the past two weeks, all for individuals previously on the waitlist for state mental health services or in receipt of commonwealth-funded mental health programs.

It says only eight assessors have been employed to deal with mental health applications – a claim the national disability insurance agency (NDIA) disputes.

The access team faces a vast workload.

By July, it had approved 6,093 people with psychosocial disabilities, mostly in NSW and Victoria. More than 1,200 new participants were added in the last three months of 2016-17 alone.

The NDIS estimates 64,000 people with a long-term psychosocial disability will be approved for support in the next three years, although the mental health sector believes the true number will be closer to 90,000.

The Vicserv chief executive, Angus Clelland, has written to social services minister, Christian Porter, to express his alarm.

Clelland said those denied NDIS support would end up in hospitals or other parts of the health system, particularly in Victoria, where he said funding has been diverted from existing mental health services to the NDIS.

“There’ll be a disaster across the country, really,” Clelland told Guardian Australia.

“Victoria is my main concern, but given the magnitude of the problems that we’re seeing already, if we start amplifying it across the rollout regions … we’re already seeing thousands of people in Victoria who will miss out,” he said.

Clelland is concerned assessors, despite lacking sufficient expertise, are ignoring or disregarding the evidence of GPs and psychiatrists.

“The impression that we’ve got is that because there’s only eight people nationally doing that access work, they’re trained in applying legislation, so if it doesn’t meet the tick-box test, then people aren’t getting through,” he said. “I think there’s huge pressure for them, workload-wise, to make this work. Inevitably those pressures will translate to the access decisions that are being made.”

An NDIA spokeswoman said there were several hundred delegates involved in assessing and approving plans, and that specialist resources were “being developed” to help with applications for psychosocial disability support.

“These specialist mental health staff are able to also provide support to all members of the national access team regarding technical matters related to psychosocial disability,” she said.

Data from NDIS trials shows those with a mental illness are much less likely to be approved than those with a physical disability. One in four applications for mental health support were deemed ineligible, compared with one in nine for the rest of the scheme.

Frontline community mental health workers, speaking on condition of anonymity, are growing despondent as they deal with a system that fundamentally misunderstands the nature of mental health. They say mental health has been treated as an afterthought in a scheme designed primarily for physical disabilities.

A glaring example, support workers say, is the requirement for participants to prove they are permanently impaired. The notion is at odds with the approach of modern mental health treatment, which emphasises recovery and the potential for positive long-term outcomes.

Support workers, desperate to get their clients onto the NDIS, now spend their days trying to prove their clients cannot recover from their mental health problems.

“People are reading these reports about themselves which might describe a very bleak situation … that notion of permanency, that’s not something typically in mental health that we talk to people about,” one support facilitator told Guardian Australia.

“We have this idea of recovery, people can change, their lives will improve. But with NDIS you really can’t say that kind of thing. [You say] this is their life, and they’ll never improve and this is permanent,” she said.

The facilitator has had three out of four clients rejected for NDIS support. One of the rejected clients – a trauma victim with severe anxiety and depression – does not leave her home or answer calls from strange numbers.

Her NDIS request form was sent to her in the post and a follow-up call was made from a blocked number. Without the help of support workers, she would have remained oblivious to the NDIA’s communications.

“That’s part of the lack of understanding: they send a letter, they call on a private number. Our clients don’t answer private numbers, they don’t get their mail. So they really need to have that understanding,” she said.

The NDIA spokeswoman said the mainstream mental health system would continue to cater for the “broader group of people” who need support outside the NDIS. She said the agency was also reviewing pathways to the NDIS and considering the recommendations of a recent joint standing committee report, which looked at psychosocial support under the NDIS.

Like most in the sector, leading mental health expert and former Australian of the year Patrick McGorry supports the notion of the NDIS. But he said mental health had again been treated as the “poor cousin”. He said the requirement to prove permanence of disability was not compatible with mental health treatment and its focus on recovery.

“They do not gel in any way, it’s like oil and water. That’s the problem,” McGorry said.

“We’ve ended up being the poor cousin … we’ve been shoehorned into a system that’s very physically focused,” he said.

An outreach worker, speaking on condition of anonymity, said his experience with the NDIS varied immensely, and that the agency’s handling of mental health had improved over time. But he complained of significant delays in decision-making, which caused anxiety among clients. He also criticised inconsistencies in the way decisions over who could access the NDIS were made.

