Prime Time Replay:
Dr. Eric Hollander
on Obsessive-Compulsive Disorders
MsgId: *brainstorms(20)
Date: Fri Mar 21 22:08:04 PST 1997
From: OMNI_Staff At: 168.100.204.58
Dr. Hollander, while we're waiting for our host, OMNI Senior Editor and Producer Rob Killheffer to arrive, I'd like to ask you a bit about the new findings in the field, especially the new neurological understanding.
MsgId: *brainstorms(24)
Date: Fri Mar 21 22:11:48 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
over the last few years, our understanding of the neurological basis of OCD has improved. we now think of hyperactivity of orbitofrontal-caudate-thalamic circuits, and exquisite sensitivity of serotonin systems in the brain.
MsgId: *brainstorms(26)
Date: Fri Mar 21 22:13:14 PST 1997
From: OMNI_Staff At: 168.100.204.58
I think we need to simplify this a bit for our viewers --but while you're at it, you might explain the spectrum of disorders that can result from imbalances in the serotonin system.
MsgId: *brainstorms(29)
Date: Fri Mar 21 22:16:10 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
there are a group of disorders that share certain features with OCD -- these fall into 3 clusters. the disorders with body image/sensations, neruological disorders with repetitive behaviors, and impulsive style disorders.
MsgId: *brainstorms(27)
Date: Fri Mar 21 22:13:19 PST 1997
From: Rob_Killheffer At: 205.198.116.220
Hi, I'm here. Sorry I'm late -- had some trouble getting on.
MsgId: *brainstorms(28)
Date: Fri Mar 21 22:14:19 PST 1997
From: OMNI_Staff At: 168.100.204.58
Hi Rob, we've been asking Dr. Hollander a few initial questions while waiting for you to arrive --but the floor is yours now!
MsgId: *brainstorms(30)
Date: Fri Mar 21 22:16:51 PST 1997
From: Rob_Killheffer At: 205.198.116.220
Hello there, Dr. Hollander. Sorry I'm late. Let's pick up where you were -- with a little summary of the types of disorder that fall under the heading of "obsessive/compulsive disorder". Remember, we're playing to a lay audience here, so try to describe things in less-than-technical terminology. What sorts of behavior do OCD suffers typically display?
MsgId: *brainstorms(33)
Date: Fri Mar 21 22:20:30 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
oc disorders are characterized by repetitive intrusive disurbing thoughts, which cause anxiety or discomfort, and compulsive repetitive behaviors designed to reduce anxiety or magically make things work out in the future.
MsgId: *brainstorms(34)
Date: Fri Mar 21 22:21:30 PST 1997
From: Rob_Killheffer At: 205.198.116.220
How has our understanding of OCD changed over the last few decades? Was it even a recognized syndrome earlier in this century?
MsgId: *brainstorms(35)
Date: Fri Mar 21 22:24:08 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
descriptions of OC behavior stem from lady macbeth, but the diagnosis has been refined more recently
MsgId: *brainstorms(32)
Date: Fri Mar 21 22:17:49 PST 1997
From: guest At: 168.100.204.58
Dr. Hollander, I'm wondering how tourette's or tic disorder relates to obsessive-compulsive disorder. Are they two sides of the same problem, one a physical repetition (Tourettes) and the other mental (OCD)?
MsgId: *brainstorms(38)
Date: Fri Mar 21 22:25:58 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
tourette's syndrome is closely related genetically to childhood onset OCD, which occurs mostly in boys, and is characterized by motoric compulsions
MsgId: *brainstorms(36)
Date: Fri Mar 21 22:25:36 PST 1997
From: Rob_Killheffer At: 205.198.116.220
From your forthcoming book I got the impression that, not too long ago, OCDs were considered pretty intractable -- resistant to treatment. But now there are effective ways of dealing with them, yes?
MsgId: *brainstorms(40)
Date: Fri Mar 21 22:28:30 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
that's right, previously considered refractory to psychological therapy and many medications, it is now known that OCD responds selectively to SSRI's such as luvox, and behavior therapy which includes exposure and response prevention
MsgId: *brainstorms(41)
Date: Fri Mar 21 22:29:55 PST 1997
From: Rob_Killheffer At: 205.198.116.220
SSRIs -- selective serotonin reuptake inhibitors -- are commonly used also to treat depression and anxiety disorders as well, yes? What's the relationship between depression, anxiety, and OCD?
MsgId: *brainstorms(37)
Date: Fri Mar 21 22:25:42 PST 1997
From: guest At: 206.170.170.130
Dr. H.: My son has had several different tics (mouth/toungue clicking), jerking his head to one side, & right now a sholder jerking) over several years. Are these anything to worry about? I have asked his doctor, who doesn't seem concerned.
MsgId: *brainstorms(39)
Date: Fri Mar 21 22:27:27 PST 1997
From: guest At: 168.100.204.58
Dr. Hollander, is attention deficit disorder related genetically to tourettes and OCD as well?
MsgId: *brainstorms(42)
Date: Fri Mar 21 22:30:18 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
some patients present with a triad -- OCD, tics, and attention deficit disorder (ADD)patients with OCD often have secondary or comorbid depression or anxiety disorders. while SSRI's help depression and some anxiety disorders, these also respond to other medications, such as tricyclic antidepressants. OCD responds only to SSRI's for the most part, not other antidepressant meds. if comorbid tics are mild, they dont need treatment. if more severe, adding small doses of dopamine blocking meds (ie risperdal) to SSRI's may be helpful
MsgId: *brainstorms(44)
Date: Fri Mar 21 22:37:09 PST 1997
From: Rob_Killheffer At: 205.198.116.220
What is currently thought to be the cause of OCDs? Is it primarily a physical problem, a disruption at the neural level, or is it more commonly brought on by psychological events? I recall seeing in your forthcoming book a mention that it sometimes comes on after an infection, or after pregnancy?
