Clinical Obsessive-Compulsive Disorders in Adults and Children PDF
Preview Clinical Obsessive-Compulsive Disorders in Adults and Children
Clinical Obsessive-Compulsive Disorders in Adults and Children Clinical Obsessive-Compulsive Disorders in Adults and Children Edited by Robert Hudak UniversityofPittsburghSchoolofMedicine and Darin D. Dougherty HarvardMedicalSchool cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown, Singapore,SãoPaulo,Delhi,Tokyo,MexicoCity CambridgeUniversityPress TheEdinburghBuilding,CambridgeCB28RU,UK PublishedintheUSAofAmericabyCambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/9780521515696 ©CambridgeUniversityPress2011 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2011 PrintedintheUnitedKingdomattheUniversityPress,Cambridge AcatalogrecordforthispublicationisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationdata Clinicalobsessive-compulsivedisordersinadultsandchildren/edited byRobertHudak,DarinD.Dougherty. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-51569-6(hardback) 1. Obsessive-compulsivedisorder. I. Hudak,Robert,1966– II. Dougherty,DarinD. III. Title. [DNLM: 1. Obsessive-CompulsiveDisorder.WM176] RC533.C6335 2011 616.850227–dc22 2010038772 ISBN978-0-521-51569-6Hardback CambridgeUniversityPresshasnoresponsibilityforthepersistenceor accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto inthispublication,anddoesnotguaranteethatanycontentonsuch websitesis,orwillremain,accurateorappropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationwhichisinaccordwith acceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthas beenmadetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,theauthors,editorsandpublisherscanmakeno warrantiesthattheinformationcontainedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantly changingthroughresearchandregulation.Theauthors,editorsandpublishersthereforedisclaimallliabilityfordirector consequentialdamagesresultingfromtheuseofmaterialcontainedinthisbook.Readersarestronglyadvisedtopaycareful attentiontoinformationprovidedbythemanufacturerofanydrugsorequipmentthattheyplantouse. Contents Listofcontributors pagevi Preface vii 1 Introductiontoobsessive-compulsive 9 Compulsivehoarding 122 disorder 1 ChristinaM.GilliamandDavidF.Tolin RobertHudak 10 Cognitive-behavioraltherapyforchildrenand 2 Neurobiologyandneurocircuitryof adolescentswithobsessive-compulsive obsessive-compulsivedisorderandrelevance disorder 138 toitssurgicaltreatment 20 AureenP.Wagner DarinD.DoughertyandBenjaminD.Greenberg 11 Communitysupportandsocietal 3 Selectiveserotoninreuptakeinhibitorsinthe influences 152 treatmentofobsessive-compulsive ElaineDavis disorder 30 12 Thefamilyinthetreatmentofobsessive- SigniA.PageandRobertHudak compulsivedisorder 172 4 Augmentationofserotoninreuptake AndreaAllenandStefanoPallanti inhibitorsinthetreatmentof 13 Providingtreatmentforpatientswith obsessive-compulsivedisorder 49 obsessive-compulsivedisorder 184 AndrewGoddardandYong-WookShin TerriLaterza,KalieD.Pierce,andRobertHudak 5 Obsessive-compulsivedisorderandcomorbid 14 Bodydysmorphicdisorder 191 mooddisorders 61 KatharineA.Phillips JonathanS.Abramowitz 15 Trichotillomaniaandotherimpulsecontrol 6 Obsessive-compulsivesymptomsin disorders 207 schizophrenia:clinicalcharacterizationand MichaelH.Bloch treatment 71 MichaelPoyurovsky 7 Medicationmanagementof obsessive-compulsivedisorderinchildren Index 216 andadolescents 92 AndrewR.Gilbert 8 Exposurewithresponsepreventiontreatment forobsessive-compulsivedisorder 102 FugenNeziroglu,BethForhman,andSony Khemlani-Patel v Contributors AndreaAllen SonyKhemlani-Patel MountSinaiSchoolofMedicine,NewYork,USA PsychiatryDepartment,NorthShoreUniversity Hospital,GreatNeck,NY,USA JonathanS.Abramowitz DepartmentofPsychology,Universityof TerriLaterza NorthCarolinaatChapelHill,ChapelHill, AdultOCDIntensiveOutpatientProgram,Western NC,USA PsychiatricInstituteandClinic,Pittsburgh,PA,USA MichaelH.Bloch FugenNeziroglu YaleChildStudyCenter,NewHaven,CT,USA HofstraUniversity,Hempstead,NewYork,USA ElaineDavis SigniA.Page ObsessiveCompulsiveFoundationofWesternPA, UPMCMedicalEducationProgramPittsburgh, Pittsburgh,PA,USA Pittsburgh,PA,USA DarinD.Dougherty StefanoPallanti HarvardMedicalSchoolandDepartmentof