Update on Common Psychiatric Medications for Children

Abstract

For children and adolescents with uncomplicated psychiatric disorders, pediatricians are often the first prescriber of psychiatric medications. Mental health disorders commonly treated by pediatricians include attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. There are several safe and effective first-line medications for these disorders. For ADHD, stimulants and nonstimulants can be used as first-line interventions. For anxiety and depression, selective serotonin reuptake inhibitors are well-established treatments and often well-tolerated. With appropriate support and training, pediatricians can increase access for children to necessary mental health treatments. [Pediatr Ann. 2018;47(8):e311–e316.]

With Short, Intense Sessions, Some Patients Finish Therapy in Just …

Before treatment, 70 percent of patients were classified as having severe O.C.D., and nearly three-quarters had previously been in therapy. Some 42 percent were taking antidepressants. The study did not have a control group.

At the Weill Cornell program, the participants, ages 10 to 15, practice exposures in a mock class. Dr. Falk gives them assignments to induce anxiety based on their individual triggers. She told the 12-year-old in the red tie and blazer — who is petrified of not acting “right” out of fear it will cause something bad to happen — to “be really inappropriate and rude, and eat in the middle of class and make a mess.”

She instructed a 12-year-old girl in a Harry Potter “Butterbeer” T-shirt to write about what she did on her recent birthday. The child has many compulsive behaviors involving writing and often has to erase and rewrite, something that causes problems in school.

For a 10-year-old with braces and a purple streak in her hair whose O.C.D. is triggered by not knowing certain things, Dr. Falk instructed the other kids to “tell me something secret and rude” that she couldn’t hear.

As class got underway one day, the boy, at Dr. Falk’s urging, ditched his tie and blazer. He was eating an orange. “Make fun of me,” encouraged a 14-year-old who has spent most of the session doodling.

The girl with the writing compulsion put down her pen and wailed. “Oh my god. It looks like an ‘I’ with a top hat on it,” she said, staring at her paper.

Dr. Falk looked it over. “I can understand it perfectly,” she said. “Let it go, which is going to be better for you long-term.”

Before the kids left, Dr. Falk wrote a new homework assignment on a colorful notecard for each of them, more exposures to complete before the next group meeting — the very next day.

I Wash My Hands a Lot, Do I Have OCD?

You can’t sit down at the dinner table without washing your hands first. Nothing annoys you more than when a public restroom fails to refill its soap dispensers. Sometimes you start to wonder if your attention to hygiene is actually something else — like OCD.

Obsessive-compulsive disorder has many symptoms, and can look different from one person to the next. In some cases, someone’s condition becomes so severe their whole life seems to fall apart out of nowhere. Others live with OCD for years without anyone knowing. They might not even know they have it themselves.

Read on to find out if your preference for cleanliness is a sign of something serious.

What is it like to have OCD?

Couple cleaning Couple cleaning | Milkos/iStock/Getty Images

OCD is a type of anxiety disorder. Though people with OCD might experience classic anxiety symptoms such as panic attacks, what makes this chronic condition different from other forms of anxiety is the ongoing cycle of obsessive thoughts — and the compulsive behaviors that accompany them.

Though it’s not the only sign someone has OCD, excessive hand-washing is a good example when trying to understand what it feels like to have this condition.

Someone who washes their hands over and over again is exhibiting what’s called a compulsive behavior. This occurs in response to an obsession — which, in this case, might be an irrational fear of germs.

Worrying about germs is a thought pattern a person with OCD might not be able to escape just by thinking about something else. The only way they can find relief is to respond with a behavior that attempts to satisfy that worry — washing their hands excessively to avoid germs.

If you wash your hands after using the bathroom, before eating, or in other situations that might expose you to germs, you probably don’t have OCD. Good hygiene isn’t a mental disorder. But if you can’t stop thinking about what could happen to you if you don’t wash or sanitize your hands ASAP — and only feel better when you do — you might.

Not everyone with OCD is obsessed with germs

Worrying about or fearing contamination and germs is just one kind of obsession that can lead to compulsions. Others might include:

  • Fear of losing things
  • Having things in perfect order
  • Worries about being harmed or harm coming to those close to you
  • Unwanted, invasive thoughts about religion, sex, and more.

In an attempt to cope with these obsessions, someone living with OCD might clean excessively, repeatedly count things, hoard objects, check that the oven is off or the door is locked over and over again, or compulsively arrange objects in a certain order.

Can OCD cause other health problems?

Anxiety disorder Anxiety disorder | iStock.com/Viktor_Gladkov

Like many other mental health issues, OCD can have major health consequences beyond anxiety, depression, and thoughts of suicide — though these are still significant and harmful complications.

Though symptoms vary in severity, and everyone’s experiences are different, obsessive thoughts and uncontrollable compulsions can cause strained relationships and difficulty attending work or school. Someone preoccupied with the possibility their food might be contaminated could severely limit their options and become malnourished.

