The Hunt for “Perfect” Jolly Green (Cannabis)

Mapping Intimacies ◽

10.1093/med-psych/9780190052775.003.0010 ◽

2021 ◽

pp. 155-172

Author(s):

Charlene Minaya ◽

Dean McKay

Keyword(s):

Substance Use ◽

Treatment Adherence ◽

Substance Use Disorders ◽

Gold Standard ◽

Response Prevention ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Lower Treatment ◽

Treatment Considerations ◽

Key Features

Obsessive-compulsive disorder (OCD) and substance use disorders (SUDs) are clinically distinct disorders that share key features such as impulsivity, obsessive thoughts, compulsive behavior, and impaired attentional distraction. OCD sufferers may turn to substance use as a maladaptive coping strategy to reduce OCD-related distress, although research also suggests that varying substances may have differential effects on OCD symptoms (i.e., mitigating or even aggravating these symptoms). As individuals with comorbid OCD and SUDs demonstrate higher rates of suicidality and distress and lower treatment adherence compared to individuals with OCD alone, treatment considerations for this population are critical. Exposure and response prevention, the gold standard of OCD treatment, intentionally provokes OCD-related distress, which could inadvertently lead to an increased desire to use substances. While substance use and stress management may serve as beneficial precursors to exposure, further research is warranted on the interactions between OCD and SUDs and strategies to manage substance use in the context of OCD treatment.

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Repeating, counting, and touching to prevent harm

Child and Adolescent Psychiatry ◽

10.1093/med/9780197577479.003.0017 ◽

2021 ◽

pp. 137-142

Author(s):

Ivana Viani

Keyword(s):

Gold Standard ◽

Selective Serotonin Reuptake Inhibitors ◽

Serotonin Reuptake Inhibitors ◽

Repetitive Behaviors ◽

Response Prevention ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Impairment In Functioning ◽

Clinically Significant ◽

Mental Acts

Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning. Obsessions are recurrent and persistent intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress. Examples of obsessions include worrying about germs, the feeling things need to be “just right,” worrying about bad things happening, and disturbing thoughts or images about hurting others. Compulsions are repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. Examples of compulsions include washing, checking, tapping, ordering, and repeating. Young children may not be able to articulate the aims of these repetitive behaviors or mental acts. Selective serotonin reuptake inhibitors (SSRIs) are the first-line class of medications used to treat OCD in children and adolescents. Exposure and response prevention (ERP) therapy is the gold standard psychotherapy treatment for OCD.

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Fear Over Facts: When Fellow Clinicians Become a Barrier to Dissemination of Exposure and Response Prevention for Obsessive-Compulsive Disorder—A Clinical Response to Licensing Board Investigation of Exposure and Response Prevention

Journal of Cognitive Psychotherapy ◽

10.1891/jcpsy-d-20-00005 ◽

2020 ◽

Vol 34 (3) ◽

pp. 179-184

Author(s):

Laura M. Lokers

Keyword(s):

Effective Treatment ◽

Obsessive Compulsive Disorder ◽

Gold Standard ◽

Standard Treatment ◽

Response Prevention ◽

Accurate Assessment ◽

Exposure And Response Prevention ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Level Student

In 2018, a graduate level student filed a complaint regarding the use of exposure-based therapy for persons with obsessive-compulsive disorder (OCD) experiencing violent obsessions. In the investigation, the licensing board expressed concern about safety of us of exposure and response prevention (ERP) with children and in public venues. The licensing board also struggled with accurate assessment of a clinician's efficacy in following the gold-standard treatment for OCD. Despite extensive research demonstrating ERP is a safe, effective treatment for OCD, stigma against exposure based treatments remain strong, even among clinicians. This commentary article discusses the specific licensing investigation and implications for change throughout the field of psychotherapy.

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Comorbidity and Personality in Body Dysmorphic Disorder

10.1093/med/9780190254131.003.0011 ◽

2017 ◽

Author(s):

Ashley S. Hart ◽

Martha A. Niemiec

Keyword(s):

Substance Use ◽

Social Anxiety ◽

Substance Use Disorders ◽

Body Dysmorphic Disorder ◽

Rejection Sensitivity ◽

Self Esteem ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Axis I ◽

The Relationship

Comorbidity is common in body dysmorphic disorder (BDD). Major depressive disorder, social anxiety disorder (social phobia), obsessive-compulsive disorder, and substance use disorders are the most frequently co-occurring Axis I conditions. Except for eating disorders (more common in women) and substance use disorders (more common in men), Axis I comorbidity rates in BDD appear similar across genders. Axis I comorbidity is associated with greater functional impairment and morbidity. Rates of comorbid personality disorders in BDD are high. Disorders from cluster C occur most frequently, with avoidant personality disorder the most common. Associated traits include low self-esteem and high levels of neuroticism, introversion, unassertiveness, social anxiety and inhibition, rejection sensitivity, and perfectionism. Research is needed on the relationship between BDD and psychiatric comorbidity, the causes and consequences of comorbidity in BDD, and the relationship between BDD and associated personality traits.

