Cognitive Behavioral Therapy for the Treatment of Child and Adolescent OCD

Cognitive behavioral therapy reduces the severity of obsessive compulsive disorder in children and adolescents, according to a new review. This form of treatment helps relieve the overall distress and reduces the interference that OCD symptoms can cause in young people's lives.
Further, the evidence indicates that cognitive behavioral therapy (CBT) and medication are equally effective in treating pediatric OCD, say lead researcher Richard O'Kearney and colleagues.

"When CBT is combined with medication, treatment is more effective than medication alone. Health professionals need to consider this therapy - particularly in view of the controversy about prescribing psychotropic medications to children and teens," said O'Kearney, director of clinical training for psychology at the Australian National University, in Canberra.

This review appears in the October 18 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

OCD can start at a very early age - review participants were as young as 7 years old. The disorder affects an estimated 0.5 percent to 4 percent of children and adolescents.

Carol A. Mathews, M.D., with the department of psychiatry at the University of California, San Francisco, called the systematic review "excellent" and said it represents an important step forward in the understanding of the effectiveness of various types of treatment for pediatric OCD. Pediatric OCD is frequently under diagnosed and under treated, she said, and this could be because of limited treatment options parents have for their children.

"This study shows convincingly that CBT is superior to placebo, not only in reducing the number of OCD symptoms, but also in effecting remission in many cases. The study also shows that CBT plus medication is more effective than medication alone in children - an important confirmation of what has been believed clinically, but never proven," said Mathews, who was not involved with the study.

"The results of this paper provide clinicians and parents with an additional effective treatment option - CBT or CBT plus medication - a treatment that involves only about 14 to 21 hours, in general," Mathews said.

"Probably the most important issue related to our findings is that while the evidence suggests that CBT is as effective as medication, relatively few children and adolescents get CBT treatment," O'Kearney said. "Part of this is because of access and part is because primary care doctors often prescribe medicine before they refer patients to CBT. Hopefully this review will make them think more about this practice."

O'Kearney said that although attempts have been made to use telephone and computer-assisted delivery to increase access, "overall, there need to be more trained CBT therapists skilled in treating pediatric OCD."


O'Kearney RT, Anstey KJ, von Sanden C. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents (Review). The Cochrane Database of Systematic Reviews 2006, Issue 4. No abstract

Use of Ritalin with Preschoolers

The National Institute of Mental Health sponsored a study, The Preschool ADHD Treatment Study that took 303 preschoolers from age 3-5 who were diagnosed with ADHD. The study included 10 weeks of behavioral treatment along with parent training and about one year of drug treatment. Nearly 300 families were enrolled, but many dropped out after the first phase, either because the behavior treatment worked or because they didn't want to put their children on drugs.

The drug phase started with 165 children, more than a dozen dropped out because of side effects. It found that the children taking methylphenidate had a more marked reduction of their ADHD symptoms compared to children taking a placebo.

Throughout the duration of the study, the children grew about half an inch less in height and weighed about 3 pounds less than expected, based on average growth rates established prior to the study.

"This is a catastrophe. It just opens up the way for drugging the younger kids," said Dr. Peter Breggin, a New York psychiatrist and longtime critic of psychiatric drug use in children.

Breggin said the research is part of a marketing push by the drug industry to expand drug use to the youngest children.
The study appears in the November edition of the Journal of the American Academy of Child and Adolescent Psychiatry. Several of the researchers have financial ties to makers of ADHD drugs, including Ritalin.

Lead author Dr. Laurence Greenhill, a psychiatrist with Columbia University and New York State Psychiatric Institute, has been a paid speaker for most companies that make the drugs.

What do you think???

Interface Consultation Services Update

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus
We continue to post 2-3 times a week.
ICS - Providing our professional blog site readers with informative clinical behavioral health material at this blog site.
Counseling Connections - Therapeutic, counseling-focused articles for consumer interests.

II. "High Risk Mental Health emergencies" Book - Craig Judd is in the process of writing a book.

III. National Training Seminars: PESI

High Risk Mental Health Emergencies - "How To" Techniques & Interventions.
Craig Judd, co-founder of Interface Consultation Services, will be presenting this seminar in the Fort Wayne and Indianapolis area on October 26 & 27. This day-long seminar is suited to mental health clinicians, school counselors, social workers, case managers, addiction counselors, nurses, emergency responders and all others that directly encounter mental health emergencies.

Clients in Crisis: Assess, Intervene and Succeed.
Kathlene B. LaCour, co-founder of Interface Consultation Services, will be presenting this seminar in South Bend and Indianapolis, Indiana on November 9 & 10 and in Trumbull, Rocky Hill and Providence, Connecticut on December 13, 14 & 15.