Thankfully, a combination of medication and cognitive behavioral therapy is a proven method for treating OCD. This type of therapy teaches you how to respond in a more constructive way to certain thoughts, instead of turning to potentially harmful behaviors.

It’s possible to lead a long, successful life with OCD. With the right treatment, many people can learn to avoid the behaviors that once ruled their days.

Some of us like things to be in a certain order, can’t leave the house without hand sanitizer, and hope our loved ones stay safe. That doesn’t mean we’re all “a little bit OCD.” When thoughts and behaviors become obsessive, though, you have a right to worry.

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Panic room

Anxiety is universal and commonplace. We have all experienced anxiety at some point of time in our lives, and most of us don’t even think it is something to be taken seriously. Perhaps we assume that it’s natural to be worrying, anxious and high-strung in today’s world and so, we don’t see how anxiety wreaks havoc on our lives. 

Sometimes we confuse an anxious mind with an active mind or as being concerned, which gives us the justification and incentive to remain anxious. A mother who’s constantly thinking about her child’s future may find not worrying as a sign of being a bad mother. If a student is not crumbling under pressure before an exam, we might be quick to judge them as ‘not serious’ about studies. A person who usually takes things in their stride calmly may not be perceived as driven or productive enough. It will not be an exaggeration to say that through many of our apparently normal thoughts, ideas and lifestyle choices, we are constantly priming ourselves to be anxious in many ways. And many of us are paying a price for it. 

Anxiety falls under the umbrella term ‘neurosis’, which is defined as maladaptive psychological symptoms usually precipitated by stress. Basically, we are said to have neurosis when our mind cannot cope with the perceived or real challenges, threats or stressful situations, and we start worrying excessively, feeling apprehensive about the small things. This causes a lot of distress and dysfunctionality. 

Anxiety can manifest as a sudden episode of acute panic attack (Panic Disorder), worry of being embarrassed in public (Social Phobia), worry of being contaminated and developing a repetitive compulsive behaviour (Obsessive Compulsive Disorder), of being away from close ones (Separation Anxiety Disorder), fear of having a serious illness (Hypochondriasis) and being overweight (Anorexia Nervosa) to a more defused but constant lurking of fear and tension (Generalised Anxiety Disorder).

Generalised anxiety disorder (GAD)

It’s when there is more or less constant worrying even when things look okay. One feels an uncontrollable, persistent, free-floating anxiety most of the time of the day, and one is also always apprehensive about everyday events or problems. 

It gets accompanied by other symptoms like restlessness, tiredness, difficulty in concentration, irritability, muscle tightness and sleep disturbance. According to the DSM V (Diagnostic and Statistical Manual for mental disorder) criteria for diagnosis, if one has at least three of the above symptoms along with pervasive and persistent worry for most days for at least six months, one can be diagnosed of having GAD. 

It is important to note that various medical conditions like hyperthyroidism or even substance abuse may mimic the symptoms of GAD.  According to ICD-10 (International Statistical Classification of Diseases and Related Health Problems), GAD is recognised by: 

• ‘Autonomic arousal’ including palpitation, increased heart rate, increased respiratory rate, trembling or shaking and dry mouth.

• Physical symptoms like breathing difficulty, choking sensation, chest pain or discomfort, nausea, abdominal discomfort or pain.

• Psychological symptoms like feeling unsteady, dizzy, light-headedness, ‘derealisation’ (which is an acute sense or suspicion of being in an unreal, unfamiliar world or/and a sense of detachment from one’s own thoughts and feelings or sense of self), fear of losing control, fear of going crazy or dying or passing out, difficulty in concentration or ‘mind going blank’ from stress, persistent irritability, sleep disturbance.

• General symptoms like hot flushes, cold chills, numbness, tingling.

• Symptoms of tension including muscle tension/aches and pains, restlessness or inability to relax, feeling on the edge or tense, feeling a lump in the throat or having difficulty in swallowing.

A more dramatic and acute presentation of anxiety is a panic attack — a short period of intense fear accompanied by some of the symptoms mentioned above, including a few others. Sometimes the fear or anxiety can be so distressing and painful that suicidal thoughts can arise. In panic attack, symptoms develop rapidly, peaking in about 10 minutes and usually don’t last for more than 30 minutes. It may happen out of the blue or when there’s a specific recognisable trigger. Having to perform in front of others, meeting unknown people, facing a crowd, being in public places or in emotionally charged moments can be some of them.

Ironically, the fear of having a panic attack itself can trigger one; and so can the fear of getting sick or lost. Sometimes attacks may happen in sleep and in rare cases, physiological symptoms of anxiety may occur without the recognisable psychological component, which is known as non-fearful panic attack.

