This document provides an overview of a lecture given by Prof. David Mataix-Cols on OCD and related disorders in young people. The key points are:
1) The DSM-5 and upcoming ICD-11 include a new "OCD and Related Disorders" chapter that recognizes OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.
2) Evidence-based treatments exist but there are still unmet needs and challenges, including improving outcomes through innovation and consolidation of research findings.
3) Specific issues addressed in developing the DSM-5 criteria for these disorders included refining diagnostic definitions and exploring potential OCD subtypes and
ESCAP 2015 - Anna van Spanje: workshop slaapUtrecht
This document discusses sleep disorders in adolescents. It begins with an overview of common psychiatric conditions that are often comorbid with sleep problems like ADHD, autism, anxiety, and mood disorders. Next, it presents a clinical case of Maria, a 16-year-old with increasing truancy and indifference who is having trouble falling asleep and waking up. The document then provides theory on sleep-wake regulation and the functions of sleep. It describes the most common adolescent sleep disorders - insomnia and delayed sleep phase syndrome - and discusses diagnostic tools and treatment approaches like cognitive behavioral therapy and melatonin.
KEYNOTE presentation (June 2015), ESCAP Expert Paper (July 2015), TV interview and abstract by professor Beate Herpertz-Dahlmann (Aachen University) on new developments in the diagnostics and treatment of adolescent eating disorders
Common mental illnesses often emerge between 10 and 30 years of age. Endophenotypes are likely formed by the first two decades of life, while activation processes may occur proximal to illness emergence. Depressive symptoms vary in severity and presentation depending on age and sample characteristics. Biomarkers like cognitive tests and gene-environment interactions can help identify individuals at risk of developing depression.
ESCAP 2015 - Jolanda van der Meer: workshop stigmaUtrecht
The document discusses destigmatization of mental illness. It outlines initiatives in several countries to fight stigma through programs like Time to Change in the UK and Say No to Stigma in Australia. It also discusses research insights on stigma, such as the idea that stigma's origins may not be related only to knowledge, attitudes, and behavior, but also cultural differences and existing on individual, interpersonal, and structural levels. The document challenges paradigms around preventing and reducing stigma and argues that the goals should be improved quality of life and reducing social inequities. It suggests partnerships within local communities and learning from patients' experiences can help in the fight against stigma.
Presentatie autisme escap 2015m4 madrid how_malleable_is_autism_escap_postUtrecht
This document discusses research on early intervention for autism spectrum disorder (ASD). It finds that high-intensity, comprehensive early intervention models can significantly improve outcomes for young children with ASD. Interventions like the Early Start Denver Model (ESDM) have been shown to substantially increase IQ scores, language abilities, and adaptive behaviors in children with ASD. Lower intensity parent-implemented interventions have also demonstrated effectiveness but produce more modest gains and have less long-term data available. The document emphasizes the need to identify children with ASD as early as possible, provide accurate early diagnoses, and ensure access to evidence-based early intervention services.
KEYNOTE presentation by professor Celso Arango (Hospital General Universitario Gregorio Marañón. IiSGM, Universidad Complutense, CIBERSAM. Madrid, Spain) on developmental trajectories in early-onset psychoses, held at the ESCAP 2015 Congress in Madrid, Monday June 22nd 2015
This document summarizes a talk on whether ADHD and ASD are two manifestations of the same underlying disorder or distinct disorders. The talk discusses evidence from clinical observations, genetics, cognitive measures, and brain imaging. Clinically, there is significant overlap between ADHD and ASD symptoms. Genetically, twin and family studies show shared genetic influences between the disorders. Polygenic risk scores predict traits related to both ADHD and ASD. Copy number variants have also been linked to both disorders. Cognitive profiles show heterogeneity but some common deficits. Overall, the evidence suggests ADHD and ASD have both shared and distinct features, possibly representing different points on a neurodevelopmental continuum.
This document outlines a presentation on emotional and behavioral difficulties (EBD). It begins with an introduction and outline, then defines EBD and challenges in defining it. Specific conditions are mentioned like obsessive compulsive disorder (OCD). Statistics on prevalence of mental health issues are provided. The document discusses identifying and diagnosing EBD. It provides information on OCD, including signs and symptoms. Support available from the government and where to seek help is outlined. Suggested teaching strategies for students with EBD are presented, along with a proposed group activity and conclusion.
ESCAP 2015 - Anna van Spanje: workshop slaapUtrecht
This document discusses sleep disorders in adolescents. It begins with an overview of common psychiatric conditions that are often comorbid with sleep problems like ADHD, autism, anxiety, and mood disorders. Next, it presents a clinical case of Maria, a 16-year-old with increasing truancy and indifference who is having trouble falling asleep and waking up. The document then provides theory on sleep-wake regulation and the functions of sleep. It describes the most common adolescent sleep disorders - insomnia and delayed sleep phase syndrome - and discusses diagnostic tools and treatment approaches like cognitive behavioral therapy and melatonin.
KEYNOTE presentation (June 2015), ESCAP Expert Paper (July 2015), TV interview and abstract by professor Beate Herpertz-Dahlmann (Aachen University) on new developments in the diagnostics and treatment of adolescent eating disorders
Common mental illnesses often emerge between 10 and 30 years of age. Endophenotypes are likely formed by the first two decades of life, while activation processes may occur proximal to illness emergence. Depressive symptoms vary in severity and presentation depending on age and sample characteristics. Biomarkers like cognitive tests and gene-environment interactions can help identify individuals at risk of developing depression.
ESCAP 2015 - Jolanda van der Meer: workshop stigmaUtrecht
The document discusses destigmatization of mental illness. It outlines initiatives in several countries to fight stigma through programs like Time to Change in the UK and Say No to Stigma in Australia. It also discusses research insights on stigma, such as the idea that stigma's origins may not be related only to knowledge, attitudes, and behavior, but also cultural differences and existing on individual, interpersonal, and structural levels. The document challenges paradigms around preventing and reducing stigma and argues that the goals should be improved quality of life and reducing social inequities. It suggests partnerships within local communities and learning from patients' experiences can help in the fight against stigma.
Presentatie autisme escap 2015m4 madrid how_malleable_is_autism_escap_postUtrecht
This document discusses research on early intervention for autism spectrum disorder (ASD). It finds that high-intensity, comprehensive early intervention models can significantly improve outcomes for young children with ASD. Interventions like the Early Start Denver Model (ESDM) have been shown to substantially increase IQ scores, language abilities, and adaptive behaviors in children with ASD. Lower intensity parent-implemented interventions have also demonstrated effectiveness but produce more modest gains and have less long-term data available. The document emphasizes the need to identify children with ASD as early as possible, provide accurate early diagnoses, and ensure access to evidence-based early intervention services.
