Saturday, December 29, 2012

ADVANCED TREATMENT IN OCD...



Dealing with resistant OCD. Other modalities
1        1. St. John's Wort and OCD
Alternative medicine such as herbal remedies have been growing in popularity in both Europe and North America. Many people with anxiety disorders such as OCD have tried alternative therapies at one time or another. One of the most popular herbal remedies for anxiety is St. John's Wort. Because antidepressant medications that target the serotonin system, such as Paroxetine and Clomipramine, are effective in treating OCD, it has been suggested that St. John's Wort -- which is said to also have antidepressant qualities -- could be an alternative therapy for reducing OCD symptoms.
2.   Repetitive Transcranial Magnetic Stimulation
r-TMS has got maximum popularity in both Europe and North America as its is safest treatment modality. rTMS, is a relatively non-invasive procedure that has received considerable attention as a possible alternative treatment to reduce OCD symptoms. Repetitive TMS is a relatively non-invasive procedure that involves placing a small device directly on the skull. This sealed device contains a coil of wire that carries electricity. The flow of electricity through the device causes cells in the brain called neurons to become either more or less active. The activity level of neurons has been linked to symptoms of mental illness like OCD. Recent research has shown very good results of this treatment in Depression and OCD. Also is approved by US-FDA.
3.   D-cycloserine and Behavior Therapy
Psychotherapeutic techniques such as exposure and response prevention therapy are highly effective in treating symptoms of OCD. However, these treatments do not always work for everyone, and the challenging nature of behavior therapy and the associated cost cause many people to decline or drop out of treatment. Given this, there has been a lot of interest in identifying ways that behavior therapy can be made both more effective and accessible for more people. One possibility may be to supplement behavior therapy with medication. A medication that has generated a lot of interest with respect to this is the drug D-cycloserine.
4.   Exercise and OCD
Most of us are familiar with the many physical benefits of aerobic exercise, including reduced cholesterol levels and lowered risk of heart disease and diabetes. However, there is growing evidence that physical activity may also help to reduce symptoms of mental illness. Indeed, it is now known that aerobic exercise can be used therapeutically to improve mild to moderate symptoms of depression, as well as reduce overall stress and anxiety levels. Recently, preliminary studies have also examined whether aerobic exercise is helpful in reducing the severity of OCD symptoms. Also Yoga and Pranayam helps in reducing anxiety symptoms.
5.   Deep Brain Stimulation for OCD
Although a number of medications and psychological therapies are available to treat OCD, it has been estimated that between 25 and 40% of people will not respond adequately to these first-line strategies. In the past 20 years, the development of sophisticated brain imaging technologies, such as functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment. Deep brain stimulation may offer such a treatment.
Although there are many effective treatments for OCD, some people have what is called treatment resistant OCD. Up to a third of people with OCD have treatment resistant OCD and do not respond to standard treatment protocols. Here are some options to consider when coping with treatment resistant OCD.
1. Explore Reasons Why Your Medication May Not Be Working
Although there are many FDA approved medications available for the treatment of OCD, medications do not seem to work for one-third of people’s OCD symptoms. There are many reasons why this can happen and there are things you can do about it.
2. Consider Augmentation Treatment Strategies
Augmentation therapy treats OCD symptoms with medication. This strategy improves the odds of relieving symptoms by using combinations of drugs, rather than a single drug. Augmentation antidepressant treatment may be helpful for people who do not achieve remission with mono-therapy.
3. Explore Reasons Why Psychotherapy May Not Be Working
Although psychological treatments have come to the forefront in the treatment of OCD, they are not always effective. There are many reasons why psychotherapy for OCD may not be working for you and there are things can do about it.
4. Investigate Intensive Treatment Programs
While there are many effective medical and psychological treatments available for OCD, not all treatments work for everybody. Unfortunately, for some people nothing seems to be effective. To combat this, a number of intensive residential OCD treatment programs have been developed.
5. Consider Taking Part in a Clinical Trial
There are a number of reasons why people with OCD consider taking part in a clinical research trial. For starters, clinical trials often offer cutting edge treatments that are not yet widely available to the public.
6. Explore r-TMS, Psychosurgery and Deep Brain Stimulation for Treatment-Resistant OCD
Although a number of medications and psychological therapies are available for OCD, it has been estimated that between 25 and 40% of people will not respond to treatment. A very small minority of individuals with OCD have symptoms severe enough to consider brain surgery. Surgical procedures for OCD involve inactivating certain brain regions that are responsible for the symptoms associated with OCD. In most cases, approximately 50% to 70% of people who have these procedures see a significant improvement in symptoms. One of these neurosurgical procedures is deep brain stimulation, which appears promising although it is still in the experimental stage and often considered a last resort.
In the last 20 years, the development of sophisticated brain imaging technologies such a functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment.
Repetitive Transcranial Magnetic Stimulation & Deep brain stimulation may offer such a treatment.
Deep Brain Stimulation - A Primer
Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. rTMS is non-invasive way of modulation. The way in which deep brain stimulation works is still unknown, but it has been suggested that it restores normal activity to areas of the brain that have become dysregulated.
Deep brain stimulation and rTMS has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease, and there is a growing body of evidence that it may be helpful for the treatment of OCD.
Deep brain stimulation and rTMS has a number of advantages over traditional brain surgery for OCD.
·         Deep brain stimulation can be used to treat symptoms with little risk of permanent changes in the brain.
·         The level of stimulation can be adjusted up or down, and the stimulation can be used continuously or intermittently depending on the treatment plan. This allows for greater precision and tailoring of treatment.
·         The surgery is minimally invasive, meaning there is a reduced potential for side effects. It is important to keep in mind, however, that -- like any surgery -- there is risk of complications or side effects, such as bleeding, infection or unanticipated changes in symptoms or personality. For this reason, deep brain stimulation is usually reserved for those people who have not responded to other forms of treatment.
Deep Brain Stimulation and OCD
Deep brain stimulation for the treatment of OCD has been evaluated in a handful of studies. However, because different techniques have been used and diverse brain areas targeted, it has been difficult to compare the results. These preliminary trials hold promise, but it's important to note that this is still an unapproved and experimental treatment for OCD.
Among the most exciting of these studies is an investigation that appeared in the New England Journal of Medicine. Over 10 months, half of the 18 treatment-resistant patients enrolled in the study first received a period of active stimulation of an area of the brain called the subthalamic nucleus, followed by a period of placebo stimulation. The other half of the patients received the placebo stimulation, and then the real stimulation.
Following active stimulation, the majority of patients showed a reduction in OCD symptoms as well as an improvement in their overall ability to return to normal family life, engage in new relationships or go back to work. Only a very small number of patients achieved this while receiving the placebo stimulation.
Although this treatment did not work for everyone, the results of this study are a very positive development in the treatment of OCD. Future studies will have to further examine which brain areas to target as well as determine the pattern of stimulation that works best.

6 comments:

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