A chronic and recurring panic disorder may present itself with only physical symptoms like chest pain, Irritable Bowel Syndrome and certain types of headaches, that is, without an actual panic attack. Another common form of anxiety is ‘Specific Phobia’ where there is an irrational fear of a particular trigger, like phobia of closed spaces, public speaking or injections.

Learning to disengage

Whatever be the symptoms, there are psychological patterns behind most cases of anxiety. We love and value a person who is constantly anticipating, recognising, getting engaged with a problem and thinking of ways to handle them or at least trying to prevent them in advance. We also love a perfectionist who is in charge and delivers perfectly every time. These same traits can also give rise to dysfunctional anxiety or panic attacks because they programme us to constantly think of the worst-case scenarios and create an urgency to micro-manage our environment according to our ideals.

Learning to disengage from anxiety-creating thoughts, beliefs and ideas is an important skill to develop. We need to be self-vigilant so that we can recognise these troublemakers and challenge them when they are causing more distress than benefit. It requires long-term commitment to change and to keep disputing the beliefs and thoughts that may be triggers. 

Daily practice of breath control techniques like the ones taught in the Vipassana meditation courses, mindfulness-based stress reduction programmes, Zazen or Zen meditation are quite useful in dealing with anxiety. 

Nowadays excellent medications are available for anxiety. Don’t shy away from consulting a psychiatrist and getting a proper evaluation and prescription. A therapist might also be able to help recognise early symptoms and teach effective tools. 

In an acute condition, one needs to affirm to oneself that, “it’s a passing phase, it will go away in half-an-hour”. Practise focusing on your breath, and try breathing slowly and deeply during an acute attack. You can listen to calming music or nature sounds, or do a quick guided anxiety-relieving meditation on one of the various apps available. Carry your medicines if you are prone to panic attacks. Educate yourself and know what works for you.

FIVE PSYCHOLOGICAL POTHOLES TO AVOID

‘Should be’ fixation: When one is too fixated on how things should be rather than being aligned with how things are, it creates a psychological environment of anxiety. It is great to try to better things but we also need to understand that not everything can be how we think it should be. We are imperfect creatures who live in an imperfect world and ‘should be’ can be aspirations and preferences but not compulsions and demands.  

‘Comfort zone’ adherence: If we only stick to things and environments that we are comfortable in, our tolerance threshold for things that we don’t know how to deal with is bound to be low. This does not help one to grow. The more we are exposed and forced to negotiate things that are outside our comfort zone, the more skilful we become to handle ourselves during stressful times. Slowly trying to get out of our comfort zone might make us less anxious. 

Need to be in control: If one constantly nurtures a need to be in control and micro-manage one’s surrounding, then there will be anxiousness. There are things that we can be in control of — these are related to us, our behaviour, and our ideas. There will always be things that will be out of our control. Unless we are okay with that, we will always be stressed.

Resistance to ‘unpredictables’: Life surprises us. If we have a strong need to have a predictable outcome, we will often find ourselves distressed. Be ready and willing to negotiate surprises, both positive and negative, and you’ll will find it easy to deal with ups and downs. 

Fixer syndrome: It is good to be a problem solver, but if you think you need to fix everyone’s  problems around you, you are in for trouble. There is a difference between the problems you can solve, problems which you want to solve and problems which need to be solved, so choose and prioritise carefully; you cannot fight every battle without getting torn apart within.

Dr Sangbarta Chattopadhyay and Dr Namita Bhuta are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions

The 7 Most Common Types Of Anxiety & How To Tell Which One You Have

Anxiety symptoms often get lumped together into one big category, and labeled as “anxiety.” But there are actually many different types of anxiety disorders, that all have very different symptoms. And getting to the bottom of which one (or which ones) might be affecting you is key to finding the right course of treatment.

As clinical psychologist Dr. Paul DePompo tells Bustle, “It is important to know which one you have because there are different treatments for each disorder,” whether it be medication, therapy, lifestyle changes — or a combination of treatments. That’s not to say, though, that you need to diagnose yourself. By keeping track of your symptoms, and discussing them with a therapist, you can start to narrow down the options, and figure out exactly what’s been holding you back.

It can feel isolating, as you deal with your symptoms and seek out treatment. But remember, you’re not alone. “Anxiety affects millions of people every year,” Julie Marie Bowen, MSW, LSW, CTS, CSAC, a psychotherapist at Hope Therapy and Wellness Center, tells Bustle. So if you’ve been struggling with anxiety-related symptoms, know that you’re definitely not alone.

Whether you have generalized anxiety disorder, a social phobia, obsessive compulsive disorder, there is a way to cope with your symptoms, and get back to feeling better. Here, the most common types of anxiety, according to experts.