“There was one case in particular that I was actually quite floored by, and it speaks to that inconsistency,” he said.

“That’s one person who’s been linked in with our service for as long as I’ve been there, not only was there mental health issues, but there was intellectual disability as well.”

Community Mental Health Australia, a coalition of the eight state and territory peak community mental health organisations, has warned the NDIS is at a crossroads.

The group’s executive director, Amanda Bresnan, said the scheme risked losing the already fragile trust of those experiencing mental health problems. If that occurred, many would simply stop engaging altogether.

“We understand that the pressure is coming from government. When they are being told you’ve got to sign up 200,000 by this particular date, and when you don’t have resources to do it, things are going to fall by the wayside,” Bresnan said.

“But these are people with complex conditions requiring support, and that’s what we should be thinking about,” she said. “We’re starting to see this evidence, it’s not just one or two outliers, as the NDIS usually says, it’s actually starting to become a systemic issue.”

A voice of hope: Mental illness survivor Genevieve Mora speaks out …

She used to wash obsessively until her hands bled, run up and down the stairs 270 times before breakfast of half a Weet-Bix and water, and was locked in a hell where the number four ruled her life, forcing her into senseless rituals of twisting door knobs and turning pages four times, believing if she didn’t she would die.

After 10 years of crippling anxiety, hiding her symptoms in shame, now 23-year-old Genevieve Mora is speaking out to remove the stigma around anxiety disorders.

She runs an organisation, Voices of Hope, with a friend, and on Monday is speaking at the organisation’s first public event to raise awareness about mental illness.

“I’m sharing my own experience because I want others to feel less ashamed,” says Mora.

It was not easy to open up.

“It was something I had been putting off for months and months. One night, I was lying in bed thinking about all the reasons why I didn’t want to share my story [and] I decided I had to do it.

“How was the stigma going to change, how [would] future generations and those suffering not feel ashamed unless I spoke out, told my story and let people know that it’s okay to not be okay and that you can get through.”

Mora feels that there is less public understanding about anxiety and Obsessive-Compulsive Disorder than depression.

“It’s amazing that depression is being spoken about a lot more openly than it used to be, and I hope that other mental illnesses begin to get discussed more openly too. Many mental illnesses work together. In my case, OCD, depression, anorexia and anxiety.

“Until recently I was happy to talk openly about them all, but kept my eating disorder a secret. I felt a massive sense of shame and worried hugely that people would judge me for my past.

“Eating is such a huge part of our culture and people find it hard to understand why I couldn’t just eat and be better. If only it was that easy.”

Genevieve Mora battled with anxiety disorder for a number of years. Photo / Supplied
Genevieve Mora battled with anxiety disorder for a number of years. Photo / Supplied

CD is defined as having obsessive, uncontrollable thoughts and performing deliberate repetitive actions. It usually starts during childhood or in teenage years and is genetic.

For some it can be a minor irritation, but for others it can become a debilitating illness.

According to the Mental health Foundation, the most effective treatment is a combination of psychological therapy and medication, which is succesful in 80-90 per cent of cases.

Mora says OCD is often not taken seriously. “It’s a term that is thrown around a lot – for example: ‘My room is so clean, I’m so OCD’. I just brush it off, but it is a little frustrating, as my struggle with OCD nearly killed me and it’s a very real and huge issue for many people.”

Mora thinks there needs to be more recognition about how anxiety can affect young people – and the fact it is on the rise.

“There’s a lot of pressure on young people not only with study commitments but social media which could be playing a big part in this rise.

“What people post on social platforms often doesn’t depict their reality. It’s easy to post an edited pic and look like your life is perfect, but everyone has a story and nobody is happy 24/7. Everyone has bad days.

“There’s a lot of pressure to act and be a certain way. I’ll often see girls commenting ‘my goal’ on a picture of someone that has been edited.”

Mora thinks schools need to speak more openly about mental illness.

“I know for a fact that there were at least 10 girls in my year at school fighting a silent battle when I was.

“Having programmes set in place within schools is important. We recently got back from a nationwide school tour and at one school the kids we talked to were as young as 11. We had kids coming up to us after and thanking us and wanting to talk because they now knew that they needed some help in dealing with what they were feeling.”