KEYNOTE presentation by professor Celso Arango (Hospital General Universitario Gregorio Marañón. IiSGM, Universidad Complutense, CIBERSAM. Madrid, Spain) on developmental trajectories in early-onset psychoses, held at the ESCAP 2015 Congress in Madrid, Monday June 22nd 2015
This document summarizes a talk on whether ADHD and ASD are two manifestations of the same underlying disorder or distinct disorders. The talk discusses evidence from clinical observations, genetics, cognitive measures, and brain imaging. Clinically, there is significant overlap between ADHD and ASD symptoms. Genetically, twin and family studies show shared genetic influences between the disorders. Polygenic risk scores predict traits related to both ADHD and ASD. Copy number variants have also been linked to both disorders. Cognitive profiles show heterogeneity but some common deficits. Overall, the evidence suggests ADHD and ASD have both shared and distinct features, possibly representing different points on a neurodevelopmental continuum.
This document outlines a presentation on emotional and behavioral difficulties (EBD). It begins with an introduction and outline, then defines EBD and challenges in defining it. Specific conditions are mentioned like obsessive compulsive disorder (OCD). Statistics on prevalence of mental health issues are provided. The document discusses identifying and diagnosing EBD. It provides information on OCD, including signs and symptoms. Support available from the government and where to seek help is outlined. Suggested teaching strategies for students with EBD are presented, along with a proposed group activity and conclusion.
Zoned, Stoned And Blown - by Louis B. Cady, M.D. and Lisa Seif, LCSW, CADAC02...Louis Cady, MD
This presentation reviews the diagnosis, treatment, and sobriety maintenance of dual diagnosis disorders ( psychiatric disorders coupled with chemical dependency and/or alcoholism), using a synthetic blend of two talented clinicians' experiences, humor, and review of precision diagnosis, treatment formulations, and interventions.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
The document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its definition, clinical presentation, diagnosis criteria according to DSM-V, epidemiology, common comorbidities, prognosis, and management approaches. ADHD is defined as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-8% of children and 2.5% of adults worldwide, and diagnosis involves evaluating symptoms, impairment, age of onset, and ruling out alternative causes according to DSM-V criteria. Management involves behavioral interventions, stimulant medications, and other pharmacological and non-pharmacological options.
The document discusses personality disorders and schizophrenic disorders. It describes three clusters of personality disorders - cluster A includes disorders like schizotypal PD characterized by odd behavior and poor social skills; cluster B includes dramatic disorders like borderline PD with unstable relationships and self-image; cluster C includes anxious disorders like avoidant PD. Schizophrenia is then discussed, characterized by positive symptoms like hallucinations and negative symptoms like flat affect. Causes may include genetic and environmental factors. Treatment involves medications to reduce symptoms and therapies like family therapy.
iCAAD London 2019 - Stefanie Carnes - SEXUALLY COMPULSIVE AND ADDICTIVE BEHA...iCAADEvents
In recent years there has been tremendous controversy about sexually compulsive behaviour. Researchers and clinicians alike have argued about the best terminology to use, diagnostic criteria, and treatment approaches. In this presentation, Dr. Carnes discusses the concerns about labelling out control sexual behaviour and examines the new research and the controversy surrounding the diagnosis. Different perspectives on conceptualisation of the disorder and treatment will be discussed.
Amanda Gulsrud, PhD: Current Research on ASD in Adulthood: The Evidence and t...Semel Admin
The document summarizes current research on autism spectrum disorder (ASD) in adulthood. It finds that while autism symptoms and behavior problems tend to decrease with age on average, adaptive functioning may decline in midlife. Most young adults with ASD are unemployed after high school, which is a critical transition point. Longitudinal studies also show influences of socioeconomic factors, with those from lower-income families showing less improvement. More research is still needed into interventions for adults with ASD, especially regarding employment. Existing programs have had some success incorporating behavioral techniques and social skills training.
The document provides information about obsessive-compulsive disorder (OCD) including diagnostic criteria, prevalence, causes, types of obsessions and compulsions, treatment options, related disorders, and differences between OCD and obsessive-compulsive personality disorder (OCPD). Key points include that OCD affects 1.2% of the population, involves recurrent unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce anxiety, has biological and environmental contributors, and is typically treated with medication and cognitive behavioral therapy.
The document discusses mental health assessment in primary care. It introduces the Look, Listen, and Test (LLT) framework for psychiatric assessment. LLT utilizes existing observational and history taking skills in primary care. The physician looks at the patient, listens to what they say, and performs appropriate tests through questions or exams. It can help structure consultations and support a holistic view. The framework draws from the more extensive SCAN assessment but is briefer and more suitable for typical primary care consultations.
Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in response to these thoughts. The obsessions or compulsions significantly interfere with daily life. OCD has been linked to imbalances in neurotransmitters like serotonin and dopamine in the brain, as well as genetic and environmental factors. Treatment involves psychotherapy like cognitive behavioral therapy and medication like selective serotonin reuptake inhibitors. Other potential treatments under research include repetitive transcranial magnetic stimulation and electroconvulsive therapy, but more studies are still needed to establish their efficacy for OCD.
Diagnosis and Management of ADHD The Adult PatientMahendra Perera
This document discusses the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in adult patients. It begins with an overview of the historical and epidemiological features of ADHD, noting that the prevalence in adults is estimated to be 3-6% and 5-10% in children. It then covers the diagnosis of ADHD based on classification systems like the DSM and ICD, describing the presentation of symptoms in adults. The document discusses common co-occurring conditions like substance use disorders and bipolar disorder. It provides guidance on the management of adult ADHD through a multimodal approach including medication, psychology, lifestyle changes, and family support.
Treating Anxiety Disorders in Children and Adolescents - Presenter: Laura Ma...Akron Children's Hospital
This document provides information from a presentation by Dr. Laura A. Markley on treating anxiety disorders in children and adolescents. It discusses the signs and symptoms of anxiety disorders in youth and acknowledges that psychotherapy is first-line treatment. It examines the evidence for medications to treat anxiety disorders in children, including SSRIs which have the most evidence but many are off-label. Key points include starting low doses of SSRIs and combining medication with CBT for best outcomes in disorders like OCD.
iCAAD London 2019 - Dr Alberto Pertusa - Addiction treatment: What new medica...iCAADEvents
In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction and Dr Pertusa will discuss ADHD & addiction.
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
Connie Kasari, PhD: Advances in Intervention Science: Current Evidence, Futur...Semel Admin
This document summarizes research on early interventions for autism spectrum disorder. It finds that comprehensive interventions delivering many hours per week can improve cognitive outcomes in young children. However, replications of original studies often do not find significant effects. The most effective interventions focus on improving core deficits in social communication and restricted behaviors through teaching approaches like joint attention, symbolic play, and engagement. The Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) method shows promise in improving these skills when delivered by therapists, teachers, and parents. However, deployment and sustainability of interventions in communities remains a challenge. Nonverbal school-aged children are underserved and may require different approaches than younger preverbal children.
Since 1996 Dr. Paul Ebben has worked as a neuropsychologist in Frankfort, Kentucky. During that time, Dr. Paul Ebben has conducted a number of psychological examinations including those for the assessment for attention deficit hyperactivity disorder (ADHD).