1Generalized Anxiety Disorder

Hannah Burton/Bustle

Generalized anxiety disorder (GAD) is “characterized by persistent worry about many areas of life; relationships, finances, health, and career,” clinical psychologist Dr. Helen Odessky tells Bustle. And it occurs without an obvious cause — you’re just anxious all the time for “no reason.”

“People with GAD see the world as a dangerous place and do not feel the confidence that they can cope with the unexpected, so they are on hyper-alert,” clinical psychologist Dr. Paul DePompo tells Bustle. “With GAD one wrestles so much with the ‘what ifs’ they ruminate to the point where it can impact, school, work, sleep, social fun, etc.”

While we all feel anxious from time to time, anxiety caused by GAD is excessive, has a big impact on overall quality of life, and can even cause physical symptoms, such as nausea, tiredness, or sweating.

The best way to overcome GAD is through therapy, where you’ll learn how to tune out those “what ifs,” Dr. DePompo says, and build up confidence so you’ll know you can handle any situation. Lifestyle changes can also help — such as drinking less coffee, and finding ways to better deal with stress. And, many people choose to take anxiety medication as well.

2Social Anxiety Disorder

Hannah Burton/Bustle

While it’s common to feel a bit nervous in certain high-pressure situations — such during an important meeting — folks with social phobia, or social anxiety disorder, will find moments like these too uncomfortable to bear.

If you have social anxiety, you might have a fear of “social situations, particularly ones that may result in potential embarrassment or judgment, such as dating, going to a get-together, giving a speech, or participating in a performance,” Dr. Odessky says.

You might not be able to make eye contact or hold a conversation without experiencing extreme anxiety, such as rapid heart beat, sweatiness, stomach issues, or even out-of-body experiences, according to WebMD.

Social anxiety can truly hold you back in life, so it’s important to seek treatment ASAP. One of the most effective ways to overcome social anxiety is through talk therapy, where a trained professional will help build up your confidence. Medication can also do the trick.

3Obsessive Compulsive Disorder

Ashley Batz/Bustle

Obsessive compulsive disorder, or OCD, has been moved to its own section of the DSM-5, and out from under the umbrella of other anxiety disorders. But because it’s so anxiety-inducing, it’s important to consider.

“OCD is a complex disorder that involves distressing thoughts (obsessions) and behaviors (compulsions) in response to these thoughts,” Dr. Odessky says. “Usually the person realizes that these rituals are unhelpful, but feels powerless to stop them.”

If you have OCD, you might “engage in repetitive behaviors; such as hand washing, checking, ordering, counting, or repeating words silently in [your] head,” Bowen says. “This desire to engage in these compulsive behaviors is in an effort to reduce anxiety. But the behaviors themselves do not actually assuage anxiety in a realistic manner. These behaviors significantly impact daily functioning and are time consuming.”

One of the most effective ways to overcome OCD is through exposure and response prevention (ERP). “This means you work up a fear ladder of situations that are difficult without using your rituals,” Dr. DePompo says. “You learn to restructure your thoughts and test out engaging in life without the rituals that keep you pseudo-safe.”

4Panic Disorder

Andrew Zaeh for Bustle

Another type of anxiety disorder, known as panic disorder, can come about if you’ve experienced panic attacks in the past. “Panic disorder is the fear that you may get another panic attack,” Dr. DePompo says. You might find yourself avoiding situations that have caused panic attacks in the past, changing your daily routine, or becoming overly-focused on your bodily symptoms.

“You end up doing things that can actually bring [on a panic attack, such as] focusing on your heart rate … [or] avoiding anxiety-provoking stimuli,” Dr. DePompo says. “What happens is you start conditioning the anxiety symptoms and this brings on the panic attacks. The more you fear it, the more power the anxiety takes over you.”

And that’s where therapy can come in handy. If you have panic attacks, or live in fear of having them, let your doctor know. They can set you up with a therapist, who may prescribe talk therapy, medications, and/or breathing techniques.

5Post-Traumatic Stress Disorder

Ashley Batz/Bustle

It’s possible you might suffer from post-traumatic stress disorder, or PTSD, after either directly or indirectly experiencing a very stressful event. “This means having the event happen to you, witnessing the event, having the event happen to a close friend or relative, or being involved in the event because of professional responsibilities (i.e. first responders, medics, etc.),” Joshua Klapow, PhD, a clinical psychologist and host of The Kurre and Klapow Show, tells Bustle.

While everyone takes a while to recover after experiencing traumatizing situations, those with PTSD tend to take longer and have more severe side effects. “Symptoms must be present for more than one month,” Dr. Klapow says, and may include things like nightmares, intrusive thoughts, re-experiencing the event, hyper-vigilance, and feeling on edge. You might also feel depressed, sad, guilty, or have sleep problems.