MountSinaiMedicalCentre,NewYork,USA PsychiatryofMassachusettsGeneralHospital,Boston, KatharineA.Phillips MA,USA ButlerHospitalandtheDepartmentofPsychiatryand BethForhman HumanBehavior,AlpertMedicalSchoolofBrown AdjunctFaculty,GraduateSchoolofSocialWork, University,Providence,RI,USA AdelphiUniversity,GardenCity,NY,USA KalieD.Pierce AndrewR.Gilbert AdultOCDIntensiveOutpatientProgram,Western DepartmentofPsychiatry,Universityof PsychiatricInstituteandClinic,Pittsburgh,PA,USA PittsburghSchoolofMedicine,Pittsburgh, MichaelPoyurovsky PA,USA RappaportFacultyofMedicine,Technion,Israel ChristinaM.Gilliam InstituteofPsychiatry,Haifa,Israel TheInstituteofLiving,Hartford,CT,USA Yong-WookShin AndrewGoddard ClinicalCognitiveNeuroscienceCenter,SNU-MRC, IndianaUniversity,Indianapolis,IN,USA Seoul,Korea BenjaminD.Greenberg DavidF.Tolin ButlerHospital,WarrenAlpertMedicalSchoolof TheInstituteofLiving,HartfordandYaleUniversity BrownUniversity,Providence,RI,USA SchoolofMedicine,NewHaven,CT,USA RobertHudak AureenP.Wagner UniversityofPittsburghSchoolofMedicine, TheOCDandAnxietyConsultancy,Rochester, Pittsburgh,PA,USA NY,USA vi Preface While obsessive-compulsive disorder (OCD) is one Comorbidity is the rule rather than the exception of the most common psychiatric disorders, accurate inOCD.Therefore,multiplechaptersdealwithtreat- diagnosis and treatment are still too often lacking. ment concerns in patients with comorbid disorders. Past studies have suggested that 17.5 years elapse, on In Ch. 5, Abramovitz discusses OCD treatment in average, between the onset of OCD symptoms and patients with comorbid mood disorders including adequate diagnosis and treatment. Recently, greater a discussion of postpartum OCD, while in Ch. 6 attention is being paid to OCD in lay media outlets, Poyurovskycoverstheimportanttopicoftherelation- which has resulted in a greater public awareness of ship between psychosis and OCD. Finally, Gilbert,in OCD. Also, clinicians are receiving more training Ch.7,reviewsmedicationstrategiesinthetreatmentof regarding the diagnosis and treatment of OCD than anotherspecialpopulation,childrenandadolescents. in the past. Hopefully, these factors will shorten the Psychotherapyplaysacriticalroleintreatmentand gap between symptom onset and adequate treatment. management, and Neziroglu and colleagues (Ch. 8) However,evenwiththisgrowingknowledgebase,clini- discuss the principles behind exposure with response cians are often required to seek out expert knowledge prevention therapy. Hoarding represents a specific regarding OCD in order to optimize their diagnostic type of OCD symptoms requiring its own individual and treatment strategies. While no textbook can be a therapies, and a review is provided by Gilliam and substitute for individual teaching and supervision, a TolininCh.9.Psychotherapyinchildrenandadoles- reviewofcontemporarydiagnosticandtreatmentstrat- cents can require different strategies than in adults, egies should enhance the clinical acumen of readers andWagnerinCh.10providesdetailedclinicalinfor- and help to ensure that readers provide their patients mation regarding the use of psychotherapy in this withoptimalcare.Thegoalofthisvolumeistodescribe population.TheperceptionofOCDinthecommunity thecurrentstateofknowledgeconcerningthediagnosis atlargecanhaveeffectsonaccesstoOCDtreatment. andtreatmentofOCDandtodescribehowitisappro- This issue, as well as strategies to mitigate this prob- priatelyappliedinaclinicaltreatmentsetting. lem,isreviewedbyDavisinCh.11.Familymembers Theclinicalpresentation,theunderlyingetiology, are greatly affected by OCD and this issue almost andpharmacotherapytreatmentofOCDarealladdre- always needs to be addressed in treatment. Allen and ssedinthistext.Thefirstchaptercoversbasicinforma- Pallanti, in Ch. 12, provide an invaluable discussion tion concerning OCD, including epidemiology and regardingtheinclusionoffamilyintreatment.Laterza, phenomenology. Hudak also provides case examples Pierce,andHudakinCh.13reviewthedifferentlevels to illustrate certain diagnostic challenges in OCD. of treatment (outpatient, day programs, residential Dougherty and Greenberg discuss the latest findings programs,etc.)availabletoOCDpatients,andprovide regardingtheneurobiologyofOCDinCh.2.Inaddi- case