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Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.

Homework

Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

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Millions of individuals live each day in fear – not of an actual physical threat, but imaginary dangers, remembered trauma, inanimate objects, or something as simple as walking outside their front door.

The most common psychiatric illnesses today are anxiety disorders.  Estimates place the number of affected Americans at up to 40 million. At least 18% of adults and 13% of children suffer from some type of anxiety disorder in a given year.

The Nature of Anxiety Disorders

We all experience brief moments of anxiety during stress.  In order to be considered an actual disorder, anxiety symptoms must be intense and frequent.

Mental health professionals recognize six different types of anxiety disorders:

  • Obsessive-compulsive disorder – continual disturbing thoughts and/or the need to perform ritualistic behaviors;
  • Generalized anxiety disorder – excessive, unrealistic worry or tension without apparent cause;
  • Post-traumatic stress disorder – frightening thoughts and memories after a traumatic event, often with emotional numbing;
  • Social anxiety disorder – overwhelming self-consciousness or phobia about being in social situations;
  • Panic disorder – sudden feelings of terror, often with incapacitating physical symptoms;
  • Specific phobias – intense fears of specific situations or objects.

Excessive fears or feelings of dread are common to all types of anxiety disorders.

Common Symptoms

While clusters of symptoms vary with the type of anxiety disorder, individuals with severe anxiety may experience:

  • Persistent feelings of panic, fear, or dread;
  • Obsessive thoughts;
  • Ritualistic, compulsive behaviors;
  • Flashbacks to traumatic experiences;
  • Feelings of losing control;
  • Frequent nightmares;
    • Intense fears in public situation;
    • Intense fears of certain objects or activities;
    • Physical symptoms such as shortness of breath, heart palpitations, nausea, muscle tension, dizziness, or dry mouth.

Causes and Risk Factors

Many factors may influence the development of an anxiety disorder.  They include genetic tendencies as well as such environmental factors as repeated exposure to stressful events or one major traumatic event. Even certain medications, including antihistamines, oral contraceptives, and insulin, have been found to trigger anxiety.  As with most mental illnesses, anxiety disorders appear to develop from an interaction of many medical, genetic, psychological, and environmental factors.

Anxiety disorders can affect anyone and often occur in conjunction with other physical and mental illnesses. Women are diagnosed with anxiety disorders more frequently than men.  No differences in prevalence have been noted across races or cultures.

Anxiety Treatment

Treatment of anxiety can greatly reduce or eliminate symptoms in most individuals.  Primary treatments for most anxiety disorders include medication and psychotherapy.  Treatment can usually be provided on an outpatient basis, although brief residential or inpatient treatment is sometimes needed, depending upon the individual’s unique needs.

Medications used to treat anxiety disorders include a variety of antidepressants and anti-anxiety drugs.

Cognitive-behavioral therapy is the preferred type of psychotherapy for severe anxiety.  Through therapy, patients learn to recognize unhealthy thought patterns and behaviors associated with their anxiety and to change both faulty thinking patterns and their reactions to “trigger” situations.

In addition to medication and psychotherapy, treatment may include relaxation therapy, changes in diet and lifestyle, and education on the illness for both patients and their families.

While anxiety disorders cannot be prevented, people can often reduce symptoms by limiting caffeine consumption, avoiding over-stimulating medications or supplements, and seeking immediate support or counseling after a traumatic experience.

Through proper treatment and symptom management, millions of individuals affected by anxiety disorders can lead fulfilling lives again.

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Attention Deficit Hyperactivity Disorder (ADHD) is a condition that can cause disruption in the daily lives of those who are affected by it.  ADHD can impact school performance, interpersonal relationships, and employment, as it affects concentration, activity levels, and impulse control.

An estimated 3 – 5 % of individuals in the U.S. are thought to have ADHD. While it develops in childhood, ADHD can continue throughout life. At least 30% of affected children continue to experience symptoms as adults.

The Nature of ADHD

Attention Deficit Hyperactivity Disorder is characterized by three hallmark symptoms:  inattention, hyperactivity, and/or impulsivity.  While all children demonstrate some degree of these traits due to their immature development, these behaviors are more frequent and severe with ADHD.  To receive a diagnosis, an individual must exhibit symptoms to a greater degree than their peers for at least six months.