1) The document discusses Attention Deficit Hyperactivity Disorder (ADHD) from a homeopathic perspective, covering etiology, pathogenesis, clinical features, diagnosis and case studies.
2) It suggests that factors like genetic predisposition, prenatal influences like stress, smoking and ultrasound exposure, and birth trauma can predispose children to developing ADHD.
3) Two case studies are presented where homeopathic remedies Thyroidinum and Arnica Montana helped address the symptoms of ADHD in children based on their medical histories and constitutional make-ups.
This document discusses alternative approaches to treating ADHD without medication. It notes that ADHD is often misdiagnosed and many conditions can cause ADHD-like symptoms. Stimulant medications for ADHD like Ritalin have many potential side effects and may cause long-term brain changes. Lifestyle factors like nutrition, sleep, screen time, and treating underlying conditions provide a safer alternative or addition to medications for managing ADHD symptoms.
A single etiology for autism or for any of the
disorders on the autistic spectrum has yet to be determined. In the past, suspected causes of these disorders included parentally induced autism, brain
injury/anomalies, constitutional vulnerability, and developmental aphasia, as well as deficits in the reticular activating system, and an unfortunate interplay between psychogenic and neurodevelopmental factors.Other suspected etiologies are structural cerebellar changes, genetics, viral infections, and immunological abnormalities, with various teratogens, seizures and
vaccines also being investigated. Until we know the multiple etiologies of those within the Autism Spectrum; as researchers, health care providers, educators and optometrists, we must offer all within
the autistic continuum the very best, most current and accessible care available based upon the latest known science.
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Zoned, Stoned And Blown - by Louis B. Cady, M.D. and Lisa Seif, LCSW, CADAC02...Louis Cady, MD
This presentation reviews the diagnosis, treatment, and sobriety maintenance of dual diagnosis disorders ( psychiatric disorders coupled with chemical dependency and/or alcoholism), using a synthetic blend of two talented clinicians' experiences, humor, and review of precision diagnosis, treatment formulations, and interventions.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
The document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its definition, clinical presentation, diagnosis criteria according to DSM-V, epidemiology, common comorbidities, prognosis, and management approaches. ADHD is defined as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-8% of children and 2.5% of adults worldwide, and diagnosis involves evaluating symptoms, impairment, age of onset, and ruling out alternative causes according to DSM-V criteria. Management involves behavioral interventions, stimulant medications, and other pharmacological and non-pharmacological options.
The document discusses personality disorders and schizophrenic disorders. It describes three clusters of personality disorders - cluster A includes disorders like schizotypal PD characterized by odd behavior and poor social skills; cluster B includes dramatic disorders like borderline PD with unstable relationships and self-image; cluster C includes anxious disorders like avoidant PD. Schizophrenia is then discussed, characterized by positive symptoms like hallucinations and negative symptoms like flat affect. Causes may include genetic and environmental factors. Treatment involves medications to reduce symptoms and therapies like family therapy.
iCAAD London 2019 - Stefanie Carnes - SEXUALLY COMPULSIVE AND ADDICTIVE BEHA...iCAADEvents
In recent years there has been tremendous controversy about sexually compulsive behaviour. Researchers and clinicians alike have argued about the best terminology to use, diagnostic criteria, and treatment approaches. In this presentation, Dr. Carnes discusses the concerns about labelling out control sexual behaviour and examines the new research and the controversy surrounding the diagnosis. Different perspectives on conceptualisation of the disorder and treatment will be discussed.
Amanda Gulsrud, PhD: Current Research on ASD in Adulthood: The Evidence and t...Semel Admin
The document summarizes current research on autism spectrum disorder (ASD) in adulthood. It finds that while autism symptoms and behavior problems tend to decrease with age on average, adaptive functioning may decline in midlife. Most young adults with ASD are unemployed after high school, which is a critical transition point. Longitudinal studies also show influences of socioeconomic factors, with those from lower-income families showing less improvement. More research is still needed into interventions for adults with ASD, especially regarding employment. Existing programs have had some success incorporating behavioral techniques and social skills training.
The document provides information about obsessive-compulsive disorder (OCD) including diagnostic criteria, prevalence, causes, types of obsessions and compulsions, treatment options, related disorders, and differences between OCD and obsessive-compulsive personality disorder (OCPD). Key points include that OCD affects 1.2% of the population, involves recurrent unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce anxiety, has biological and environmental contributors, and is typically treated with medication and cognitive behavioral therapy.
The document discusses mental health assessment in primary care. It introduces the Look, Listen, and Test (LLT) framework for psychiatric assessment. LLT utilizes existing observational and history taking skills in primary care. The physician looks at the patient, listens to what they say, and performs appropriate tests through questions or exams. It can help structure consultations and support a holistic view. The framework draws from the more extensive SCAN assessment but is briefer and more suitable for typical primary care consultations.
Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in response to these thoughts. The obsessions or compulsions significantly interfere with daily life. OCD has been linked to imbalances in neurotransmitters like serotonin and dopamine in the brain, as well as genetic and environmental factors. Treatment involves psychotherapy like cognitive behavioral therapy and medication like selective serotonin reuptake inhibitors. Other potential treatments under research include repetitive transcranial magnetic stimulation and electroconvulsive therapy, but more studies are still needed to establish their efficacy for OCD.
Diagnosis and Management of ADHD The Adult PatientMahendra Perera
This document discusses the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in adult patients. It begins with an overview of the historical and epidemiological features of ADHD, noting that the prevalence in adults is estimated to be 3-6% and 5-10% in children. It then covers the diagnosis of ADHD based on classification systems like the DSM and ICD, describing the presentation of symptoms in adults. The document discusses common co-occurring conditions like substance use disorders and bipolar disorder. It provides guidance on the management of adult ADHD through a multimodal approach including medication, psychology, lifestyle changes, and family support.
Treating Anxiety Disorders in Children and Adolescents - Presenter: Laura Ma...Akron Children's Hospital
This document provides information from a presentation by Dr. Laura A. Markley on treating anxiety disorders in children and adolescents. It discusses the signs and symptoms of anxiety disorders in youth and acknowledges that psychotherapy is first-line treatment. It examines the evidence for medications to treat anxiety disorders in children, including SSRIs which have the most evidence but many are off-label. Key points include starting low doses of SSRIs and combining medication with CBT for best outcomes in disorders like OCD.
iCAAD London 2019 - Dr Alberto Pertusa - Addiction treatment: What new medica...iCAADEvents
In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction and Dr Pertusa will discuss ADHD & addiction.
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
Connie Kasari, PhD: Advances in Intervention Science: Current Evidence, Futur...Semel Admin
This document summarizes research on early interventions for autism spectrum disorder. It finds that comprehensive interventions delivering many hours per week can improve cognitive outcomes in young children. However, replications of original studies often do not find significant effects. The most effective interventions focus on improving core deficits in social communication and restricted behaviors through teaching approaches like joint attention, symbolic play, and engagement. The Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) method shows promise in improving these skills when delivered by therapists, teachers, and parents. However, deployment and sustainability of interventions in communities remains a challenge. Nonverbal school-aged children are underserved and may require different approaches than younger preverbal children.
