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New Institute headed by McGill researcher will focus on training, better dissemination of knowledge.

Experts used to think that Obsessive-Compulsive Disorder (OCD) was not curable. That is simply not true anymore, says Dr. Debbie Sookman, an internationally renowned OCD expert who has treated 7,000 cases in her clinic.  The problem is that sufferers do not have access to sufficient specialized resources and therefore are often not treated early enough or appropriately.

“I hear so many tragic stories from parents of children who are not receiving the appropriate treatment during their formative and vulnerable years,” says Dr. Sookman, Associate Professor at McGill University’s Department of Psychiatry and Director of the Obsessive Compulsive Disorder Clinic at the McGill University Health Centre, the only clinic in Canada devoted solely to the disorder through the life span. “With timely and appropriate treatments the prognosis for OCD is excellent. Too many patients are mislabeled ‘resistant to treatment’ without ever having received best-practice treatment.”

OCD is the fourth most common mental health disorder and among the ten leading causes of medical disability worldwide. It is estimated that OCD and related disorders affect five per cent of the population, or 1.6 million Canadians*. Symptoms include excessive fear of illness or disaster, distressing intrusive thoughts, and associated rituals such as repetitive washing or checking. When left inadequately treated, OCD symptoms can rapidly worsen and interfere with essential functioning such as school attendance and childcare. In extreme cases, OCD-related symptoms may become life threatening. Specialized and timely interventions are required to reduce unnecessary suffering and prevent progression to disability.

“Intervention for OCD is a specialized field,” explains Sookman. “The first-line treatment of choice for OCD is specialized cognitive behavior therapy (CBT), but this is not happening for many patients. Very few clinics across Canada have the necessary expertise or resources to treat OCD relative to the clinical need. Many sufferers including children and seniors are prescribed medication prematurely or repeatedly without specific psychological interventions that are essential to recovery. When experts have developed effective treatments but these are inaccessible to sufferers, this is a truly tragic situation that requires urgent change.”

To address the shortage of professionals specialized in OCD and improve the dissemination of expertise on the disorder, Dr. Sookman has established The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) whose Scientific Advisory Committee comprises over 40 of the top OCD expert psychologists and psychiatrists in the world. Among the Institute’s mandates across Canada are to advance best-practice specialty OCD treatment through the life span, and to promote scientific research designed to improve preventative strategies and clinical intervention.

The CIOCD Accreditation Task Force is developing criteria to increase the number of clinicians and centers credentialed to treat OCD with pharmacotherapy and/or CBT. The goal of the Institute’s Accreditation Program is to ensure that OCD sufferers of all ages across Canada have access to reliable information about updated treatment options and timely specialized treatment delivery. The CIOCD Affiliate Outreach Educational Program will have representation and input from every Canadian province. The Canadian Institute for Obsessive Compulsive Disorders expects to take a leadership role in establishing the specialty OCD accreditation standard internationally.

The CIOCD will hold its inaugural event on November 11 in Toronto. For more information about this event and the CIOCD, please visit: http://www.CIOCD.ca.

News Source: HealthCanal (link)

 

It's a common form of hyperbole.

The neighbor who keeps his house tidy has Obsessive Compulsive Disorder (OCD). A socially awkward colleague is autistic. The weather isn't just changeable, it's bipolar.

Such analogies are so familiar they surely qualify as clichés. They are also inaccurate and, to many, deeply offensive.

As Mental Health Awareness Week begins, campaigners are targeting what many say is an increasingly common practice - deploying the language of clinical diagnosis to describe everyday personality traits.

Using these terms metaphorically is just a joke, not to be taken seriously, argue some. Others, however, warn that this serves to further obfuscate conditions that are widely misunderstood and stigmatized.

Either way, you don't have to look hard for evidence of such terminology being deployed in this manner - even from sources you might not anticipate.

In December 2010 the Observer newspaper apologized for describing TV presenter Gok Wan's dress sense as "schizophrenic". The International Monetary Fund's September 2011 World Economic Outlook, characterized a volatile global economy as "bipolar". In an article for the Sunday Times, the writer Robert Harris described Gordon Brown and Richard Nixon as displaying "political Asperger's syndrome".

The mental health metaphor also has the distinction of having been deployed by that noted savant of the English language, Katie Price. During a court appearance in which she insisted she had been spraying scent rather than using her mobile phone while driving, the glamour model said: "I am quite OCD about my perfume habits, all my friends know that I'm always spraying perfume."

Research suggests these are far from isolated examples. A 2007 study of the terms "schizophrenia" and "schizophrenic" in the UK national press found that 11% of references were metaphorical, with broadsheet papers more likely to deploy such phrasing than tabloids. By contrast, cancer was only used in this manner in 0.02% of cases.