There’s good news though. “PTSD is in most cases very treatable with a combination of behavioral and cognitive behavioral psychotherapy methods and psychotropic medication,” Dr. Klapow says. “PTSD requires professional intervention by mental health professionals trained specifically to address the condition.”

6Specific Phobias

Andrew Zaeh for Bustle

Everyone has a few fears. But if you have a bonafide phobia, you’ll likely experience an “exaggerated or irrational fear of certain situations (dark places, severe weather, enclosed places, heights), people or animals (clowns, dogs, snakes, insects), or objects (foods, weapons, mirrors),” Dr. Klapow says.

The thing about phobias is you know you’re being irrational, but you feel the anxiety anyway. As Dr. Klapow says, “Symptoms include nervousness and anxiety when thinking about the feared situation or object, avoidance of the object at all costs, and feelings of panic in the presence of the object.”

Since phobias can lead to severe limitations in life — you might, for example, not take a job if it requires you to face a certain fear — it is important to seek help. Treatments for phobias include mindfulness strategies, exposure therapy, cognitive behavioral therapy, and even certain anxiety medications.

7Agoraphobia

Hannah Burton/Bustle

Agoraphobia is a type of anxiety that can form all on its own — possibly because it tends to run in families — but it can also crop up most after a series of panic attacks. “Very often individuals will have a panic attack in a public situation and because the panic attack is so aversive, they begin to develop anticipatory anxiety — or fear about being in a public situation where they might have an attack without the ability to leave,” Dr. Klapow says.

This type of anxiety might cause you to feel anxious on public transportation, while in crowded areas, or even in wide open spaces. “The sufferer can develop a general fear or phobia of any … situation where they cannot easily leave,” Dr. Klapow says. “Unlike other phobias, though, agoraphobia is focused on anticipating a panic attack and fearing the setting. The result in the most extreme situations is where the person fails to leave their home, as it often is the only place they feel safe.”

The good news is, there is a way to treat it so you can get on with your life. Exposure therapy can help by getting you out into the world, and learning how to breathe through the anxiety. Medication can also help boost your ability to cope.

If you feel any type of anxiety, let a therapist know. By describing your symptoms, and explaining what you’ve been struggling with, they can figure out which type of anxiety disorder you might have, and prescribe the best course of action.

New discovery sheds light on proteins critical in mood and behavior disorders

New York, NY (August 8, 2018)–Researchers at Columbia University Irving Medical Center (CUIMC) have found new evidence of how certain transport proteins are working at the molecular level, paving the way for new, improved drugs to treat psychiatric disorders.

The study’s findings have been published in the prestigious Proceedings of the National Academy of Sciences of the United States (PNAS).

Neurotransmitter:sodium symporters (NSS) regulate signals between nerve cells, and are the molecular target of antidepressants (SSRIs like Prozac) and of various psychostimulants. The understanding of their structure and function, therefore, is key to the development of appropriate therapeutics to treat disorders such as depression, anxiety, and obsessive-compulsive disorder (OCD), which are a burden to millions of people in the US.

Led by CUIMC researchers Matthias Quick, PhD, Associate Professor of Neurobiology (in Psychiatry) at Columbia University Vagelos College of Physicians and Surgeons and Jonathan Javitch, MD, PhD, Lieber Professor of Experimental Therapeutics in Psychiatry and Professor of Pharmacology at Columbia University Vagelos College of Physicians and Surgeons, the team had previously studied a bacterial version of NSS (LeuT). This work revealed the existence of an unexpected second substrate binding site that was shown to also bind drugs. The team’s new study examined another bacterial NSS homolog (MhsT) that is even more functionally similar to its human counterparts. Their finding of a second substrate binding site in this NSS, too, powerfully suggests that the same configuration is likely found in human NSS as well, and dispels much of the previous skepticism.

“These data suggest that the involvement of two binding sites in neurotransmitter transport is not unique to LeuT but shared by other NSS members, and is possibly a universal feature of these many transport proteins,” says Dr. Javitch.

The study of neurotransmitter:sodium symporters has proven challenging, and three-dimensional images of LeuT were first captured only in 2005 using X-ray crystallography. While a central binding site was identified in the crystal structure, imaging of the second binding site remains elusive, and its identification has required biochemical, biophysical and computational approaches.

“Looking forward, incorporating the knowledge from this new discovery into future NSS research could lead to better-informed therapeutics research and design, ultimately improving the lives of the millions of Americans afflicted with psychiatric disorders,” says Dr. Quick.

The study is titled “The LeuT-fold neurotransmitter:sodium symporter MhsT has two substrate sites.”

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The other authors of this paper are Ara M. Abramyan, PhD (NIH/NIDA/IRP), Pattama Wiriyasermkul, PhD (CUIMC), Harel Weinstein, DSc (Weill Cornell Medical Center), and Lei Shi, PhD (NIH/NIDA/IRP).