Genevieve Mora (left) and Jazz Thornton, co-founders of charity Voices of Hope. Photo / Supplied
Genevieve Mora (left) and Jazz Thornton, co-founders of charity Voices of Hope. Photo / Supplied

Her own anxiety began at just 10 years old, when she started to worry about leaving the house because of “an irrational fear of teenagers”.

She would wash her hands till they bled, and performed rituals from the moment she woke until the moment she got to sleep. If she didn’t complete rituals such as doing things in fours she believed there would be terrible consquences.

“I thought either my parents or sister would die or I would die or someone I love would get hurt in a car crash.”

She turned to food and exercise, “to find something I could control”.

Eating too became an obsession. “I would run 270 times up and down the stairs before allowing myself breakfast of half a Weet-Bix with water.”

“I began to hate life, hate myself, and wished myself dead. I would wake up each morning and wish I hadn’t.

“I ate less and less to the point where I was barely eating at all and exercising a few hours a day”.

When her weight plummeted to dangerous levels – she weighed just 48kg despite being 184cm – she was referred to hospital.

She packed an overnight bag. In the end she stayed for 12 weeks.

“There are a lot of people who are struggling terribly with no place to go, who are turned away from hospital because they haven’t attempted to take their life, even though they are suicidal.

“I was one of the lucky ones to get the intense treatment I did because I was physically in danger.”

In hospital she met someone who became significant in her own recovery – a 2-year-old girl with a chronic illness, which made Mora want to fight against her own illness.

“She and her family became a massive part of my journey and to this day are some of the most important people in my life. I often talk about her as ‘the silver lining’ of my hideous illness. I cannot imagine life without her.”

Genevieve Mora who for a number of years battled with anxiety disorder. Photo / Dean Purcell
Genevieve Mora who for a number of years battled with anxiety disorder. Photo / Dean Purcell

Despite this, she says it is a “tough battle”.

“Fighting a mental illness takes huge strength, and it shouldn’t be seen as a weakness. It’s an exhausting battle, trying to do the opposite of what the nasty voices in your head are telling you to do 24 hours a day.

“Every part of me wanted to be well again, to be socialising with friends, eating freely, to be able to read a book without having to read the page four times.”

Nadine Isler, Registered Psychologist at Anxiety New Zealand, said anxiety disorders were on the rise though experts were not clear on exactly why.

“It can affect almost every area of a person’s life – their relationships, their health, their life goals and of course general mental health – the individual may believe they are the only ones who suffer from these thoughts and compulsions, feel guilty, or as though they are ‘going crazy’.”

Isler said symptoms could show up as early as pre-school age, though it often went undiagnosed until a few years later.

“There is help though, and with help comes hope. I have enormous respect for anyone who has recognised they have a problem and does the hard work to get well … it’s certainly not easy, but definitely worth it.”

Now well, Mora lives in Auckland and works as a teacher aide while auditioning for acting roles, and the organisation Voices of Hope also takes up a lot of her time.

Since making a YouTube video of her experience she has been overwhelmed with support from people she knows and strangers from all over the world.

“It gives people hope and that’s more than I could have wished for … I made myself very vulnerable but it has all been so worth it.

“I feel a huge weight off my shoulders. I can live authentically and I am proud of where I am today.”

She has a message for other young people experiencing anxiety symptoms.

“People need to learn to love themselves and not compare themselves to others. Easier said than done, I know. Social pressure can create a lot of anxiety.

“It’s also important to acknowledge that some mental illnesses have no cause other than some of us are born with a tendency to depression or anxiety.

“But whatever the reason it’s vital to reach out and get help.”

EVENT

What:

How to fight: an evening focusing on the practical ways to fight suicidal thinking and mental illness

When:

Monday, 7pm to 8pm

Where:

EVENT Cinemas, Westfield Albany.

Restrictions:

R15

Admission:

Free

Read more:

WHERE TO GET HELP:

If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

OR IF YOU NEED TO TALK TO SOMEONE ELSE:

LIFELINE: 0800 543 354 (available 24/7)
SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
YOUTHLINE: 0800 376 633
NEED TO TALK? Free call or text 1737 (available 24/7)
KIDSLINE: 0800 543 754 (available 24/7)
WHATSUP: 0800 942 8787 (1pm to 11pm)
DEPRESSION HELPLINE: 0800 111 757 (available 24/7)
SAMARITANS: 0800 726 666

There are lots of places to get support. For others, click here.