Since 1996 Dr. Paul Ebben has worked as a neuropsychologist in Frankfort, Kentucky. During that time, Dr. Paul Ebben has conducted a number of psychological examinations including those for the assessment for attention deficit hyperactivity disorder (ADHD).
1) The document discusses Attention Deficit Hyperactivity Disorder (ADHD) from a homeopathic perspective, covering etiology, pathogenesis, clinical features, diagnosis and case studies.
2) It suggests that factors like genetic predisposition, prenatal influences like stress, smoking and ultrasound exposure, and birth trauma can predispose children to developing ADHD.
3) Two case studies are presented where homeopathic remedies Thyroidinum and Arnica Montana helped address the symptoms of ADHD in children based on their medical histories and constitutional make-ups.
This document discusses alternative approaches to treating ADHD without medication. It notes that ADHD is often misdiagnosed and many conditions can cause ADHD-like symptoms. Stimulant medications for ADHD like Ritalin have many potential side effects and may cause long-term brain changes. Lifestyle factors like nutrition, sleep, screen time, and treating underlying conditions provide a safer alternative or addition to medications for managing ADHD symptoms.
A single etiology for autism or for any of the
disorders on the autistic spectrum has yet to be determined. In the past, suspected causes of these disorders included parentally induced autism, brain
injury/anomalies, constitutional vulnerability, and developmental aphasia, as well as deficits in the reticular activating system, and an unfortunate interplay between psychogenic and neurodevelopmental factors.Other suspected etiologies are structural cerebellar changes, genetics, viral infections, and immunological abnormalities, with various teratogens, seizures and
vaccines also being investigated. Until we know the multiple etiologies of those within the Autism Spectrum; as researchers, health care providers, educators and optometrists, we must offer all within
the autistic continuum the very best, most current and accessible care available based upon the latest known science.
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
ESCAP 2015 - Anna van Spanje: autism clinical guidelinesUtrecht
1) While the Netherlands and Belgium guidelines for autism were developed independently, they have many similarities in their development processes by including input from researchers, clinicians, and patients and incorporating feedback.
2) The main differences are that the Belgian guideline focuses only on treatment while the Dutch one covers both diagnosis and treatment, and the Belgian one includes recommendations on what not to do.
3) Implementation of autism guidelines remains a challenge due to issues like who receives training, whether they are binding, policy vs budget conflicts, and differences between departments. Cooperation between countries could help address these issues.
KEYNOTE presentation and abstract by professor Katya Rubia (King's College London) on Brain imaging in ADHD: disorder specificity, medication effects and clinical translation, held at the ESCAP 2015 Congress in Madrid, Tuesday June 23rd 2015
Themamiddag over ROM in de jeugd-ggz én LVB: presentatie Kirstal - 30 oktober...Utrecht
Hoe kan ROM goed worden ingezet bij jeugd-ggz voor kinderen en jongeren met een licht verstandelijke beperking (LVB)? Welke toegevoegde waarde heeft ROM bij LVB, waar het niet verplicht is gesteld om de behandeluitkomst te meten? En wat kan de reguliere jeugd-ggz leren van de ervaring bij LVB met routine outcome monitoring? Op donderdag 30 oktober organiseerde het Kenniscentrum Kinder- en Jeugdpsychiatrie samen met het Landelijk Kenniscentrum LVB de ROM themamiddag ‘ROM bij LVB’, waarin deze vragen aan de orde komen. Dit is de presentatie van Maartje Boon van Kristal.
Lees verder over ROM op: http://www.kenniscentrum-kjp.nl/Professionals/ROMCKAP/ROM
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
NVvP Voorjaarscongres 2014 - Prof. dr. Theo Doreleijers: Oude MeestersUtrecht
De presentatie van Prof. dr. Theo Doreleijers, hoogleraar kinder- en jeugdpsychiatrie, op het Voorjaarscongres van de Nederlandse Vereniging voor Psychiatrie (NVvP) 2014.
OCD Action - Guided Self Help – Karina Lovelljoelocdaction
This document discusses guided self-help for obsessive compulsive disorder (OCD). It begins by outlining the aims of exploring what guided self-help is, if it is effective for OCD, and how it is applied. It then provides background on OCD, describing obsessions and compulsions. The document discusses the rationale for alternative delivery systems for OCD treatment due to lack of therapists and long waitlists. It presents the stepped care model and treatment options. Low intensity interventions like brief CBT using structured self-help are described. Evidence is presented that self-help with minimal therapist contact can be effective for OCD. Application of self-help involves assessment, family involvement, self-help materials, ongoing monitoring, and exposure/
This document systematically reviews randomized controlled trials of pharmacological treatments for pediatric OCD. It summarizes 10 studies evaluating clomipramine, fluoxetine, paroxetine, fluvoxamine, and sertraline. The studies involved hundreds of children and adolescents and showed moderate effect sizes for SSRIs with common side effects of insomnia, nausea, and fatigue. A meta-analysis found SSRIs were equally effective but clomipramine had a greater effect. Future research is still needed on dosing, treatment duration, and safety.
Cognitive behavioral therapy is an effective treatment for Islamic religious obsessive compulsive disorder. It involves exposing patients to feared religious obsessions while preventing compulsions, to help reduce anxiety and compulsions over time. Religious rituals in Islam can relate to OCD symptoms, like repetitive washing and praying, so CBT techniques must be adapted sensitively while respecting patients' faith. The document discusses prevalence, symptoms, and treatments for religious OCD in Islamic cultures.
OCD Action - Making CBT work - Paul Salkovskis joelocdaction
This document provides information about cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD). It discusses what OCD is, how it can be understood, and what CBT involves. CBT aims to help patients understand the nature of their problem and "choose to change" by identifying and modifying unhelpful beliefs and behaviors. The document emphasizes that CBT requires active participation from both the patient and therapist working together as "two experts." It provides tips for choosing a therapist and getting the most out of therapy through preparation, goal setting, and behavioral experiments.
Patricia Perrin - CBT for OCD Characterized Primarily By Intrusive Thoughts, ...IOCDF
CBT and ACT approaches are used to treat OCD characterized by intrusive thoughts. CBT utilizes exposure and response prevention (ERP) by creating hierarchies of triggers to facilitate habituation of anxiety through repeated, prolonged exposure. ACT incorporates mindfulness, acceptance, defusion, values, and committed action to increase psychological flexibility rather than experiential avoidance. Both approaches aim to reduce compulsions and distress from intrusive thoughts, but CBT focuses more on thought content and anxiety reduction while ACT emphasizes the context of thoughts and movement toward valued actions.
CBT is an effective treatment for OCD due to its ability to trigger lasting neural changes through learning. It involves psychoeducation, challenging irrational assumptions, exposure to feared situations without compulsions, and response prevention. Studies show large effect sizes for CBT compared to medications alone. CBT aims to reduce anxiety and distress from obsessions by stopping thoughts and using distractions, while exposure therapy targets compulsions. Success requires understanding all symptoms, motivated patients, and therapists able to systematically implement the CBT techniques.