The study was supported by grants from the National Institutes of Health (U54 GM087519, R01 DA041510, and P01 DA012408), and by the Intramural Research Program of National Institutes of Health, National Institute on Drug Abuse.

The authors report no financial or other conflicts of interest.

Columbia University Department of Psychiatry

Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

OCD Associated With Socioeconomic Factors and Mental Health Comorbidities

People diagnosed with OCD were associated with a lower socioeconomic status and comorbid conditions affecting their mental health.

The estimated prevalence of lifetime obsessive compulsive disorder (OCD) in the Canadian population is 0.93%, according to a study published in Psychiatry Research. People diagnosed with OCD were associated with a lower socioeconomic status and comorbid conditions affecting their mental health. Additionally, substance or alcohol abuse and negative childhood experiences had links with OCD.  

This cross-sectional study sought to examine the prevalence of OCD in Canada and the association of OCD to related comorbidities, sociodemographic factors, childhood experiences, and utilization of healthcare services. Data was analyzed for a cohort of 25,097 participants aged 15 and older who responded to the population-based Canadian Community Health Survey – Mental Health 2012.

The study examined data specific to lifetime OCD diagnoses, including prevalence of comorbid conditions, substance abuse and dependence, negative childhood experiences, and healthcare utilization. Demographic and socioeconomic factors were considered, including gender, age, education, employment, and income. Participants were screened for presence of specific mood disorders, anxiety, and attention deficit disorders. Utilization of health care was examined by the number of hospitalizations, likelihood of hospitalization, or likelihood of speaking with healthcare professionals.

Of the 25,097 participants, 267 responded positively to having received an OCD diagnosis, indicating that OCD was prevalent in 0.93% (95% CI 0.75 to 1.11) of the Canadian population. Compared to the control population, demographic factors associated with OCD pointed to younger individuals with lower incomes, and a higher proportion of patients with OCD were diagnosed with mood disorders (such as depression and bipolar disorder), ADHD, and general anxiety disorders. An OCD diagnosis was significantly associated with alcohol dependence and substance abuse; negative childhood experiences were more common in people with OCD, in which 72.33% (95% CI 62.25% to 82.41%) suffered some form of childhood maltreatment.

A final result of the survey showed that patients with OCD frequently utilized healthcare services. While the number of hospitalizations per year was similar to the control population, people with OCD were more likely to report needing but not receiving help for emotional and mental health problems or problems with substance abuse. The study investigators suggest that this finding exposes a gap in treatment and resources available to help patients with OCD.

Limitations of the study included relying on subjects to self-report professionally diagnosed OCD. The survey did not include screening questions for OCD and therefore did not account for people with undiagnosed OCD. Institutionalized individuals were also left out of the survey, which may have contributed to an underestimation of the prevalence of OCD.

Overall, a lower socioeconomic status, childhood maltreatment, and the presence of comorbid mental health conditions were associated with diagnosed OCD in the studied Canadian population. Although the OCD cohort felt like they received inadequate support for their problems, they were more likely to utilize different healthcare services, indicating that improved access to clinical resources could benefit patients with OCD.   

Reference

Osland S, Arnold PD, Pringsheim T. The prevalence of diagnosed obsessive compulsive disorder and associated comorbidities: a population-based Canadian studyPsychiatry Res. 2018;268:137-142.

Lena Dunham sends a powerful message about her battle with mental health

Actress Lena Dunham has shared a reminder to everyone that looks can be very deceiving – especially on social media.

And her latest Instagram post also contains an important message about mental health.

The 32-year-old has shared side-by-side photos of herself taken at two different times in her life, detailing the way she was feeling during both stages.

“In the first picture I look like a cashmere princess made of miracles and in the second I look like I’ve killed 9 husbands and hidden them in the bayou,” Dunham writes on Instagram.

“But in the first I was hiding wildly untreated illness physical and mental under my fancy coat and in the second I am restored to sanity, talking to someone I love about the job I love on my way home from a really enriching morning.”

The Girls star was photographed by the paparazzi speaking on the phone outside her hotel in New York City, where she lives.

“I am out of pain. This is your (and my) daily reminder that there are things more honest than pictures and that your feed is a bastion of lies!”

Dunham has previously spoken about her struggles with anxiety and Obsessive-Compulsive Disorder. 

(Instagram/lenadunham)

“I have obsessive compulsive disorder and a generalized anxiety disorder that often leads to dissociative anxiety,” she told People in 2017.

“I would tell my younger self that there’s no shame in asking a teacher for help, telling a friend that you’re uncomfortable and that it’s just the same as falling down and scraping your knee.”

The author, actress and director has come to be viewed as a champion for self-love.

And it’s not the first time Dunham has shared contrasting photographs of herself.

(Instagram/lenadunham)

Last month she posted two images, one when she weighed 63 kilograms and another when she was 10 kilos heavier – but, happier.

