Treatments (non OCD) + Other Flashcards
what is first line therapy for excoriation (skin picking) disorder
CBT –> including habit reversal and acceptance enhanced therapy
what is the main treatment for people with excoriation disorder
habit reversal training (i.e as part of CBT) is main treatment
What pharmacological treatment is available for excoriation disorders
SSRIs may be helpful but with limited effects
N-acetylcysteine may be helpful
naltrexone may be helpful
what is the approach to treatment of hoarding disorder
current approach = attempt trial of SSRIs or CBT
SSRIs likely to not be as helpful as for people with OCD for example
which SSRIs have been investigated in the treatment of hoarding disorder
citalopram, escitalopram, venlafaxine
effectiveness in hoarding disorder remains controversial
is CBT effective for hoarding disorder
yes can be
specialized topics for hoarding disorder include:
-psychoeducation
-skills training (organizing, decision making, problem solving)
-behavioural exposures (discarding, non-acquiring)
-cognitive strategies
what other resources can be helpful for hoarding disorder
support services like the Toronto Hoarding Support Services Network
what must be taken into account in safety planning for people with hoarding disorder
at very high risk for fires in home and for falls
high risk for infestations like bed bugs
consider persons frailty, mobility, medical conditions and visual/hearing impairments as part of safety planning
hygiene, risk of infection, air quality = major issues
make sure can enter and exit home, bathrooms, fire escapes
make sure people have access to emergency services
a forced “clean out” is last resort–> i.e when serious fire or health hazards–> build rapport and consider risk management if possible
what psychotherapeutic interventions are there for BDD
CBT
-exposure to social situations
-identification of safety behaviours
-resisting compulsions (i.e mirror checking, reassurance seeking)
there is a treatment manual “CBT for BDD” and “the broken mirror”
BDD tends to me generally more responsive to which two pharmacologic agents?
fluoxetine
clomipramine
*also potential role for antipsychotics
how does dosing and titration tend to differ when starting medications in someone with BDD
trial of meds may need 12-16 weeks and SSRI doses are usually higher in BDD (just like in OCD) than those required to treat depression
other than psychotherapy and pharmacotherapy, are there any other treatments for BDD
very small case report on ECT for BDD–> typically in context of comorbid depression
are approaches used to treat trichotillomania similar or different to those for OCD
quite different
what % of those with trichotillomania engage in trichophagia
about 5-20%
unclear how many of these develop bezoars
which patients who have trichotillomania and engage in trichophagia should be more closely monitored for medical complications of the hair eating
really for anyone eating their hair
particularly those with:
abdominal or epigastric pain
chest discomfort
change in stool color to dark green-to-black color
vomiting
unexplained weight loss or diarrhea or constipation
what physical exam should be done if person has trichotillomania and bezoar is suspected/possible?
abdo exam–> check for LUQ mass
bloos test to assess for anemia
consider abdo CT–> diagnostic in 97% of trichobezoar cases
why do people with trichotillomania avoid seeking medical care
social embarrassment
belief condition just a “bad habit” or is not treatable
does trichotillomania go away on its own
not really–> only 14% rate of spontaneous remission
*with treatment, 50% may experience symptom reduciton
what psychotherapy has evidence in treating trichotillomania (is first line psychotherapy for trichotillomania)
behavioural therapy–> HABIT REVERSAL THERAPY
sometimes includes components of acceptance and committment therapy and DBT as well
what are the main aspects of habit reversal therapy
self monitoring (track his her tics or hair pulling)
awareness training
competing response training
stimulus control procedures (i.e modifying environment to reduce cues for hair pulling, skin picking, tics)
what are the pharmacological options for treating trichotillomania
no current pharmacotherapies that would be universally accepted as first line
Cochrane review–> SSRIS do NOT have strong evidence
Cochrane review–> CLOMIPRAMINE has some benefit
Other meds:
N-ACETYLCYSTEINE
OLANZAPINE
DRONABINOL may be future treatment option (cannabinoid)
Based on article from 2016 in American Journal of Psychiatry, what is recommended as the initial pharmacological treatment
N-acetylcysteine
(though recommendation is to do habit reversal therapy first)
should you offer pharamcotherapy, psychotherapy, or both for BDD
NICE guidelines recommend CBT for BDD for mild to moderate functional impairment, either SSRI or more intensive individual CBT for moderate functional impairment and combination of SSRI + CBT including ERP for severe functional impairment