The document provides an overview of non-pharmacological management in psychiatry including psychotherapies, brain stimulation methods, and neurosurgery/deep brain stimulation. It discusses various types of psychotherapies such as psychoanalysis, cognitive behavioral therapy, rational emotive behavioral therapy, dialectical behavioral therapy, group psychotherapy, family therapy, and couples therapy. It also covers brain stimulation methods like electroconvulsive therapy and transcranial magnetic stimulation.
Psychiatric disorder in elderly & consultation liaison psychiatry 2Nur Idris
This document discusses schizophrenia and mood disorders in elderly patients and consultation-liaison psychiatry. It provides details on the epidemiology, clinical features, diagnosis, management and prognosis of schizophrenia and mood disorders. It also describes the role of consultation-liaison psychiatry in assessing and treating psychiatric conditions that occur alongside medical illnesses.
The document discusses Body Dysmorphic Disorder (BDD) and Hypochondriasis. It compares the two disorders and outlines their key characteristics, including prevalence, demographics, comorbidities, and treatments. BDD involves a preoccupation with an imagined or slight defect in appearance. Hypochondriasis involves a preoccupation with fears of having a serious illness despite medical reassurance. Both disorders share similarities with OCD but also have distinct features and impacts on quality of life. Cognitive-behavioral therapy is an appropriate treatment approach for both.
The importance of quality in item generation; a prerequisite for Rasch analysisStephen McKenna
The quality of a patient reported outcome scale depends on: a coherent and valid measurement model, quality item generation, and a simple response format.
After these criteria are met, we can think about fit to the Rasch model.
Body dysmorphic disorder (BDD) is characterized by a preoccupation with perceived defects or flaws in physical appearance that are not observable or appear slight to others. This preoccupation causes clinically significant distress or impairment in functioning. BDD was first described in the 19th century and involves repetitive behaviors like mirror checking or mental acts like appearance comparisons. While its exact causes are unclear, BDD likely stems from a combination of genetic, personality, life experience, biological, and environmental factors interacting together. Cognitive behavioral therapy and antidepressant medication can help treat BDD by reducing preoccupation and distress rather than focusing on appearance.
Geriatric assessment for mental illnessramkumar g s
The document provides details on assessing the mental health of elderly patients. It discusses the adaptive tasks of aging, the purpose of geriatric psychiatric assessment, and outlines the domains to assess including mental health, physical health, functioning, and social situation. It then describes specific aspects of the assessment including the interview process, tools to evaluate cognition, and scales to measure depression, daily functioning, and physical health.
1. Anxiety disorders involve excessive and persistent worries or fears that interfere with daily functioning, unlike ordinary worries or fears.
2. Common anxiety disorders include generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.
3. Proposed causes of anxiety disorders include biological factors like abnormal neurotransmitter levels or brain structures, as well as psychological factors like repressed urges, conditioning, or traumatic experiences.
1. The document discusses anxiety disorders and how they differ from ordinary worries and fears. It defines anxiety and lists some common physical symptoms.
2. Specific anxiety disorders discussed include generalized anxiety disorder, panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder, agoraphobia, and post-traumatic stress disorder. The causes and symptoms of each disorder are described.
3. Psychologists believe anxiety disorders may be caused by biological, cognitive, and behavioral/learning factors like classical and operant conditioning which can lead to the conditioning of anxiety responses.
People with obsessive-compulsive disorder experience distressing and repetitive thoughts (obsessions) that often lead to repetitive behaviors (compulsions) like cleaning, checking, or counting. The most effective treatment is exposure therapy, where the person is exposed to the source of distress while preventing ritualized responses, though this therapy is often ineffective due to patient refusal or quitting treatment. A cognitive intervention to help reinterpret thoughts can also help. Substance dependence or addiction involves an inability to stop a self-destructive habit and is explained by factors like withdrawal avoidance, distress coping, and drug-altered brain synapses.
This document provides information on obsessive compulsive disorder (OCD) and obsessive compulsive spectrum disorder. It discusses the definitions of obsessions and compulsions according to DSM-5. It also covers the epidemiology, comorbidities, neurobiological causes, diagnostic criteria, and treatment options for OCD which include psychotherapy such as exposure and response prevention, and pharmacotherapy with medications like SSRIs, TCAs, and augmentation agents.
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
1. Anxiety disorders are characterized by excessive and persistent worry, fear or anxiety that interferes with daily functioning. They differ from ordinary worries in their severity, frequency and impact.
2. Common anxiety disorders include generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder and post-traumatic stress disorder. Each has distinct symptoms but all involve disproportionate fear responses.
3. Potential causes of anxiety disorders include biological factors like neurotransmitter imbalances, genetic predispositions or brain abnormalities. Psychological theories also point to learned fears from conditioning or repressed unconscious urges.
This document provides information from the DSM-IV on various mental disorders and diagnostic criteria. It begins with cautionary statements about using the DSM for diagnosis and discusses key concepts like the difference between a mental disorder and deviance. It then covers disorders usually diagnosed in childhood, including learning disorders and autism. It also discusses schizophrenia and related psychotic disorders, major depressive disorder, and the multiaxial assessment system used in the DSM-IV. The document provides diagnostic criteria and descriptions for many disorders.
This document discusses personality disorders and aging. It begins by defining personality and outlining the "Big Five" personality traits. It then discusses how personality traits generally change with age, with agreeableness and conscientiousness increasing and extraversion and openness decreasing after age 50. The document outlines the diagnostic criteria for personality disorders and clusters them into groups A, B, and C. It notes several challenges with diagnosing personality disorders in older adults and provides case examples of how different clusters may present. Overall management tips focus on balancing structure with flexibility, validating feelings, and empowering independence.
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Presenatatie ocd escap 2015 t5 david mataix_cols_escap_madrid_keynote_2015_final
1. P r o f . D a v i d M a t a i x - C o l s , P h D
C h i l d a n d A d o l e s c e n t P s y c h i a t r y R e s e a r c h C e n t r e
D a v i d . M a t a i x . C o l s @ k i . s e
OCD and related disorders in young people:
Innovation and consolidation
2. Disclosures
— I have no relevant financial or nonfinancial
relationships to disclose
5. OCD and related disorders at KI/SLL
Research group
• Clinical research
• Genetic epidemiology
• Neuroscience
Specialist clinic
• Regional and national
referrals
• Multiple packages of care
• Treatment development/
testing
Full integration of
clinic and research
6. Overview of this lecture
— OCD-RDs chapter in DSM-5/ICD-11
— Evidence-based treatments
— Unmet needs and challenges
— Improving outcomes through innovation and
consolidation
8. OBSESSIVE-‐COMPULSIVE
DISORDER
BODY
DYSMORPHIC
DISORDER
HOARDING
DISORDER
TRICHOTILLOMANIA
(HAIR-‐PULLING
DISORDER)
EXCORIATION
(SKIN-‐PICKING)
DISORDER
OBSESSIVE-‐COMPULSIVE
AND
RELATED
DISORDERS
American
Psychiatric
AssociaFon,
2013
New ‘OCD and Related Disorders’ Chapter in DSM-5
- Chronic Tic Disorders remain in Childhood Disorders
- Hypochondriasis remains in Somatic Disorders
10. DSM-5 Obsessive-Compulsive and Related
Disorders SubWorkgroup: Main issues
— What refinements are needed to the diagnostic
criteria?