RELATED: Lena Dunham shares the truth behind these before-and-after photos

Dunham’s brutally honest social media posts are always a hit with her legion of fans.

One wrote, “An important message needed now more than ever” while another user said, “This is an amazing attitude and such a positive message. I hope you get through to many”.

Woman Sues Abilify Marketers Over Hefty Gambling Losses

A Minnesota woman, Denise Miley, is suing Bristol-Myers Squibb and Otsuka Pharmaceutical, alleging that their depression and anxiety drug Abilify (aripiprazole) caused a gambling impulse. She filed the suit in January 2016, claiming that the companies knew or should have known that the drug could cause compulsive gambling.

Her suit isn’t the only one. There are hundreds more claiming that Abilify resulted in a number of compulsive behaviors, including gambling, eating and sex. The U.S. Food and Drug Administration (FDA) expressed its own concerns in a 2016 safety warning, noting uncontrollable urges to gamble, binge eat, shop, and have sex.

“We have people who have lost their retirement accounts, spent their children’s college funds, blown through a lifetime of savings,” said Gary Wilson, a lawyer with Robins Kaplam, the firm representing Miley and some of the other plaintiffs.

STAT notes, “Scientists haven’t figured out how, exactly, a drug might trigger compulsive behavior. Psychiatrists say that even if Abilify does have a role, it’s probably just part of the explanation, since millions of people take the drug without experiencing such problems.”

Japanese firm Otsuka developed the drug and Bristol-Myers Squibb markets it jointly in the U.S. with Otsuka. Both companies have denied the allegations.

Levin Papantonio, a law firm in Pensacola, Florida, notes that as of July 2018, more than 1,600 lawsuits have been filed against the companies over Abilify in federal court. Papantonio writes, “Court records state the drug makers failed to properly test Abilify; exaggerated the benefits of the drug; and encouraged physicians to use the medication for purposes not approved by the FDA. Abilify is not approved to treat anxiety disorders, dementia, eating disorders, insomnia, obsessive-compulsive disorder, or post-traumatic stress disorder. Yet, the makers of Abilify convinced doctors to try it for these conditions.”

The drug was originally approved in 2002 by the FDA to treat schizophrenia. Since then it has been approved for bipolar disorder, irritability linked with autism, Tourette’s syndrome, and major depressive disorder. In 2007, Bristol-Myers Squibb paid more than $500 million to settle federal charges that it “illegally marketed the drug to pediatric physicians and nursing homes,” writes STAT. “And in 2016, the company reached a $19.5 million settlement with 42 states and Washington, D.C., which accused the drug maker of illegally promoting Abilify to people with Alzheimer’s disease and other forms of dementia.”

The drug is one of the most-prescribed drugs on the market, despite facing generic competition since 2015. Since it was approved, the brand-name version has brought in more than $51 billion—yes, billion with a “b”—worldwide. And the drug has another landmark—the FDA approved Abilify MyCite in 2017, “a version of the drug embedded with a sensor that can alert a patient’s physician or caregiver when it’s been ingested. It was the first approval of a so-called smart pill,” STAT writes.

The European Medicines Agency (EMA) issued a warning about the drug in 2012, linking it to compulsive behavior, and in 2015, Canada’s regulatory agency did the same thing. However, “pathological gambling” wasn’t added to the warning labels until January 2016. The FDA didn’t issue a warning until May 2016.

Meanwhile, much of the court battles revolve around whether the drug is the cause of the impulse control issues, and if it is, how it does so. Abilify partially blocks dopamine, a neurotransmitter that transports signals between neurons in the brain. It has quite a number of roles in the brain, including regulating reward processing, pleasure and motivation.

But with a drug used by millions, only a small proportion are showing these problems. “If it were as simple as it causing [the behavior], then the streets would be filled with impulsive people,” Jon Grant, a psychiatrist at the University of Chicago, told STAT.

But that is the very nature of drugs when it comes to side effects. There are significant genetic components to how individuals process drugs, which is why some people have few, if any, side effects and others may have severe side effects. And when it comes to the central nervous system, those effects are often more complicated and difficult to understand.

Still, anecdotally at least, these people started their compulsive behavior when they started taking the drug, and the behavior stops when they stop taking the drug. And it appears that other drugs that affect the dopamine system, such as drugs for Parkinson’s Disease, have also been linked to compulsive behavior.

Cognitive Therapy Plus Exposure and Response Prevention Effective in OCD

The treatment led to significantly greater symptom relief and belief reduction compared with exposure and response prevention.

The addition of cognitive therapy to exposure and response prevention (ERP) resulted in improved outcomes in patients with obsessive-compulsive disorder (OCD), according to the results of a study published in the British Journal of Clinical Psychology.