If anything, the UK is less prone to this tendency than other developed nations. Separate surveys in the United States, Germany and Switzerland found respectively that 28%, 58% and 31% of references to the condition were metaphorical.

Nonetheless, Arun Chopra, a consultant psychiatrist at Queen's Medical Centre in Nottingham and the author of the British research, believes the tendency has a negative impact on the treatment of patients.

He argues that deploying terms in such a way contributes to public misunderstanding - for instance, reinforcing the false notion that schizophrenia is a "Jekyll and Hyde" illness related to split personalities.

Moreover, he says it can be deeply upsetting to patients and their families, and recalls seeing a woman whose son was diagnosed with the condition bursting into tears when she read a newspaper article, which described the weather as "schizophrenic".

"The use of the word as a metaphor is tremendously damaging," Chopra adds. "It's part of the process of creating a stigma around mental illness.

"You would never hear it used in relation to a physical condition. You wouldn't hear someone being described as a bit diabetic."

As such, he says he would like the Oxford English Dictionary to remove its secondary definition of schizophrenic: "With the implication of mutually contradictory or inconsistent elements".

Of course, deploying medical language to describe character traits is hardly a new phenomenon. Words like cretin and lunatic were originally formal terms to describe specific conditions before they more commonly came to be used pejoratively.

However, not all those affected by frequently misapplied conditions object to their use in this manner.

The Daily Telegraph columnist Bryony Gordon, who has been diagnosed with OCD, says she frequently has to point out that her disorder involves more than simply cleaning her house.

But she feels that attempting to clamp down on this kind of use of the term veers close to political correctness - and, moreover, that she is grateful the condition is, at least, widely discussed.

"It doesn't offend me when people trivialize it," she says. "It's almost a vehicle to talk about it.

"In a way it's a good thing because people acknowledge it exists. You're stuck in your own head and to see other people making light of something makes you think, 'Ah, this is what's happening.' It makes you feel better about it."

Most advocates for such conditions disagree, however.

Andrew McCulloch, chief executive of the Mental Health Foundation, argues that using a clinical diagnosis to describe minor personality traits can only serve to fuel misunderstanding.

"The upside is that we have moved on from a fear of mentioning these things at all, but it is a tiny step forward," he says. "The trouble is these terms all come to mean the same thing. Then they become as unpleasant as describing someone with schizophrenia as a lunatic.

"The reality is we still have a long way to go when it comes to educating people about mental health. People might use these terms more frequently now but the stigma of having a mental illness is as bad as it has ever been."

Still, attempts by some mental health service users to reclaim pejorative labels under the banner of so-called "mad pride" demonstrate that there is unlikely to ever be consensus about the best way to respond.

The flippant use of such terms nowadays may offend some and not bother others. But such a dynamic is part of the words' evolution, says Joel Rose, director of OCD Action.

"Five years ago people wouldn't have known what you were talking about if you mentioned OCD," he says. "Now they have a sense of what it is about and use it, but don't really fully understand it. The next five years will be about working to fully educate people.

"What we want people to understand is how serious and debilitating OCD can be. We're talking about people who might clean a floor repeatedly for eight hours or someone who can't leave the house. It's not having a tidy house or arranging the tins of food in your cupboard. We also want to get across that it is treatable."

Indeed, many of those diagnosed with the condition have successfully learned to manage it. Overcoming its metaphorical use, however, may prove more difficult.

This brain surgery is used for illnesses such as depression and severe obsessive-compulsive disorder. It has also been used in the treatment of Parkinson's disease. However, according to researchers only 10 to 15% of Parkinson's patients are appropriate candidates for this treatment.

Listen to health report below:

Guests
Professor Ron Alterman: Professor of Neurosurgery and Head of Functional Neurosurgery, Mount Sinai School of Medicine and Medical Center, New York.
Professor Helen Mayberg: Professor of Psychiatry, Emory University, School of Medicine, Atlanta.
Professor William Weiner: Professor of Neurology, University of Maryland, School of Medicine, Baltimore.

Presenter
Norman Swan

Producer
Brigitte Seega

Source: TheHealthReport (link)

A professional theater company has been performing stories about people who struggle with mental illness. This week, the theater company "Erasing the Distance," is doing an entire show on Obsessive Compulsive Disorder.

OCD is the fourth-most diagnosed psychiatric disorder. It's a neuro-biological condition that causes ritualistic behaviors and thoughts. "OCD: Real Stories, Real People" will be performed Tuesday at 7 p.m. at Ann Sather Restaurant, 909 W. Belmont Ave., Chicago. Tickets are $10 per person or $5 for students.

"We use theater to shed a light on issues of mental health, so that can be anything from depression to anxiety to things like OCD," Said Brighid O'Shaughnessy, who founded the company six years ago. "We do it by gathering true stories and then taking those tru stories and sculpting them into monologues and scenes that then come to plays."