— How strong is the evidence for specific OCD
subtypes and symptom dimensions?
— Should OCD leave the Anxiety Disorders grouping?
— Should an Obsessive-Compulsive Spectrum
Grouping of Disorders Be Included in DSM-5?
— If so, what disorders should be included?
11. Refinements to the OCD criteria in DSM-5
— Word ‘impulse’ changed to ‘urge’
— Obsessions and compulsions are ‘time
consuming’ (from 1h to e.g. 1 hour)
— Expand insight specifier to 3 categories:
¡ Good or fair insight
¡ Poor insight
¡ Absent insight (delusional beliefs)
— Add tic-related specifier
12. OCD subtypes
— Tic-related OCD
¡ Highly familial, specific characteristics (sensory phenomena), course
and differential response to SRIs (but not CBT!)
¡ Most experts agree it’s a valid subtype
— Early-onset OCD
¡ Some special features but evidence is less compelling. One problem is
the definition of ‘early onset’
— PANDAS/PANS
¡ Some supporting evidence but remain controversial
¡ 53% of OCD experts do not agree (Mataix-Cols et al 2007)
Recommendation: add tic-related OCD as specifier in
DSM-5
Leckman et et al (2010) Depression and Anxiety
14. OCD dimensions
— OCD is clearly clinically and etiologically
heterogeneous
— There may be clinical value in identifying main OCD
dimensions to guide treatment
— Wide support from experts
— However, not needed to establish diagnosis
— Additional burden for clinicians
— Recommendation: to list them in the text
Leckman et et al (2010) Depression and Anxiety
15. Should OCD leave the Anxiety Disorders grouping?
EXPERTS: NO CONSENSUS!!
Mataix-Cols, Pertusa & Leckman (2007), AJP
16. Initial recommendation (some time in 2010)
— OCD to be retained in the category of anxiety
disorders, but that the name of this category be
changed to reflect the uniqueness of OCD
— Some options are:
¡ “Anxiety and Obsessive-Compulsive Disorders”, or
¡ “Anxiety, Posttraumatic and Obsessive-Compulsive Disorders”
— Compromise option that would acknowledge
similarities and differences
— Would bring DSM and ICD closer together
— Eventually OCD was separated from anxiety
disorders
Stein et al (2010) Depression and Anxiety
17. OCD ‘Spectrum’
— An OC-spectrum grouping of disorders should be
included in DSM-5
— This should be narrow and only include a few
disorders
Phillips et al (2010) Depression and Anxiety
from Hollander
18. Body
Dysmorphic
Disorder
www.ifeelugly.info!
Head/face
General
body Body odor
Skin
Genitalia
Arms/legs
20. Areas of perceived defect
Head/face
General
body Body odor
Skin
Genitalia
Arms/legs
21.
22. Phenomenology: ‘Obsessions’
Like OCD
— Intrusive, persistent, repetitive,
unwanted thoughts
— Usually recognized as excessive
(in terms of time spent)
— Recognized as own thoughts
— Cause anxiety and distress
— Usually resisted
— Sometimes similar content and
core beliefs (e.g., symmetry)
Unlike OCD
— BDD patients have poorer
insight. ~2% of OCD patients are
currently delusional vs 27%-39%
of BDD patients.
— Underlying core beliefs in BDD
focus more on unacceptability of
the self -- e.g., being unlovable,
inadequate, worthless. Moral
repugnance is unusual.
23. Phenomenology: Ritualistic behaviours
90% 89% 88%
51% 47%
32%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
C
am
ouflaging
C
om
paring/scrutinising
M
irrorchecking
Q
uestionning/reassuranceseeking
G
room
ingSkin
picking
24. BDD
— Es@mated
prevalence
of
approximately
2%
in
community
samples
of
adults.
— Associated
with
high
levels
of
occupa@onal
and
social
disability,
including
absenteeism,
unemployment,
marital
dysfunc@on,
and
reduced
quality
of
life.
— Adolescent
onset
reported
in
70%
of
cases…
— …
but
has
received
liRle
empirical
aRen@on
in
this
age
group.
25. BDD
in
adolescents
— Results
in
major
func@onal
impairment
(e.g.,
reduced
academic
performance,
social
withdrawal,
dropping
out
from
school).
— High
suicidality
rates
(reported
21-‐44%
of
pa@ents
aRemp@ng
suicide).
26. Why is BDD under-diagnosed?
— Patients often seek non-psychiatric treatment
— Some mental health clinicians are unfamiliar with BDD
— Patients are secretive about the condition
— Young people: Symptoms are often mistaken as normal developmental
concerns
Often, to make the diagnosis, BDD
symptoms have to be specifically asked
about
27. Simple BDD screening questions
— Concern with appearance: Are you very worried
about your appearance in any way? (OR: Are you
unhappy with how you look?) If yes, What is your
concern?
— Preoccupation: Does this concern preoccupy you?
That is, do you think about it a lot and wish you
could think about it less? (OR: How much time
would you estimate you think about your
appearance each day?)
— Distress or impairment: How much distress does
this concern cause you? Does it cause you any
problems socially, in relationships, or with school/
work?
28. Cosmetic treatments: Bad idea!
— 76% sought non-psychiatric treatment
— Received treatment: 60% (45% dermatological; 23%
surgical)
— Surgeries per patient: mean=2, SD=1.4, range: 1-8
— Outcome
¡ No change or worse: 69%
¡ New appearance preoccupations can develop
¡ Spiral of multiple procedures
¡ Doctors can be sued and even attacked by dissatisfied clients!