Behavioral Managed Care: 20 Insider Tips to Get Your Clients What They Need!
Psychiatric Telephone Triage
High Risk Mental Health Emergencies
Clients in Crisis
Look for more dates in the Spring!!

IV. Telemental Health Triage:
We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

V. MPRI - Michigan Prisoner Re-entry Initiative: Mental Health
Interface Consultation Services are now the regional care coordinators for the Southwest Michigan Region. The initiative provides supports and services to improve successful reintergration of mentally illness prisoners into our communities.

VI. Utilization Management:
We continue to provide acute care preauthorization services for Riverwood Center.

VII. Counseling Connections:
We are providing online, telephone and email counseling services for individuals preferring a non-traditional, more accessible means of receiving counseling services. Click above to see our site and services. We are continuously exploring various approaches and mediums for educating healthcare providers and the public about behavioral mental health.

Culture and Suicide in Late Life

Suicide among the elderly is undoubtedly a complex phenomenon, and the difficulty in preventing suicide, regardless of cultural delineation, is apparent. Across cultures, suicide in older age is more prevalent in Latin and Asian countries, compared to Anglo-Saxon nations. In all countries, primary care physicians and mental health care professionals face a common dilemma in detecting symptoms of depression and suicidality among the elderly. Ideally, in order to prevent suicide in late life, complete consideration should be paid to both the personal characteristics and circumstances and the sociocultural milieu of an elderly person.

More......

Copyright © 2006 CMP Healthcare Media Group LLC

The highest suicide rates in the US population is still the elder white male although declining over the past decade.

Mental Illness and Celebrites

Celebrity on the couch: 40 faces of depression in the spotlight.

In the public confessional of the media, more and more household names have come out of the shadows to talk about their depression and mental illness. This is what they say about it. By Jonathan Owen 10 October 2006 .

1. George Michael: Singer
"Twelve years of depression and fear and lots of other bad stuff. It was as if I had a curse on me. I couldn't believe how much God was piling on at once."

2. Uma Thurman: Actress
"Nobody seemed to have any perspective any longer. Those were low points. But we got through it."

3. Jack Dee: Comedian
"Depression is something that has always figured in my life but now I'm dealing with it. I wish I'd done this years and years ago because it's been really helpful."

4. Kylie Minogue: Singer
"You get such a kick and then suddenly it's all over. That's good ground for uncertainty and depression. I usually burst into tears."

5. Paul Gascoigne: Footballer
"Everywhere I looked life seemed to be full of problems and they were just going to go on and on. It was never going to get any better."

6. Katie Price/Jordan: Model
"I was a psycho woman. It felt like something in me that I had no control over."

7. Russell Grant: TV presenter
"It is a maze of total confusion... it can get to the point where you don't care if you live or die."

8. Frank Bruno: Ex-boxer
"It's like a kettle. If it's a kettle, you turn the kettle off, you know what I mean? I wish I could put a hole in my head and let the steam come out. The steam was getting so high and the pressure was just getting a little bit much for me."

9. Ben Stiller: Actor
"I have not been an easygoing guy. I think it's called bipolar manic depression. I've got a rich history of that in my family."

10. Meg Mathews: Noel Gallagher's ex-wife
On the recent news of her going into rehab: "I can confirm Meg is receiving treatment. She is suffering from depression and needs time out."
11. Lord Bragg: Broadcaster, author and president of Mind
"Occasionally now I feel a wang that goes in my head - once you've got it you've got it. The [illness] was quite severe, leaving me deeply unhappy and frightened."

12. Neil Lennon: Footballer
"It's a bit like walking down a long, dark corridor never knowing when the light will go on."

13. Carrie Fisher: Actress
"Mania starts off fun, not sleeping for days, keeping company with your brain, which has become a wonderful computer, showing 24 TV channels all about you. That goes horribly wrong after a while."

14. Keisha Buchanan: Singer, Sugababes
"With depression, you can go in and out of it and not really know whether it's still there or not. Sometimes I'd find myself bursting into tears for no reason."

15. Ben Moody: Musician
"I was horribly depressed, and I felt like I had failed as a band leader, a professional, as a person."
16. Jim Carrey: Actor
"I was on Prozac for a long time. It may have helped me out of a jam for a little bit, but people stay on it for ever."

17. James Dean Bradfield: Manic Street Peachers
"I became a completely dysfunctional, miserable person, completely uncommunicative and aggressive."

18. Trisha Goddard: TV presenter
"I was in danger of having my children taken away from me when I needed five weeks in psychiatric care... There is the smiling depressive which is the biggest time bomb and when they go they usually go with a bang, which was me..."