Three ADHD subtypes have been identified:

  • Predominantly hyperactive-impulsive — difficulty controlling behavior and over-activity, with few attention problems;
  • Predominantly inattentive – difficulty with inattention, with few problems with hyperactivity or impulse control;
  • Combined hyperactive–impulsive and inattentive – presence of strong symptoms of hyperactivity, impulsivity, and inattention.  Most children are found to have the combined type of ADHD.

While adult symptoms of ADHD may be similar, they may be expressed differently– for example, restlessness rather than hyperactivity.

Causes of ADHD

As with many other disorders, ADHD is the likely result of a combination of factors.  Researchers have found that levels of certain chemicals or neurotransmitters in the brain tend to be lower in individuals with ADHD.  Known or suspected contributing factors include:

  • Genetics. ADHD often runs in families, and scientists are attempting to isolate genes that may contribute to the development of the disorder.
  • Pre–natal problems.  Low birth weight and difficulty pregnancies have been linked to ADHD.
  • Environment.  Studies have found potential links between ADHD and alcohol use or smoking during pregnancy and exposure to high levels of lead and such environmental toxins as PCBs or pesticides.
  • Brain injury.  Head injuries, particularly to the frontal lobe, seem to increase the risk for ADHD.
  • Nutrition.  Much speculation has focused on the possible effects of refined sugar and food additives, but research is inconclusive.

Treatment of ADHD

While there is no known cure, ADHD is a manageable disorder that responds to proper treatment.  Treatments focus on symptom reduction and management.

Medication is the primary treatment mode. Stimulant drugs are often used with children because, unlike with adults, they actually have a calming effect.  A few non-stimulant medications have demonstrated benefits. While parents are understandably cautious about medication, the proper regimen can help a child learn to focus and behave more appropriately.

In addition, treatment may include psychotherapy, education, or specialized training.  For example, behavioral therapy can assist a child in controlling his or her symptoms.  Structured routines can be developed that will assist parents and teachers in managing behaviors.  Social skills training can provide children with tools to interact more appropriately with others.

The good news for many:  most individuals “outgrow” ADHD as they mature into adulthood.  But strides in treatment give hope to all, regardless of age.

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Today, approximately 5.7 million U.S. adults in the U.S. have bipolar disorder, a serious mental illness.  Also known as manic-depressive disorder, the illness is characterized by extreme mood swings.

Bipolar disorder typically develops during an individual’s late teen or early adult years, with half of all cases emerging before age 25.

Symptoms

Bipolar disorder is characterized as one of several types, depending upon the cluster of symptoms:

  • Bipolar I— requires at least one full manic episode, with or without depressive episodes.
  • Bipolar II – features cycles of depression and elevated moods (often referred to as hypomanic episodes) that do not reach the level of a full mania.
  • Bipolar Disorder Not Otherwise Specified (BP-NOS) — does not fully meet criteria for Bipolar I or II or follow a fixed pattern.
  • Cyclothymia – exhibits much milder symptoms of the disorder.

An estimated 10-20% of affected individuals also experience rapid cycling, characterized by at least four episodes in one year.

Manic symptoms include excessive excitement, restlessness, increased energy, racing thoughts, irritability, sleeplessness, and a tendency to engage in reckless and impulsive actions.

Depressive symptoms include sadness, crying episodes, weight loss or gain, feelings of hopelessness or helplessness, decreased energy, loss of interest in daily activities, and thoughts of death or suicide.

Sometimes psychotic symptoms may also be present, such as hallucinations or delusions; e.g., “I am the wealthiest person in the world.”

Causes

While the causes of bipolar disorder are not completely understood, several risk factors may influence its development.

An individual whose parent or sibling has the disorder is up to six times more likely to develop the illness.  Researchers are seeking specific genes that play a causative role.  MRIs have shown structural changes in the brains of affected individuals. Imbalances in neurotransmitters, important brain chemicals, may be another culprit, as well as hormone imbalances.