Phillips et al (2001) Psychosomatics
29. Hoarding Disorder:
A new mental disorder in DSM-5
The majority report that their problems
began in the teenage years
Approx 2% of Swedish teenagers report
difficulties discarding (Ivanov, 2013)
Substantial health risks
Most sufferers are diagnosed as
adults
32. Collecting: a widespread human activity
— Up to 70% of children own a collection (Evans et al
1997)
— 30% of British adults have a collection at any given
time (Pearce, 1998)
— Regarded as normative
and benign
36. Treatment of OCD-RDs:
MAIN CHALLENGES
WE HAVE GOOD
TREATMENTS FOR
OCD BUT MOST
CHILDREN ARE
NOT RECEIVING
THEM
SOME OCD
PATIENTS DO NOT
RESPOND TO TR
WE DO NOT HAVE
TREATMENTS FOR
OCD-RDS
38. OCD: Evidence-based treatments Work!
— Cognitive behaviour therapy (ERP) +/- medication
(SRI) are effective treatments in 60-70%: (Heyman et al,
2006; Turner, 2005; POTS, 2004)
— Unclear if combining CBT and medication is superior
to CBT alone; probably not (POTS, 2004; Ivarsson et al 2015)
— Individual or group + family therapy (Barrett et al 2004)
— ERP or CBT (Bolton et al 2011)
— Long or short duration (12 sessions vs 5 sessions)
(Bolton et al 2011)
— Very early age of onset vs later age of onset (Nakatani et al
2011; POTS Jr)
39. Meta-analysis of SRI trials: Effective but
effect sizes are modest
Ivarsson et al (2015), Psychiatry Res
41. SRI non-responders (POTS II study)
Franklin et al, JAMA 2011
Responders
Medication: 30%
CBT instructions: 34%
CBT: 68%
42. CBT non-responders (NordLOTS study)
Skarphedinsson, et al 2014, Eur Child Adolesc Psychiatry
• Phase I: 73% response
• Phase II: 48% response
• Combined response: 81%
R
43. The many challenges of OCD
— Some patients (1/3) do not respond sufficiently
— Long delays in the detection of OCD
¡ 17 years on average in adults (Hollander et al., 1998)
¡ 3 years on average in children (Chowdhury et al., 2004)
— Misdiagnosis is not uncommon
— Need for increased recognition at the earliest stages of the
disorder (Micali et al., 2010) è BETTER OUTCOMES
— Once diagnosed, patients not always getting the right
treatments, particularly CBT (e.g., Choddhury et al 2004)
— Ethnic inequalities (Williams et al., 2010; Fernández de la Cruz et al., in
press)
44. Maudsley clinic: young people with OCD had rarely received
CBT before assessment
0
5
10
15
20
25
30
35
40
45
no treatment
CBT
SSRI/clomipramine
SSRI/clomipramine + CBT
other treatment
% of
children
treatment
Chowdhury et al (2004) Clinical Child Psychology and Psychiatry
45. How resistant is ‘treatment-resistant’ OCD?
¡ CYBOCS >30
¡ Previous failure
÷ CBT *
÷ SSRI
¡ 58% responded to treatment
¡ 22% in remission
¡ Medication group tended to do
better (non-sign)
Krebs et al., Brit J Clin Psychol 2014
* CBT inadequate in 95.5% of cases
(insufficient focus on ERP)
46. Pharmacoepidemiology of pediatric OCD
(N=905)
• 85% RECEIVE AN SSRI
• ONLY 53% RECEIVE ADEQUATE DOSE!
• ONLY 43% RECEIVE AN ADEQUATE DOSE FOR
ONE YEAR OR LONGER
SRI prescription guidelines
American Academy of Child and
Adolescent Psychiatry (2012)
Isomura et al, in preparation
Swedish National Patient Register
Swedish Prescriptions Register
47. Fernández de la Cruz et al., in press, British Journal of Psychiatry
48. Outcomes in white vs non-white patients
— Patients treated at the Maudsley specialist OCD clinic
Fernández de la Cruz et al., 2015, JOCRDs
50. OCD in Autism Spectrum Disorder
— High rates of anxiety disorders in ASD
¡ Child and Adult Studies (Kim et al, 2000; Ghaziuddin, 2005)
¡ 11 to 84% ( White, Oswald, et al. 2009)
— OCD particularly common
¡ South et al. (2005)
¡ McDougle et al.(1995)
¡ Russell et al (2005)
— Often untreated (“part of the ASD”)
— Unnecessary distress and disability
— Predicts poor response to CBT
0
5
10
15
20
25
30
35
40
Beginning
End
ASD+OCD
NoASD
+OCD
Murray et al, 2015, Psych Res
51. ASD+OCD project
— Develop and manualise a CBT protocol for OCD in
this particular population
— Systematically evaluate it via a RCT
¡ Adapted CBT for OCD vs a credible control treatment
Ailsa Russell’s PhD
52. Adapted CBT protocol
— Manual: CBT for OCD with adaptations for ASD
¡ Expert recommendations (Attwood, 1999; Anderson & Morris, 2006)
¡ Experience from pilot study
¡ Theoretical literature
— Up to 20 sessions (mean 17 sessions)
— Longer period of assessment/formulation (4 sessions or more if needed)
— Education about anxiety and OCD
¡ Visual aides
¡ Special interest/concrete analogy
— Exposure & Response Prevention (ERP)
¡ Graded hierarchy
¡ Therapist modelling/direction
— Cognitive elements
56. Analyzed (n=20)
Excluded from analysis (n=3):
Discontinued/lost to follow-up
Lost to follow-up n=1
Discontinued intervention n=2
Allocated to CBT
(n= 23)
Received allocated intervention
(n= 23)
Discontinued intervention (n=3):
Depression (n=1)
Withdrew assent (n=1)
Reason unknown (n=1)
Allocated to Anxiety Management
(n= 23)
Received allocated intervention
(n= 23 )
Analyzed (n=20)
Excluded from analysis (n=3):
Discontinued intervention
Analysis
Randomised
(n=46)
1 month
follow-up
Attended (n=17)
Did not attend (n=2)
Cross-over to other treatment
after this point (n=9)
Entered follow-up (n=11)
Attended (n=18)
Did not attend (n=2)
Cross-over to other treatment
(n=3)
Entered follow-up( n=17)
Allocation
Follow-up
Assessed for
eligibility
(n= 75)
Excluded (n=29)
57. Anxiety Management (control)
— Based on previous studies with some ASD adaptations
(Cautela & Groden, 1978, Schneider et al, 2006)
¡ Anxiety education
¡ Breathing practice
¡ Relaxation training and practice
¡ Mood monitoring
¡ Healthy Habits
¡ Problem solving
— No ERP or cognitive techniques
— Up to 20 sessions (Mean 16 sessions)
59. Augmenting CBT with fear extinction enhancers
— No clear benefit of combining CBT with SRIs
— Novel treatment combinations, e.g. use of fear
extinction enhancers to augment CBT
— D-Cycloserine is a partial NMDA-agonist
60. DCS in various anxiety disorders
— Promising trials
¡ Fear of heights (Ressler et al., 2004)
¡ Social phobia (Hoffman et al., 2006; Guastella et al., 2008)
¡ Panic disorder (Otto et al., 2009)
¡ OCD (Kushner et al., 2007; Wilhelm et al., 2008; Storch et al., 2010)
— Negative trials (adults)
¡ Spider phobia (Guastella et al., 2007)
¡ OCD (Storch et al., 2007)
— Many more ongoing trials in
adults as well as children Wilhelm et al AJP 2008
61. Maudsley pilot double blind RCT in adolescents
with OCD
Funded by: NIHR Biomedical Research Centre for Mental Health
Mataix-Cols et al 2014, British Journal of Psychiatry
62. Standard clinic protocol
— 14 sessions on a weekly basis (within 17 weeks)
¡ Session 1-2 : education about anxiety and OCD
¡ Session 3-12: E/RP
¡ Session 13-14: Relapse prevention
¡ Standard follow-up: 1, 3, 6 and 12 months
Followed by 50mg DCS or placebo
Mataix-Cols et al 2014, British Journal of Psychiatry
64. …but homework compliance matters
5
7
9
11
13
15
17
19
2 3 4 5 6 7
CYBOCSattheEndoftheWeek
PEAS Score for the Preceeding Week
DCS
PBO
DCS may more effectively facilitate the effects of CBT when
patients are compliant with prescribed homework.
