Ben Assan Senior Clinician and family Therapist Austin CAMHS, Melbourne.

Transcription

1 Ben Assan Senior Clinician and family Therapist Austin CAMHS, Melbourne.

2 Introduction OCD in adolescents Current treatment models Review of cases Rethink of current treatment models Current treatment plus Role of admission Addressing family emotions

3 The key diagnostic feature of obsessive compulsive disorder (OCD) is the presence of persistent, intrusive, and distressing obsessions or compulsions, with marked impairments in quality of life. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR; American PsychiatricAssociation,2000)

4 Obsessive Compulsive Disorder(OCD)is common, afflicting 1 3% of children (Douglass, Moffitt, et al.1995).

5 Jack The case of the school bag. Jim Long showers with a cake of soap Jay Outdoor father and cooking direction Jan Special, secluded space in family home Jill Instructing sib and young visitors to wash hands

6 LOSS OF A CHILD LOSS OF THE A RELATIONSHIP WITH THE CHILD LOSS OF FATHER/SON RELATIONSHIP (no fishing trip, no bike ridding) FAMILY IMMOBILISED BY OCD ( it affects the whole family

7 ACCOMMODATION (Gordon et al, 2013) GIVING AUTHORITY TO CHILD WHO OWNS THE HOME? (Lebowitz et al 2011) BEHAVING AS IF THEY HAVE OCD

8 Children s Yale Brown Obsessive Compulsive Scale ( CY- BOCS) Family Accommodation Scale for OCD

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12 Family accommodation(fa)in obsessivecompulsive disorder (OCD)refers to family members or significant others participation in or facilitation of patients rituals and/or avoidance (Norman et al, 2015) Nearly 90% of persons with OCD live with family members who accommodate their symptoms in some significant way(pinto et al, 2012)

13 WORRIES THAT THINGS MAY GET WORSE HE WILL BECOME VIOLENT (Krebs et al, 2013) TO CARE FOR HIM MAKE SURE HE HAS A GOOD MEAL every day I WANT TO KEEP THE PEACE

14 WORRIED THAT MY ACTONS WILL MAKE THINGS WORSE WORRIED ABOUT NOT CONTROLLING MY ANGER I KNOW HE IS TRYING BUT IT IS ALL BULLSHIT

15 ocd adolescent family accom Parents/couple

16 AACAP (2012) Recommendation 6. For moderate to severe OCD, medication is indicated in addition to CBT, six to eight sessions of E/RP Exposure Response Prevention (Lebowitz et al, 2011) plus Parent coaching prevent accommodation (Lebowitz, 2011)

17 FAMILY EMOTIONS

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21 FAMILY EMOTIONS Fear Anger Sadness Shame Guilt

22 Medication CBT Parent Coaching Attention to Family emotions Admission To break accommodation pattern Role modeling by NS Medication CBT Parent Coaching success challenge

23 1. acknowledge the challenges in PA 2. list PA and link the emotions attached 3. priorities areas for attention 4. select a PA that parents are ready to address 4. link addressing PA to intent and desire to assist recovery 5. develop and negotiate plan to address PA

24 Canavera, K. E., Ollendick, T. H., Ehrenreich May, J. T., & Pincus, D. B. (2010). Clinical Correlates of Comorbid Obsessive-Compulsive Disorder and Depression in Youth. Child Psychiatry And Human Development, 41(6), Caporino, N., Morgan, J., Beckstead, J., Phares, V., Murphy, T., & Storch, E. (n.d). A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder. Journal Of Abnormal Child Psychology, 40(1), Renshaw, K. D., Steketee, G., & Chambless, D. L. (2005). Involving Family Members in the Treatment of OCD. Cognitive Behaviour Therapy, 34(3), doi: / Krebs, G., Bolhuis, K.,Isobel Heyman, I.,David Mataix-Cols, D., Turner, T., & Stringaris, A. (2013).Temper outbursts in paediatric obsessivecompulsivedisorder and their association with depressed mood and treatment outcome. Journal of Child Psychology and Psychiatry 54((3), JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 51 NUMBER JANUARY 2012

25 A. Futh et al. / Journal of Anxiety Disorders 26 (2012) Coskun, M., Zoroglu, S., & Ozturk, M. (2012). Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive-compulsive disorder. Child & Adolescent Psychiatry & Mental Health, 6(1), doi: / Lebowitz, E. R., Vitulano, L. A., Mataix-Cols, D., & Leckman, J. F. (2011). Editorial Perspective: When OCD takes over...the family! Coercive and disruptive behaviours in paediatric obsessive compulsive disorder. Journal Of Child Psychology & Psychiatry, 52(12), doi: /j x GORDON, W. M. (2013). Treatment Refusal and Family Accommodation. PCSP: Pragmatic Case Studies In Psychotherapy, 9(1), Hanna, G. L., Himle, J. A., Hanna, B. S., Gold, K. J., & Gillespie, B. W. (2011). Major depressive disorder in a family study of obsessive-compulsive disorder with pediatric probands. Depression & Anxiety ( ), 28(6), doi: /da Brakoulias, V. (2011). Obsessive-compulsive spectrum disorders: a comorbidity and family history perspective. Australasian Psychiatry, 19(2), Valleni-Basile, L. A., Garrison, C. Z., Jackson, K. L., Waller, J. L., McKeown, R. E., Addy, C. L., & Cuffe, S. P. (1995). Family and Psychosocial Predictors of Obsessive Compulsive Disorder in a Community Sample of Young Adolescents. Journal Of Child & Family Studies, 4(2), Renshaw, K. D., Steketee, G., & Chambless, D. L. (2005). Involving Family Members in the Treatment of OCD. Cognitive Behaviour Therapy, 34(3), doi: / Kaila R. Norman, Wendy K. Silverman, Eli R. Lebowitz, (2015). Family Accommodation of Child and Adolescent Anxiety: Assessment and Treatment. Br J Clin Psychol. 54(4): doi: /bjc.12088