Trauma or extreme stress may influence the development of the disorder or trigger episodes.

Treatment

Without treatment, bipolar disorder often worsens over time. Treatment is usually a combination of medication and psychotherapy.

Common medications used include:

  • Mood stabilizers, including Lithium and various anticonvulsants.
  • Atypical antipsychotics, such as Zyprexa or Abilify.
  • Antidepressants, usually in combination with a mood stabilizer.
  • Symbyax, FDA-approved specifically for bipolar disorder.
  • Benzodiazepines, such as Klonopin or Ativan for anxiety and sleep disturbance.

Medication may be a lifetime commitment for a person with bipolar disorder.

Psychotherapy can help individuals learn to cope with the effects of the illness and avoid situations which might trigger episodes.  Cognitive behavioral therapy (CBT) teaches individuals to change negative patterns of behavior and thought, while interpersonal and social rhythm therapy focuses on improvement of relationships and more stable daily routines.  Psychoeducational approaches provide information to increase understanding and assist in recognition of warning signs.

Therapists also work with entire families or with groups of individuals with bipolar disorder.  Family-focused therapy helps families with communication, symptom recognition, and more effective coping skills.  Group therapy allows individuals to learn from others with the disorder, while practicing better interpersonal skills.

For individuals who have been resistant to other treatment methods, electroconvulsive therapy (ECT) has offered some benefit.

While there is no permanent cure for bipolar disorder, effective treatment can lead to better illness management and allow individuals to live normal lives.

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Constant hand washing, repetitive touching of doorways, checking ten times to make sure the stove is turned off:  these are all examples of behaviors we frequently associate with obsessive compulsive disorder, or OCD.

The nature of obsessive compulsive disorder

OCD is a type of anxiety disorder, characterized by unwanted, uncontrollable thoughts as well as repetitive or ritualized behaviors.  While the thoughts and actions are irrational and unproductive, the affected individual is unable to resist the urge to express them.

An obsession is a frequent and uncontrollable impulse, thought, or mental image that an individual experiences.  They are often quite disturbing or unpleasant, as well as distracting.

A compulsion is a behavior or ritual that an individual repeatedly completes as a way of trying to make an obsessive thought go away.  Individuals with obsessive thoughts about being unclean may wash their hands until they are raw.  However, compulsive behavior not only does not reduce an obsession; these frustrating and time-consuming acts usually increase anxiety.

Treatment of obsessive compulsive disorder

OCD is a mental disorder that responds successfully to treatment.  The two most effective types of OCD treatment are cognitive-behavioral therapy and medication, often used in combination.

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves retraining one’s thought patterns so that compulsive behaviors no longer feel necessary.

Two CBT components are most effective in treatment of obsessive compulsive disorder:

  1. Exposure and response prevention, or ERP, is a treatment that involves repeated exposure to a source or common cue for an obsession, while the individual refrains from the associated compulsive behavior.  Using the previous example of compulsive hand washing, an individual might be asked to repeatedly touch a public restroom’s door handle and then be prevented from hand washing.   Gradually the individual learns that nothing catastrophic occurs when the behavior is not performed. The more an individual is exposed to an anxiety-provoking trigger without incident, the more the association weakens. ERP is a therapy based upon literally facing one’s fears.
  2. Cognitive therapy focuses on the obsessive thoughts themselves.  Individuals with OCD often think of “worse-case” scenarios or experience an exaggerated sense of personal responsibility for things they cannot really control; e.g., a plane crash. Through “cognitive restructuring,” harmful thought patterns can be challenged and healthier, alternative ways of thinking can be developed. For example, the hand-washing individual may explore the underlying belief prompting this behavior, such as “I am unclean.” Once an unrealistic belief is discovered and challenged, the need to engage in the anxiety-reducing behavior may disappear over time.

Medication has also been found to be effective in obsessive compulsive disorder treatment for many individuals.  Some psychiatric or psychotropic medications help control obsessions and compulsions.  These include antidepressants that increase serotonin levels in the brain, which may be low in individuals with OCD.  Medication, if indicated, is normally used in conjunction with psychotherapy.