The theater company has been working with OCD Chicago and its executive director, Ellen Sawyer.

"Unlike some of the major physical diseases like cancer and heart disorders, brain disorders aren't as popular, and a lot of people don't really want to talk about them," Sawyer said.

O'Shaughnessy said many people think OCD behaviors are visual, but many who suffer try to hide their symptoms.

"One of our story tellers has issues with germs and with the bathroom and cleanliness that's part of what his OCD surrounds and he talked about being in college and literally going to bathrooms off the beaten path."

In addition to professional actors performing, there will be people with OCD telling their personal stories as part of the performance.

"We've been working hard to raise the awareness of having Obsessive Compulsive Disorder and teaching people that it's an illness and it's not their fault and that there is a treatment for it," Sawyer said. "I think more people are coming forward and feeling more comfortable about it."

For more information visit www.erasingthedistance.org or www.ocdchicago.org.

News Source: ABC7News (link)

The International OCD Foundation and its affiliates from across the country will come together to educate their communities and the public as a whole about obsessive compulsive disorder and its treatments. Learn from the nation's leading experts about how they work with those who suffer daily from the debilitating disorder. Have the opportunity to hear testimonials from patients both recovering and just beginning treatment and learn about the different treatments and therapies that help people hold jobs, balance relationships with family and friends, and lead more typical and productive lives.

Obsessive Compulsive Disorder is an all-consuming, debilitating disorder that affects up to 4 million people in the United States. The disorder also affects millions more: family, friends and caregivers of those with OCD suffer along side their loved ones.

OCD Awareness Week is presented by the International OCD Foundation as a vehicle for support, advocacy and education to help end the stigma surrounding OCD and encourage sufferers to identify the disorder and/or seek treatment. The national Foundation has enlisted the support of its Affiliates nationwide to join in this education effort.

Source: IOCDF (link)

A short documentary recalling the filmmaker's struggles with Obsessive-Compulsive Disorder:

By Valerie Berenyi

Dr. Frank MacMaster wants people to rethink mental illness in children.

“The knee-jerk reactions are, ‘They must be terrible parents, or ‘The kid’s just faking, stop it.’ How do you tell an kid with obsessive compulsive disorder to just stop it? Or, worse, ‘Don’t tell anyone, keep it a secret,’” says MacMaster, a pediatric neurobiologist and researcher recruited from Detroit a year ago to work at Alberta Children’s Hospital.

He points to a 2008 poll that found 46 per cent of Canadians think people use the term mental illness as an excuse for bad behavior.

“That’s horrifying. If people were picking on kids with cancer or epilepsy, the outcry would be colossal. It would be a national emergency.”

MacMaster will be using a state-of-the-art MRI scanner in his research to observe brain structure, chemistry and function in children and youth. In the past, scientists could only see inside the brain during surgery or, worse, after death.

His mission is to look at the biological underpinnings of mental health problems when they start in kids and teens, to try to understand what’s going wrong and to develop better ways of treating them.

His big research project is looking into using transcranial magnetic stimulation, or TMS, for kids and youth with depression — a first. He’s investigating if there’s a way to use TMS to stimulate or “coach” the brain’s prefrontal cortex, the area responsible for executive function, to take charge more so than it typically does in depression.

About two per cent of children have depression, but that figure rises to 10 per cent in adolescents. It’s thought puberty, with its hormonal and physiological and cognitive changes, is the trigger.

TMS is being used as a treatment in adults in the U.S and has been to work best in young adults “where the prefrontal cortex is still more plastic and can change,” he says. “But nobody’s really done it on kids.”

For years, psychiatric medications were developed for adults and then used in children and teens, without a lot of evidence about their effects on the developing brain, he says. Given that only 30 to 45 per cent of teens respond to drugs and it takes up 20 years to bring new ones to market, “we need new ideas for treatment, and fast.”

His other project, still in its infancy, is looking into using aerobic exercise as an intervention for depression in teens.

“There’s a lot of great data out there that exercise is a great way for reducing depression symptoms. From a neurobiology point of view, effective aerobic exercise actually helps encourage growth of the hippocampus — a part of the brain that in depression really takes a beating from the disorder,” he explains.

The side-effect of exercise, he says, is general good health.

“The message I’m trying to give people is that your brain is just another body part. If you broke your leg, you’re going to have trouble with your hockey or golf game. If you have a problem with your brain, you’re going to have problems with behavior. It really is that simple,” says MacMaster.

“The brain’s not immune to trouble. It can have problems, just like a kidney or a liver. People need to move beyond that outdated assumption, that it is character or weakness.”

By Judy Siegel-Itzkovich

Ritualistic behavior develops as a way to induce calm and manage stress; Depression can lead to increased risk of stroke.

