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Medical Edge Newspaper Column from Mayo Clinic

CONFRONTING FEARS KEY TO TREATING OBSESSIVE-COMPULSIVE DISORDER

DEAR MAYO CLINIC: I have been diagnosed with obsessive-compulsive disorder and it’s beginning to consume my life. What are the best treatments for this problem? — Atlanta

ANSWER: Obsessive-compulsive disorder, once believed to be a rare condition, is now known to affect about one in 40 adults, making it more common than other severe mental illnesses such as schizophrenia.

OCD is characterized by obsessions and compulsions. Obsessions are involuntary, recurrent, unwanted thoughts or impulses that appear senseless yet evoke anxiety. Common OCD obsessions include fear of contamination; unwanted violent, sexual or sacrilegious thoughts; and fear of certain words or numbers. Compulsions are intentional physical or mental behaviors performed purposely to reduce anxiety. Common compulsive rituals include washing, checking, arranging, and replacing unacceptable thoughts with “good” thoughts. As you note, OCD can be a consuming illness.

Although there is no cure for OCD, medication and psychological treatments have both proven effective. While very different, each treatment has strengths and limitations.

Medications used for OCD are called serotonin reuptake inhibitors. These drugs enhance the brain’s ability to use serotonin, a chemical believed to play a crucial role in mood and anxiety states. Tricyclic antidepressants (such as clomipramine) are also used for OCD. Medications can be very effective in reducing symptoms. They are widely available and very convenient. However, they usually do not completely eliminate symptoms, are often accompanied by side effects, and must be take continually to maintain their effectiveness.

Cognitive-behavioral therapy is the only psychological treatment proven effective for OCD. CBT attempts to reduce OCD symptoms by weakening the patient’s pattern of feeling extreme anxiety in certain situations, then using compulsive behavior to reduce the anxiety.

A psychologist helps the patient gradually confront feared situations and thoughts (exposure) while practicing resistance to their compulsive rituals (response prevention). A majority of patients treated with CBT experience reduced symptoms. CBT is highly effective, time limited (most programs require about 20 therapy sessions), and most patients maintain their improvement even after treatment has ended. CBT does require a lot of effort — patients must confront their obsessive fears, and it may be difficult to find a treatment provider who is adequately trained to do CBT.

In many cases, medication therapy may be a good initial treatment, and we advocate including CBT as a long-term solution. You should work closely with your medical team — which should include a psychiatrist and a psychologist — to determine the best course of treatment for you.

— Katherine M. Moore, M.D., and Jonathan S. Abramowitz, Ph.D.,
Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Obsessive-Compulsive Disorder
Appointment Information
More Information on Obessive-Compulsive Disorder

READERS: Hospital emergency departments just don’t operate like the ones on television. Most emergency departments feature far less drama and far more waiting for those who arrive without life-threatening emergencies.

Emergency departments are designed to treat people who are critically ill or injured. For those with less urgent health problems, it’s usually better to seek treatment from a primary care doctor or a walk-in clinic. For most people without a life-threatening emergency, the average time in the ED is three hours. Even longer stays aren’t unusual.

Still, EDs remain the best place to go for a serious and immediate health concern. Mayo Clinic Women’s HealthSource lists some of the symptoms that indicate you need emergency care:

— A sudden or unexplained loss of consciousness
— Chest pain; numbness in the face, arm or leg; difficulty speaking
— Severe shortness of breath
— High fever accompanied by a stiff neck, mental confusion or difficulty breathing
— Coughing up or vomiting blood
— A cut or wound that won’t stop bleeding
— Possible broken bone

Whether you are in the waiting area, being questioned by the nurses or being examined by the doctor, speak up if you are experiencing these serious symptoms.

Most EDs see people according to a triage system — a process that involves sorting people according to their need for care. To get the best care, be proactive in providing information about your symptoms, medications, drug allergies and other pertinent health information.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.