MsgId: *brainstorms(46)
Date: Fri Mar 21 22:42:49 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
most patients with ocds have a genetic predisposition to develop the disorder. however, sometimes environmental stressors, such a pregnacy (with a rise in oxytocin levels) or strep infection (in patients with a marker D8/17 also present in rhuematic fever or sydenhams chorea) may serve as an enviornmental second hit
MsgId: *brainstorms(47)
Date: Fri Mar 21 22:44:36 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
most patients with ocds have a genetic predisposition to develop the disorder. however, sometimes environmental stressors, such a pregnacy (with a rise in oxytocin levels) or strep infection (in patients with a marker D8/17 also present in rhuematic fever or sydenhams chorea) may serve as an enviornmental second hit. psychological factors -- such as anger, lack of sleep, loss of a parent early in life -- may overwhelm a lowered threshold in genetically vulnerable people
MsgId: *brainstorms(48)
Date: Fri Mar 21 22:45:41 PST 1997
From: Rob_Killheffer At: 205.198.116.220
It's not only humans that develop OCDs, is it? I recall from your book a chapter on OCDs in animals, and in fact my cat has something that seems like a kind of OCD -- he'll lick at himself so intently that he'll wear away his fur and open shallow wounds. It's been getting better, but it had me pretty worried for a while.
MsgId: *brainstorms(51)
Date: Fri Mar 21 22:49:50 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
that's true - other species, such as dogs, cats and parrots may have repetitive behaviors, such as licking their paws repetitively, (acral lick syndrome) or plucking their feathers. these repetitive behaviors actually respond in animals to ssri's such as prozac or anafranil
MsgId: *brainstorms(49)
Date: Fri Mar 21 22:46:12 PST 1997
From: pam At: 168.100.204.58
Dr. Hollander, just a quick question --sorry to interrupt your flow, Rob-- but how can we best treat someone with attention deficit hyperactivity disorder, tic disorder, and OCD ALL in one package --because don't some meds make one disorder worse while treating the other, even though all these disorders are along the same genetic spectrum?
MsgId: *brainstorms(53)
Date: Fri Mar 21 22:51:42 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
if a patient has ocd, ts and add, they may require an ssri, stimulant and dopamine blocker.
MsgId: *brainstorms(54)
Date: Fri Mar 21 22:54:58 PST 1997
From: Rob_Killheffer At: 205.198.116.220
What do you think is the most effective treatment for OCDs? Is it pharmaceutical -- with SSRIs -- or behavioral, through psychotherapy -- or a combination of both?
MsgId: *brainstorms(55)
Date: Fri Mar 21 22:57:29 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
while some patients respond to ssri's or behavior therapy alone, many patients do best on a combination of ssri's plus behavior therapy. if a patient is refractory, a combination of medications may be helpful. in very rare cases, selective neurosurgical procedures may be helpful as a last resort.
MsgId: *brainstorms(56)
Date: Fri Mar 21 23:00:03 PST 1997
From: Rob_Killheffer At: 205.198.116.220
Dr. Hollander, our time is running short, so let me ask you to speculate a little in my final question. What are the next steps in OCD research -- that is, what are the issues that are at the forefront of researchers' minds on the subject, and how will they change our understanding and treatment of these disorders? Do you foresee the development of much more effective treatments -- in drugs and behavioral therapies alike?
MsgId: *brainstorms(57)
Date: Fri Mar 21 23:01:10 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
at mt. sinai med. ctr. in nyc, we are conducting treatment studies in OCD, body dysmorphic disorder (imagined ugliness), pathological gambling, autism, and panic disorder. we need to better understand what drives repetitive behaviors accross these various disorders - ocd, autism, gambling etc. this will lead to better treatments. our journal cns spectrums address common mechanims accross various neuropsychiatric disorders
MsgId: *brainstorms(59)
Date: Fri Mar 21 23:03:16 PST 1997
From: Rob_Killheffer At: 205.198.116.220
And do you see new treatments emerging from those studies?
MsgId: *brainstorms(61)
Date: Fri Mar 21 23:07:19 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
yes - new treatments will arise from understanding brain mechanisms - ie oxytocin, immune modulation, etc that modify the common underlying brain mechanisms shared accross these disorders.
MsgId: *brainstorms(63)
Date: Fri Mar 21 23:08:31 PST 1997
From: Rob_Killheffer At: 205.198.116.220
Welll, I think we're out of time for tonight. Members of the audience, if you're interested in learning more about OCDs and their treatment, you might want to take a look at the journal Dr. Hollander edits, CNS Spectrums, and the book he co-edited (forthcoming from Marcel Dekker) entitled Obsessive-Compulsive Disorders. That's all for tonight -- thank you, Dr. Hollander, for appearing here on our show. My apologies once again for being late. Viewers, please join us next week for another edition of Brainstorms. Goodnight!
MsgId: *brainstorms(64)
Date: Fri Mar 21 23:11:50 PST 1997
From: Dr._Eric_Hollander At: 206.133.37.21
thank you, and goodnight
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