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Obsessive Compulsive Disorder Can Be Devastating, But Highly Treatable
“It’s my OCD.” I hear that on and off from friends and patients who half-jokingly use the term to describe overly careful behavior (such as double-checking to make sure the stove is off) but don’t actually have obsessive-compulsive disorder. True OCD can be a devastating disease. Patients have intrusive, uncontrollable thoughts and severe anxiety centered around the need to perform repetitive rituals. They can be physical such as hand washing or mental such as counting. The behavior significantly interferes with normal daily activities and persists despite most patients being painfully aware that the obsessions or compulsions are not reasonable.
OCD affects 2-3 percent of the world’s population. We’ve seen characters with the disorder portrayed in television (e.g., Tony Shalhoub’s Adrian Monk) and in film (e.g., Jack Nicholson’s Melvin Udall in “As Good As It Gets.”) Yet it’s still associated with stigma, shame, and an alarming level of ignorance by many health professionals. On average, people look for help for more than nine years and visit three to four doctors before receiving the proper diagnosis. In an excellent review article on the subject, Dr. Michael A. Jenike, offers three helpful screening questions: “Do you have repetitive thoughts that make you anxious and that you cannot get rid of regardless of how hard you try?” “Do you keep things extremely clean or wash your hands frequently?” And “Do you check things to excess?” He suggests that answering “yes” to any of these questions should prompt an evaluation for possible OCD. Of course, these are just screening questions and keeping a spotless kitchen doesn’t mean you have a disorder.
For this week’s CBS Doc Dot Com, I interviewed Jeff Bell, KCBS radio broadcaster and author of Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder and When In Doubt, Make Belief: Life Lessons from OCD. He poignantly told me about the mental anguish associated with his illness, how it threatened to sabotage his career and personal life. His OCD focused on a fear of unintentionally harming others. He found himself unable to drive a car because every time he hit a bump he was afraid he had run somebody over; each time, he needed to get out and check. Even walking to work presented a challenge. He explained that a twig on the sidewalk could stop him in his tracks and fill him with what he knew were irrational thoughts but was powerless to control. Maybe somebody would be harmed by the twig if he didn’t move it. But if he did move it then maybe somebody would be harmed who wouldn’t have if he had just left it alone.
Jeff Bell sought treatment and turned his life around. His message is that others can do the same. Highly successful approaches including cognitive-behavioral therapies and medication can help the majority of patients. But only those who ask for help.
Resources for OCD include: The Obsessive Compulsive Foundation, The Association for Behavioral and Cognitive Therapies, and The New England Journal of Medicine.
Reaching Adults – Teens Text Questions About Sex
As if we needed any more indications that the sexuality education we teach in schools might not be working, the latest place for teens to find answers to their questions is via cell phone.
In spite of web sites that allow teens to ask anonymous questions like We’re Talking Teen Health and Go Ask Alice!, teens are still looking for answers to immediate sexuality-related questions, and texting them is the newest way to get answers.
In California, teens can text their sexuality questions to ISIS by texting the word ‘hookup’ to the phone number 365247 which will allow them to sign up for weekly health tips. Each tip contains a prompt to text the word ‘clinic’ plus a zip code to get contact information for two local clinics.
In North Carolina, they can text questions to The Birds and Bees Text Line. Both services provide non-judgmental and medically accurate information within 24 hours to teens with questions.
Neither site provides medical advice, only information from an adult and encouragement to seek medical care. The important part is that these services are another place teens can reach out to adults for information and support.
I worry a little bit about what happens when teens admit they were raped, or are being sexually abused – what do the adults receiving this information do – and are they responsible for reporting what they learn to the authorities, but I guess that is a abridge we cross when we come to it.
For now, I am happy there are more adults willing to provide the information teens need to make good decisions, get medical care, and protect themselves. As always, parents would be the best source of sexuality information, but they might need their own texting site for their questions!
This post, Reaching Adults – Teens Text Questions About Sex, was originally published on Healthine.com by Nancy Brown, Ph.D..
Pearls of Wisdom From An Old Psych Nurse
Nurses are experts at navigating through rough waters. We are always there for our patients in their time of need. Check this nurse out. She is using her critical thinking skills while she sails her boat through a stormy ocean. It’s true. Nurses can do just about anything, just so long as they have a good mentor to show them the way.