Professional treatment for OCD is highly effective, with research findings of long-term recovery rates of up to 75% or more.  With proper intervention, individuals struggling with the anxiety and frustration of obsessive compulsive disorder can resume productive lives.

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Mason, OH – Steven F. Kendell, MD, has joined Lindner Center of HOPE as a staff psychiatrist.

Dr. Kendell is board certified in general psychiatry.  As a staff psychiatrist atDr. Steven J. Kendell Lindner Center of HOPE his principal work is in adult partial hospitalization, adult inpatient care and outpatient services.

Prior to joining the Lindner Center of HOPE, Dr. Kendell served as Director of Research at Blue Horizon International Stem Cell Investigation and Treatment Program in New York, New York. Dr. Kendell’s other clinical positions have included serving as Attending Psychiatrist at Appalachian Behavioral Healthcare, Athens, Ohio; Attending Psychiatrist at Kettering Behavioral Medicine Center in Kettering, Ohio and Attending Psychiatrist at Butte County Department of Behavioral Health in Chico, California.

Dr. Kendell’s academic appointments have included Assistant Professor of Psychiatry at Ohio University College of Osteopathic Medicine in Athens, Ohio; Assistant Professor of Psychiatry at Boonshoft School of Medicine in Dayton, Ohio, and Assistant Professor of Psychiatry at Yale School of Medicine, New Haven, Connecticut.

Dr. Kendell has received a number of awards and honors and has been a member of several professional societies. He also has supervised medical students and has co-authored several original reports, book chapters and scientific abstracts.

Lindner Center of HOPE  provides patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, free-standing mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization for individuals age 12-years-old and older, outpatient services for all ages, research and voluntary, live-in services. The Center’s clinicians are ranked among the best providers locally, nationally and internationally. Lindner Center of HOPE is affiliated with the University of Cincinnati (UC) College of Medicine.

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Statistics can be somewhat ambiguous when it comes to eating disorders. Over the years, there have been countless studies conducted surrounding the prevalence of illnesses such as anorexia nervosa, bulimia nervosa and binge eating disorder. Although many of these studies convey slightly different findings, one thing is certain: Millions of Americans struggle with eating disorders.

While the majority of eating disorder sufferers are young women and adolescent girls, research has discovered that more and more males — an estimated 10 to 15 percent — are struggling with eating disorders as well. Additionally, incidents of these disorders in older women have been on a steady incline in recent years.

Why the Upward Trend?

New information is surfacing in regard to women in their 40s, 50s and 60s maintaining a negative body image, and as a result, continuing unhealthy eating patterns or developing eating disorders. Recent studies have found that over 60 percent of women 50 years of age and older are acutely concerned about their weight. Roughly 13 percent of these women suffer from some type of eating disorder.

Some older women keep their eating-related struggles hidden for years. Others, after having addressed an eating disorder earlier in life to at least some degree, relapse as they approach middle age. There are of course a variety of other factors that may contribute to the development of eating disorders in middle-aged women. These include a divorce or the loss of a mate where a woman feels she needs to lose weight to regain a level of attractiveness. It’s also not out of the question for a woman to develop an eating disorder for the first time later in life.

Never Too Late to Begin Treatment

Regardless of age or gender, anorexia treatment, bulimia treatment and treatment methods for other eating-related illnesses have evolved throughout the years. The percentage of successful outcomes continues to increase. Treatment for eating disorders usually consists of a combination of nutritional counseling, individual or group therapy, and in many cases, medications.

With the discovery of eating disorders in so many older women, mental health professionals are realizing that life-long care may be required even after a young woman has shown significant signs of recovery. However, those who get help for eating disorders early do have the best chance at long-term recovery.

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This blog is written and published by Lindner Center of HOPE.

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Armodafinil - Donuts2

 

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This blog is written and published by Lindner Center of HOPE.

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When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.

What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.

The SSA and Mental Illness Claims

The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.

Getting Back on their Feet

It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.

When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.

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This blog is written and published by Lindner Center of HOPE.

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Shire BP Depression - Blue Man - 11-17-10

 

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This blog is written and published by Lindner Center of HOPE.