This month Chloe Volz (Clinical Psychologist) and Georgina Krebs (trainee Clinical Psychologist) joined us, from the Obsessive Compulsive Disorder (OCD) clinic for children and young people from the Institute of Psychiatry.
The team:
- The OCD clinic consists of Dr Hayman, 2 part time clinical psychologists, trainees and specialist registrars.
- The team is a tier 4 specialist team, where they do not co-ordinate care packages and do not manage risk.
- The team see a narrow range of psychological problems;
- Tourettes
- OCD
- Tic disorders
- Eating disorders
- Referrals come from the local tier 3 CAMHS service, with referrals up to 18 years old.
- A weekly team meeting allows the staff to talk through the clients and reflect on treatment
OCD:
- OCD affects about 1 in 100 people, and the cause is unknown
- Obsessions = intrusive, unpleasant thoughts that pop up again and again
- Compulsions = Describes the behavioural part, where you feel you have to do particular rituals
- Obsessive thoughts and compulsions becomes a disorder when it interferes with an individual’s life and the individual responds to these obsessions and compulsions in a compliant way.
The OCD Clinic
- There are 2 parts to the service:
- Specialised assessment
- Treatment
Assessment
- The assessment is carried out with the view of treatment, has the Child got OCD? There is one new assessment per week. The whole team is involved, with medical screening and questions to the whole family and child.
- The Childrens Yale-Brown Obsessive Compulsive Scale is used to identify the child’s obsessions. This scale is re-administered half way through the treatment and at the end.
- CAMHS is very stretched, and has a lack of resources. Some of the referrals come straight through from the GP-usually early onset OCD. OCD is very treatable if caught early.
- The team receive many multiple diagnoses, including; eating disorders, autistic spectrum disorders.
Treatment
- The treatment for OCD is Cognitive Behavioural Therapy (CBT), which is evidence based-NICE Guidelines. SSRIs are effective too.
- The John March protocol (Talking back to OCD) is a valuable resource used to treat OCD in children and adolescents, emphasis is on behavioural therapy.
- Treatment focuses on the internalisation of OCD, ‘the OCD is making you do …’, so the individual needs to fight the OCD and what it is telling them to do.
- Usually there is about 14 sessions, the first 2 are very psychoeducational
Case Study: Chloe, 13 yeards old, with 6 months history of OCD.
- Her obsessions included: harm would come to her family and her dogs, through illness of intruders or accidents
- Rituals included: Counting Mums medication repeatedly, ringing the family in breaktimes at school
- This was distressing for Chloe, she cried a lot, felt depressed and was put on SSRIs
- The first 2 sessions included psychoeducation; what is anxiety, how it affects people, normalising anxiety. Chloe was asked to rate how anxiety affects her, and a list of obsessions, compulsions and rituals. Asking questions such as ‘if you did not wash your hands-how anxious would you feel?’. A list is generated of rituals, Chloe’s anxiety was listed so that if she did not perform these rituals-how anxious would she be, this ranged from asking teacher for reassurance – 3, to checking the gate at 10/10 for anxiety.
- OCD is likely to occur again, and usually psychoeducation can help if it does.
- The family are involved in the treatment, younger children more so.
- Groups can be run with people with OCD
- Some rituals can be self harming, but not usually life threatening. Some obsessions can be linked to religious beliefs.
- The group watched an extract of a channel 4 programme, entitled ‘The boy who could not stop washing’.
The group thanked Chloe and Georgina for an interesting discussion about OCD.
The next group will meet on 28th August 2007, we hope to see you there!