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Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

Brain Sciences ◽

10.3390/brainsci11070856 ◽

2021 ◽

Vol 11 (7) ◽

pp. 856

Author(s):

Giovanni Martinotti ◽

Stefania Chiappini ◽

Mauro Pettorruso ◽

Alessio Mosca ◽

Andrea Miuli ◽

...

Keyword(s):

Eating Disorders ◽

Substance Use ◽

Obsessive Compulsive Disorder ◽

Substance Use Disorders ◽

Patient Characteristics ◽

Cochrane Library ◽

Post Traumatic Stress ◽

Obsessive Compulsive ◽

Compulsive Disorder

The obsessive–compulsive spectrum refers to disorders drawn from several diagnostic categories that share core features related to obsessive–compulsive disorder (OCD), such as obsessive thoughts, compulsive behaviors and anxiety. Disorders that include these features can be grouped according to the focus of the symptoms, e.g., bodily preoccupation (i.e., eating disorders, ED) or impulse control (i.e., substance use disorders, SUD), and they exhibit intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics and clinical outcomes. The non-competitive N-methyl-D-aspartate receptor (NMDAr) antagonist ketamine has been indicated to produce remarkable results in patients with treatment-resistant depression, post-traumatic stress disorder and OCD in dozens of small studies accrued over the past decade, and it appears to be promising in the treatment of SUD and ED. However, despite many small studies, solid evidence for the benefits of its use in the treatment of OCD spectrum and addiction is still lacking. Thus, the aim of this perspective article is to examine the potential for ketamine and esketamine in treating OCD, ED and SUD, which all involve recurring and intrusive thoughts and generate associated compulsive behavior. A comprehensive and updated overview of the literature regarding the pharmacological mechanisms of action of both ketamine and esketamine, as well as their therapeutic advantages over current treatments, are provided in this paper. An electronic search was performed, including all papers published up to April 2021, using the following keywords (“ketamine” or “esketamine”) AND (“obsessive” OR “compulsive” OR “OCD” OR “SUD” OR “substance use disorder” OR “addiction” OR “craving” OR “eating” OR “anorexia”) NOT review NOT animal NOT “in vitro”, on the PubMed, Cochrane Library and Web of Science online databases. The review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The use and efficacy of ketamine in SUD, ED and OCD is supported by glutamatergic neurotransmission dysregulation, which plays an important role in these conditions. Ketamine’s use is increasing, and preliminary data are optimistic. Further studies are needed in order to better clarify the many unknowns related to the use of both ketamine and esketamine in SUD, ED and OCD, and to understand their long-term effectiveness.

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Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.667167 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kristian Tjelle ◽

Håvard Berg Opstad ◽

Stian Solem ◽

Gunvor Launes ◽

Bjarne Hansen ◽

...

Keyword(s):

Treatment Outcome ◽

Obsessive Compulsive Disorder ◽

Treatment Adherence ◽

Well Being ◽

Response Prevention ◽

Exposure And Response Prevention ◽

Obsessive Compulsive ◽

Exposure Treatment ◽

Compulsive Disorder

Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD.Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up.Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1–7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up.Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD.

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Co-Occurrence of Obsessive-Compulsive Disorder and Substance Use Disorders Among U.S. Veterans: Prevalence and Mental Health Utilization

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.33.1.23 ◽

2019 ◽

Vol 33 (1) ◽

pp. 23-32 ◽

Cited By ~ 1

Author(s):

Anthony H. Ecker ◽

Melinda A. Stanley ◽

Tracey L. Smith ◽

Ellen J. Teng ◽

Terri L. Fletcher ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Obsessive Compulsive Disorder ◽

Substance Use Disorders ◽

Mental Healthcare ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Obsessive Compulsive ◽

Compulsive Disorder

Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization. Using VHA administrative data, we identified veterans with an OCD diagnosis from 2010 to 2016 (N = 38,157); 36.70% also had a SUD diagnosis. Specific SUD rates are alcohol-use disorder, 17.17%; cannabis-use disorder, 5.53%; opioid-use disorder, 3.60%; amphetamine-use disorder, 1.49%; cocaine-use disorder, 3.37%; and tobacco-use disorder, 26.50%. Veterans with co-occurring OCD and SUD used more mental health services throughout the data capture period. Findings suggest that OCD and SUD co-occur at high rates within the VHA, and that this is associated with more burden to the healthcare system. Targeted screening and treatment efforts may help address the needs of this population.

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