examples of how differing intensities of therapy tion, they review surgical treatments for intractable impactsoutcome. OCD. First-line medication treatments are reviewed Finally,OCDisoftenconsideredaspectrumdisor- in Ch. 3, by Page and Hudak, while pharmacological der. Therefore, other putative spectrum disorders are augmentationstrategiesaredescribedbyGoddardand reviewedinchaptersbyPhillips(Ch.14:bodydysmor- ShininCh.4. phicdisorder)andBloch(Ch.15:trichotillomania). vii 1 Chapter Introduction to obsessive-compulsive disorder Robert Hudak biological underpinnings became widely accepted. History and diagnosis Becauseoftheheterogeneousnatureofthesymptoms Thereisprobablynootherpsychiatricillnessthathas of OCD, it is unlikely that a single factor will be gonethroughamorefascinatingevolutioninitscon- identified as the biological origin for OCD. ceptualization during contemporary times than Consequently,multipleavenuesofresearcharebeing obsessive-compulsivedisorder(OCD).Justinthelast explored. Genetic, neuroanatomical, and infectious 30yearsthechangeintheperceptionandtreatmentof causesforOCDarethefocusofcurrentresearchand OCD has been dramatic. In fact, this process is still theunderlyingcauseofOCDislikelymultifactorial. ongoing as psychiatry increasingly moves towards a AsdefinedbytheDiagnosticandStatisticalManual multidimensional model of OCD. This work-in- of Mental Disorders, 4th edition (DSM-IV; American progress will be interesting to follow. At the turn of Psychiatric Association 1994), OCD has fairly thetwentiethcentury,Freudwroteaboutobsessionsas straightforward criteria. The DSM simply asks that a defensive psychological responses to unconscious personhaseitherobsessions(Box1.1)orcompulsions impulses.He alsotalked about theunderlyingrole of (Box 1.2), that at some point during the disorder the childhood sexual experiences. Pierre Janet first pro- personhasrecognizedthatthesymptomswereexces- vided clinical descriptions of OCD in 1903 in Les siveorunreasonable,andthattheycausemarkeddis- Obsessions et la Psychasthenie. As a result, through tress, are time consuming, or significantly interfere most of the following decades, OCD was thought to with the patients functioning. The DSM-IV does result from unresolved unconscious conflicts. For allow that the person can have poor insight (i.e., not years, parents were thought to be the root cause recognize that the symptoms are unreasonable or of this disorder through “excessively harsh toilet excessive).Becauseoftheintrusivenatureofanobses- training”(Adams1973).Itisimportanttonote,how- sion,apersonmaydescribeitasanalienthought,oras ever, that a disease model should not simply present a feeling as if the thought is not their thought. a theory that on the surface appears to explain an However, the person will state that they know that illness but should also predict a related treatment. thethoughtiscomingfromtheirownmind:justthat Significantly,notreatmentbasedontheresolutionof it feels as if it is not. Careful interviewing by the unconscious impulses was ever shown to work for practitioner should easily distinguish this from OCD. thought insertion, a symptom of schizophrenia that With psychoanalytic models clearly not valid in isnotseeninOCD. explaining the pathology of OCD, cognitive models The differential diagnosis of OCDcan be difficult were then explored. The cognitive models postulated enough that the illness has been termed chameleon- thatindividualswithOCDmaypossessdysfunctional like(Attiullahetal.2000).Acontributingfactorinthis beliefsincludingover-inflatedpersonalresponsibility, difficultyisthatobsessionscanfocusonvirtuallyany overestimationofthreat,theneedtocontrolthoughts, thoughtcontent.WhileOCDissometimesportrayed andperfectionism(Freestonetal.1996;Boucardetal. astheillnessinwhichpeoplehaveafearofgermsora 1999). Interestingly, it was not until the latter part of need to check things, the content of obsessions can thetwentiethcenturythatamodelforOCDbasedon include virtually anything. It is the nature of the ClinicalObsessive-CompulsiveDisordersinAdultsandChildren,ed.RobertHudakandDarinD.Dougherty. PublishedbyCambridgeUniversityPress.Copyright©CambridgeUniversityPress2011. 1
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