The use of ERP in patients with OCD is considered an effective first-line therapy and is recommended by major guidelines. ERP therapy results in effective and lasting change in OCD, regardless of symptom presentation and severity and the presence of comorbidities. Both intensive and outpatient therapies are effective. Cognitive therapy is less well established in the treatment of OCD, although it is effective as well. Most studies have compared ERP with cognitive therapy (CT) and both have shown significant and equivalent efficacy. However, the integration of ERP and CT has been proposed in treatment guidelines such as those from the National Institute for Health and Care Excellence (NICE). This is the first randomized controlled study to directly test whether integrated manualized CT offers a therapeutic benefit greater than ERP alone.

Neil A. Rector, PhD, C.Psych, of the Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, and the Department of Psychiatry, University of Toronto, Canada, and colleagues conducted a longitudinal randomized controlled trial to compare treatment that integrated CT with ERP (ERP + CT) with ERP alone. The investigators measured obsessive-compulsive symptoms before treatment, post-treatment, and at 6-month follow-up.

The investigators randomized 127 patients with OCD to receive individual outpatient ERP or ERP + CT. ERP + CT led to significantly greater symptom relief and belief reduction compared with ERP. The added benefit was equivalent to a medium to large treatment effect. More participants in the ERP + CT group were judged to be recovered than patients in the ERP group. Benefits were found in the main OCD dimensions, including contamination/washing, doubting-harming/checking, order-symmetry/repeating and pure obsession (harming, sexual, somatic, and religious).

Limitations of the study included the failure to examine the differential effects of ERP or ERP + C vs another form of psychotherapy, and given the high rates of depression in individuals with OCD, that a diagnosable mood disorder was the basis for exclusion from the trial. Nonetheless, the investigators argued that these findings support NICE treatment guidelines that recommend the integration of ERP and cognitive therapy for OCD.

Reference

Rector NA, Richter MA, Katz D, Leybman M. Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting [published online July 8, 2018]. Br J Clin Psychol. doi:10.1111/bjc.12188

Retroactive jealousy: Obsessed with my partner’s past

Illustration of a couple talking in a restaurant

Zachary Stockill’s obsessive thoughts about his partner’s previous sexual experiences led to the collapse of his first serious relationship. It took time for him to discover that his problem had a name – and that thousands of other people also suffer from it.

I was in my early 20s and, for the first time, I was in love.

One evening my girlfriend and I did what a lot of new couples do at the beginning of a relationship – we started talking about our pasts. The conversation moved on to previous relationships we’d both had.

A switch flicked in my brain.

There was absolutely nothing she said that was out of the ordinary, no details that were particularly unusual, shocking or even titillating. But something changed.

Her romantic history was suddenly all I could think about.

I grew up in a small town in northern Ontario, Canada. My parents had an excellent marriage and for the most part I had a great relationship with them. I didn’t grow up with mental health challenges – no depression, no anxiety, no obsessive compulsive disorder (OCD).

I loved women.

By grade three (aged eight) I had two girlfriends! But that was probably one of the few times I dated more than one person at a time. I enjoyed typical high school relationships.

Then I went to university and as an undergraduate I met and fell in love with a woman unlike any I’d met before. She was beautiful, extremely intelligent, artistic, and curious.

But when she spoke about her earlier life an emotion I’d never experienced began to take over.

Most of us have an impression of what “normal” jealousy looks like. Maybe feeling a pang when you see your partner attract the attention of someone in a bar or perking up when a colleague’s name starts cropping up more often in conversation.

Illustration of a final frame of a movie

Most people don’t like the idea of imagining their partner with someone else, such as an ex, but what I was feeling was entirely different.

My romantic history was, shall we say, more “colourful” than hers, but the thought she had been intimate with anyone other than me started plaguing me.

I didn’t know the name of it then but what I had is sometimes called “retroactive jealousy”. I’d learn much more about it in the years that followed.

I started playing mental movies in my head of her in situations with her ex and imagine them as if was happening in real time, right in front of me. It was as if she was cheating on me.

Her past suddenly became my present.

I’d latch on to some trivial detail and paint a hugely vivid picture around it. I would add details and turn insignificant events into full-blown scenarios in my mind.

If we went out to eat I’d wonder if she and her previous partner had been to the same restaurant. We’d walk by a hotel and suddenly I’d wonder if they had made love there.

Her previous relationships were the first thing I thought about in the morning and the last thing at night.

Social media is a huge magnifier for this issue. You have a backlog of posts and comments and images from your partner’s past. And I dived into it.

I became an online detective.

Illustration of a desk and laptop showing social media sites

I’d scroll through old photos from before I knew her, reading comments, trying to figure out who certain people were, how they fitted into her life, whether there was an untold adventure from her past.

These were the things I did in private, then there was the real-life toll on our relationship.

I’m ashamed of how I acted then.