Humans are not the only ones to show repetitive behavior – animals do too. Provided it isn’t exaggerated (as manifested by obsessive-compulsive disorder, or OCD), it can minimize stress, according to a researcher at Tel Aviv University.

Prof. David Eilam and his graduate student Hila Keren of TAUs zoology department at the George S. Wise Faculty of Life Sciences found that both humans and animals normally exhibit repetitive behavior in general – and especially ritualistic-like behavior. They concluded that ritualistic behavior in both humans and animals developed as a way to induce calm and manage stress caused by unpredictability and uncontrollability, heightening our belief that we are in control of a situation that is otherwise out of our hands. Carried out in collaboration with Prof. Pascal Boyer of Washington University and Dr. Joel Mort of the US Air Force Research Laboratory, the research was recently published in Neuroscience and Biobehavioral Reviews.

Eilam explains that almost every human and animal activity can be divided into three parts – preparatory, functional and confirmatory. The functional aspect is defined by the specific actions that must occur in order to complete a task. But the preparatory and confirmatory actions, dubbed “head” and “tail” actions by the researchers, are not strictly required to get the job done. We complete them both before and after the central task, but they are not necessarily related to it. Individuals complete different head and tail activities for every task.

During their study, Eilam and his colleagues watched and analyzed videotapes of people completing common tasks such as putting on a shirt, locking a car, or making coffee, as well as basketball players completing a free-throw. In the case of basketball players, explains Eilam, all they actually need to do to complete their action is throw the ball. So why, he asked, is there ritualistic behavior preceding the throw such as bouncing the ball exactly six times? “The routine they perform in the moments before shooting the ball is a method to focus their full concentration and control their actions,” he says. “It’s also an essential part of sports psychology. If players feel that completing their repetitive actions will enhance their performance, they tend to be more successful. This could include anything from locker room antics to LeBron James’s infamous pre-game chalk toss.”

Even in the context of daily activities, head and tail activities can be differentiated quite easily from the functional action in between – but they are exaggerated in OCD sufferers, who might, for example, check and recheck whether the stove has been turned off. These idiosyncrasies are like fingerprints, says Eilam, unique to each individual.

While everyone exhibits repetitive behavior, not everyone’s behavior is obsessive, the researchers say. OCD patients present a pathological tendency towards repetitive behavior or thought patterns. OCD patients were observed to engage in more tail activity than basketball players, who displayed more “head” activity, says Eilam. Those with OCD suffer more than the basketball players from a feeling of incompleteness – they are unsure whether or not their task has been completed, and compulsive behavior is driven by a need to verify the action. Unlike a free-throw, where there is a distinct cue – throwing the ball – which that signals the end of the action, a common compulsive behavior such as washing one’s hands might not have as clear an ending. There is no external reference to indicate “absolutely clean.”

Because those who suffer from OCD can set themselves complicated routines, they often cannot trust that they have fully completed an action, thereby extending the confirmatory tail phase of an action. This is the key difference between normal and pathological rituals, Eilam concludes.

DEPRESSION LINKED WITH MORE STROKES AND DEATH

Depression can lead not only to self harm and suicide, but also to increased risk of suffering a disabling or fatal stroke, according to a meta-analysis of 30 studies encompassing some 300,000 patients.

“Stroke is a leading cause of death and permanent disability, with significant economic losses due to functional impairments,” says Dr. An Pan of the Harvard School of Public Health in Boston. “Depression is highly prevalent in the general population, and it is estimated that 5.8 percent of men and 9.5% of women will experience a depressive episode in a 12-month period.

The lifetime incidence of depression has been estimated at more than 16% in the general population. Whether depression increases the risk of stroke has been unclear.”

Dr. Pan led a systematic review and metaanalysis of prospective cohort studies to describe the association between depression and risk of total and subtypes of stroke.

The researchers found that when the data from the studies were pooled, analysis indicated that depression was associated with a 45% increased risk for total stroke; a 55% increased risk for fatal stroke; and a 25% higher risk for ischemic stroke (caused by a blood clot in the brain); but was not associated with an increased risk of stroke due to brain hemorrhage.

The researchers speculate that depression may contribute to stroke through a variety of mechanisms, including known nervous system and endocrine system and immunological/ inflammation effects; poor health behaviors such as smoking, physical inactivity, poor diet, not taking prescribed medicines and obesity; having other major disorders such as diabetes and hypertension and antidepressant medication use.

“In conclusion, this meta-analysis provides strong evidence that depression is a significant risk factor for stroke. Given the high prevalence and incidence of depression and stroke in the general population, the observed association between depression and stroke has clinical and public health importance. More studies are needed to explore the underlying mechanisms and elucidate the causal pathways that link depression and stroke,” the researchers said.

News Source: TheJerusalemPost (link)