From time to time, I get letters from new psych nurses asking me for advice.
I was very lucky when I first started out as a psych nurse. Nurses and doctors who gave me valuable tips when I was new in the field surrounded me on the unit, and made sure that I didn’t get myself into trouble. Here are some pearls of wisdom that my mentors passed onto me when I was the new kid on the block. I hope they help you, too.
Pearl of wisdom #1: The first rule that I learned was that I never was to accept abuse from a patient. Patients may be angry about how things are going in their life, but they must learn to vent their anger appropriately. That means no hitting, swearing, or throwing stuff at other people. Period! Just because someone has “problems” doesn’t give them a license to act inappropriately on the unit. Seriously. Nurses are not punching bags. We have rights. Nurses must teach their patients to function in the real world, and we do them a disservice if we allow our patients to act out on a psych unit.
Pearl of wisdom #2: The second pearl of wisdom has to do with the myth that nurses can say something wrong to a psych patient. Many nurses are afraid that a patient will crumble if they say the wrong thing to the wrong person. I’ve never seen this happen during my nursing career. Just listen to your patients with your ears and with your heart. Everything else will fall into place.
Pearl of wisdom #3: Never turn your back on a patient. This is self explanatory. Psych units are unpredictable.
Pearl of wisdom #4: Don’t get offended if a patient hates you. That probably means that you are doing your job. Many patients come to the hospital because they have boundary issues, and issues involving the need for immediate gratification.
Pearl of wisdom #5: Never forget that you are a REAL nurse. You may not be caring for a wounded body, however you are caring for a wounded soul.
*This blog post was originally published at Nurse Ratched's Place*
Smoking Cessation Programs: Lessons From The UK
I’ve previously written about what face-to-face smoking cessation services typically do, largely based on my own experience. However, while at the SRNT annual conference I met two Smoking Cessation Advisors working in Lancashire, England who appeared to have a successful service, so thought it worth sharing some of their information.
Jan Holding and Eileen Ward manage a UK National Health Service (NHS) Stop Smoking Service in Lancashire in the north of England. Both are nurses by training and many of the 14 staff providing the treatment have primarily a nursing background. Their service sees around 450 new clients per month (i.e. over 5000 new clients per year). Services are provided at “community sessions” at various locations all over their catchment area, and clients are given their own hand-held record which they keep, and take with them to sessions, enabling them to attend whichever community location suits them at the time. While clients can make scheduled appointments, the service is also flexible, allowing clients to “drop-in” to community sessions without an appointment. Although some initial assessment sessions take place in a group format, most of the sessions are delivered in a one-to-one format via a relatively brief discussion with a smoking cessation advisor. These community sessions often take place in a large community room from 4pm to 8 pm in the evening, with multiple types of services being provided in the same room at the same time at different corners (e.g. initial assessments in one corner, prescribing of varenicline in another, and nicotine replacement therapy in another). It is not uncommon for around 200 clients to attend a single community session.
Clients are frequently encouraged to use NRT prior to quitting smoking (about half do this) and usually use more than one smoking cessation medicine (more than half do). Nicotine replacement therapy is provided via a voucher system requiring either no cost to the client, or just a co-pay (around $10 USD).
The service runs 6 days per week and includes evening sessions, and aims to reduce most of the usual barriers to entering treatment. Their “3 As” approach emphasizes “Accessibility, Availability and Adaptability”. They also specifically try to develop smoking cessation advisors who are passionate about their role, have a positive attitude to the importance of quitting smoking, and are therefore very committed to that work, as well as being knowledgeable about it.
My understanding is that the quit rates at this service are pretty good. But perhaps the best testimony to its success is the fantastic volume of clients who attend…..largely influenced by positive word-of-mouth via other clients. The success of this service reminds us that there isn’t just one way to do it, that all smoking cessation counselors and systems may need to be flexible and adaptable in order to help as many smokers to quit as possible.
For further information on what a smokers’ clinic does, see: What does a tobacco treatment clinic do?
This post, Smoking Cessation Programs: Lessons From The UK, was originally published on Healthine.com by Jonathan Foulds, Ph.D..