Olatunji et al submitted
66. Developing
treatments
for
pediatric
BDD
BACKGROUND
— CBT
efficacious
for
adults
with
BDD
— No
evidence
in
pediatric
popula@ons
(case
series)
AIMS
— Develop
a
developmentally
tailored
CBT
protocol
for
young
people
with
BDD,
involving
family
when
appropriate.
— Evaluate
its
efficacy
in
a
pilot
randomized
controlled
trial.
68. ¡ CBT:
14
sessions
offered
flexibly
over
4
months
÷ Sessions
1-‐2
(90
minutes):
PsychoeducaFon,
resolve
ambivalence,
case
formulaFon,
goal
seZng,
ERP
raFonale.
÷ Sessions
3-‐12
(60
minutes):
Exposure
and
response
prevenFon
(ERP).
Other
opFonal
modules
to
promote
engagement
with
ERP
(mainly:
mirror
retraining
and
a^enFon
training).
÷ Sessions
13-‐14
(60
minutes):
Relapse
prevenFon.
¡ Developmentally
appropriate
content
¡ Strong
parental
involvement,
depending
on
individual
formulaFon
(e.g.,
more
accommodaFon
=
more
parental
involvement)
Protocol
69. 2-‐month
follow-‐up
measures
administered
14
sessions
of
CBT
over
4
months
Wri^en
material
with
informaFon
about
BDD
Weekly
phone
calls
to
assess
and
manage
risk
over
4
months
CBT
group
End
of
acFve
phase
Control
group
BDD
Assessment
Crossover
to
CBT
Follow-‐up
assessments
completed
at
6
and
12
months
acer
end
of
treatment.
End
of
study.
§ Trial
design:
70. CONSORT
Diagram
Assessed
for
eligibility
(n
=
51)
Excluded
(N
=
21):
-Other
Axis
I
diagnosis
(n
=
6)
-No
Axis
I
diagnosis
(n
=
2)
-High
risk
(n
=
5)
-Opted
for
different
treatment
(n
=
7)
-‐Family
difHiculties
(n
=
1)
Randomised
(n
=
30)
Allocated
to
CBT
(n
=
15)
-‐ Received
allocated
intervention
(n
=
15)
-‐ Did
not
receive
allocated
intervention
(n
=
0)
Allocated
to
control
group
(n
=
15)
-‐ Received
allocated
intervention
(n
=
14)
-‐ Did
not
receive
intervention
(n
=
1;
dropped-‐out
after
knowing
condition)
Allocation
Completed
CBT
(n
=
15)
Dropped-‐out
(n
=
0)
Completed
Control
(n
=
14)
Dropped-‐out
(n
=
0)
Treatment
Followed-‐up
at
two
months
(n
=
15)
Lost
to
follow-‐up
(n
=
0)
Followed-‐up
at
two
months
(n
=
13)
Lost
to
follow-‐up
(n
=1;
did
not
want
treatment)
2-‐month
follow-‐up
Analysed
(n
=
15)
-‐
Excluded
from
analysis
(n
=
0)
Analysed
(n
=
15)
-‐
Excluded
from
analysis
(n
=
0)
ITT
analysis
Enrollment
71. Results
— Primary
outcome:
interac@on
@me
x
group
is
sign
at
post-‐treatment
and
at
2m
FU.
2030402535
BDD-YBOCS-ATotalScore
Baseline Mid-treatment Post-treatment 2m FU
Time
Control CBT
d=1.13 d=0.85
72. Results
— Treatment
response
(≥30%
reduc@on
in
the
BDD-‐
YBOCS)
at
post-‐treatment
and
at
FU:
¡ 40%
(n=6)
in
the
CBT
group
¡ 6.7%
(n=1)
in
the
control
group
— CGI
score
of
2
(much
improved)
or
1
(very
much
improved):
¡ 53%
(n=8)
in
the
CBT
group
¡ 0%
(n=0)
in
the
control
group
• Developmentally tailored CBT is a promising
intervention for youths with BDD
• There is substantial room for improvement
• Pressing need to compare CBT, SSRIs and
their combination in pediatric BDD
74. ‘Consolidation’
— After decades of evidence-based treatments for
OCD…
¡ the majority of patients remain untreated…
¡ or receive the wrong treatment!
— Still poor awareness
— Lack of expertise (particularly CBT)
— Difficult to access remote areas
— Ethnic minorities underserviced
— = HUGE UNMET NEED!! WHAT CAN WE DO?
77. Dissemination of evidence-based treatments
— Training of clinicians
— Self-help (e.g., bibliotherapy)
— Telephone treatment
— Internet treatment
— Reaching disadvantaged groups (e.g., ethnic minorities)
78. Telephone treatment for youth with OCD
— Improve access to and
availability of CBT
— Establish efficacy
— Establish feasibility
— Determine acceptability
79. Standard clinic protocol
— 14 sessions on a weekly basis (within 17 weeks):
¡ Session 1-2 : education about anxiety and OCD
¡ Session 3-12: E/RP
¡ Session 13-14: Relapse prevention
¡ Standard follow-up: 1, 3, 6 and 12 months
83. Telephone vs face to face CBT results
Turner et al.2014 JAACAP
• Non-inferiority demonstrated
• Highly acceptable for patients
• No savings in clinician time
84. Internet CBT for young people with OCD with
minimal therapist backup: BIP OCD
Lenhard et al., 2014 PLOSONE
88. Internet CBT for young people with OCD with
minimal therapist backup: BIP OCD
d = 2.29
Clinician time:
About 20
minutes per
patient per
week!!
Lenhard et al., 2014 PLOSONE
89. Towards a stepped care model
Mataix-Cols and Marks, 2006 Eur Psychiatry
90. Conclusions
— OCD-RDs are prevalent and there is a huge unmet
need
— Treatments for OCD are pretty good but there is
room for improvement
— Biggest challenge: to disseminate existing evidence-
based treatments
— Much work needs to be done for the other OCD-RDs
— This work would be optimally orchestrated from
specialist centres, where clinical work and research
go hand in hand
91. Acknowledgements
OCD/ASD BDD Hoarding Tic
Disorders
Trich/
Excor
I Heyman G Krebs A
Nordsletten
P Andren B Monzani
G Krebs D Veale A Pertusa M Boman P Andren
L Fernandez J Cadman L Fernandez C Ruck C Ruck
A Jassi L Bowyer D Billotti E Serlachius K Aspvall
A Russell B Monzani D Landau F Lenhard
E Serlachius L Fernandez A Iervolino M Silverberg
F Lenhard J Enander V Ivanov