19. Linda Hamilton: Hollywood actress
"The lows were absolutely horrible. It was like falling into a manhole and not being able to lift the lid and climb out."

20. Mel C: Former Spice Girl
"There is always a fear the depression could return but I do all the right things. I try to get the right amount of sleep because I know that I need sleep to function and I need to eat properly and to do some exercising."

see 20 more....

© 2006 Independent News and Media (NI) a division of Independent News & media (UK) Ltd

Commonwealth Care

As of October 1, 2006, Massachusetts has implemented a universal health care program for the state. They were crossing their Ts and dotting their Is. Connector COO Rosemarie Day told the Board that all systems are "Go" from the administrative end.

"The biggest concerns centered around the hardship waivers. The draft mirrored MassHealth regulations which allow the agency to waive premiums if an enrollee has extreme financial hardship due to a number of specific factors."

Weeeeeeeee........Here we go! It's a bold exciting move by Massachusetts and many other states and individuals will be watching closely to see how successful the system becomes. If it succeeds, there may be more systems to follow modeled after Commonwealth Care. In Michigan, our own governor Jennifer Granholm has been eluding to developing a program modeled after Commonwealth Care.

Can You Catch a Mental Illness?

Luke R. remembers exactly when the bizarre urges first hit. Two years ago, soon after summer vacation started, Luke, then 11, bounded into his Westchester, NY, home, said something to his mother he can't remember—and then, for no reason, said it three more times in exactly the same way. "Is anything wrong?" Luke's mother asked, somewhat unnerved. Luke shook his head, puzzled. "I just feel like I have to repeat things," he said.

Luke's compulsion snowballed: A week later, he felt impelled to take four steps at a time, blink four times, even count to four as he ran bases. He had to read backward every phrase he read forward. Soon, he was darting his eyes back and forth, rolling his head around like a loose ball, and sticking his fingers into his mouth. Luke—an accomplished saxophone player, honor student, and athlete—says he never felt embarrassed about his new "habits." If he felt like he had to control his hands, he would trap them under his arms. But his parents were frightened. "He looked like he was possessed," recalls his father, Don. "Thank God this didn't happen 300 years ago, because they would have burned him at the stake."

The only thing stranger than Luke's sudden behavior was the diagnosis. After 2 weeks of the writhing motions and compulsions, Luke's pediatrician, Gary Wenick, MD, ran a blood test and concluded that the symptoms were caused by an infection—specifically, a strep infection. Wenick had read studies linking streptococcus bacteria with childhood obsessive-compulsive disorder (OCD) and tics.

Luke, whose blood test showed that he'd recently been exposed to the bacteria, seemed to be unusually susceptible to the bug: He'd gotten a nasty strep-triggered kidney infection a few years earlier and had contracted strep throat five times the previous winter. So, on a hunch, Wenick put Luke on amoxicillin. Just 1 month later, Luke was nearly back to normal, playing baseball (without counting) and reading Hardy Boys mysteries (forward only). After two more rounds of antibiotics, the language tics disappeared as well.
Cases like Luke's raise a startling question: Could infections be responsible for abnormal behavior we think of as purely psychological?

Absolutely, says Paul Ewald, PhD, a biology professor at the University of Louisville and author of Plague Time: The New Germ Theory of Disease. "The mental condition itself isn't contagious. But you can catch an infectious agent that can lead to mental illness."
A growing number of doctors and medical researchers agree: They believe that viruses, bacteria, and parasites may play a key role in some childhood mental disorders such as OCD. Other cutting-edge research is looking at a possible connection between germs and obesity. If these researchers are right, knowing the source of these infections—and the ways to prevent or treat them—may make all the difference in the harm they can cause you and your family.

Read more about, How Bugs Affect the Brain at http://www.prevention.com/article/1,,s1-1-74-112-7442-1,00.html

Stigma Watch

As a society, we are bombarded with negative images of people with mental illnesses. The media and entertainment industries overwhelmingly present people with mental illnesses as dangerous, violent and unpredictable individuals. These inaccurate and unfair portrayals shape the public’s perception of those who suffer from mental disorders as people to be feared and avoided.

This stigma has tragic consequences. Many people with mental health problems fail to seek treatment because of the shame associated with their illness. And most will experience some form of discrimination, whether in the workplace, health insurance plans or social settings.

The National Mental Health Association’s Stigma Watch program tracks news and entertainment coverage of mental health issues for fairness and accuracy. Our goal is to correct and prevent stigmatizing advertising, television and radio programming, and print features.

More information regarding the stigmatizing of mental illness is available by linking to Stigma on the National Mental Health Association website.