Are You Monk-ish?Actor Tony Schalhoub, the star of “Monk”, (a television series that lasted for eight seasons) advocates for Obsessive Compulsive Disorder - OCD, a type of anxiety disorder. Adrian Monk, for those not in the know, is a warm and brokenhearted detective who has OCD; a disorder with specific traits that Shalhoub says is not all that hard for him to identify with.

“I certainly have those kinds of feelings and preoccupations,” says the actor of OCD. “And what I do with Monk is think of it as uncorking the bottle and letting everything flow.” This helps Shalhoub, who has won three Emmys and a Golden Globe for Monk, understand its challenges firsthand. “For a lot of people, there is a fear of embarrassment. But people who suffer with the disorder don’t have to be outcasts. They can be and are contributing members of society.”

MONK EXHIBITS SYMPTOMS OF OCD

• Brilliant crime fighter that Monk is, he struggles with distraction, focusing at times on the inconsequential, such as dandruff on someone’s shoulder or the arrangement of doughnuts in a box. He must touch every parking meter he passes and wipe his hands after every handshake. For millions of Americans with OCD and their families, Monk has become a source of empathy and inspiration. That’s why Shalhoub and Monk co-creator David Hoberman recently teamed with the Anxiety Disorders Association of America to launch an OCD awareness campaign called, “Treat It, Don’t Repeat It: Break Free From OCD.”

Children and adults with obsessive-compulsive disorder (OCD) suffer from unwanted and intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety.

OCD OBSESSIONSMany OCD obsessions revolve around cleanliness or contamination. For example, some people with OCD may constantly feel dirty, and may view every surface as contaminated with germs or dirt. They obsessively worry that they may be harmed when parts of their body such as their hands come into contact with these surfaces.

OCD COMPULSIONSCompulsions are the second type of OCD characteristics, or rituals that people with OCD perform in response to their obsessions. They might keep their food, drinks, cans, eating utensils, clothing, etc., facing in one direction.

Many well-known individuals have struggled or currently struggle with OCD, as do millions of other Americans.

OCD RUNS IN THE FAMILY

• Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

MYTHS AND FACTS

Causes of OCD

OCD CLINICAL RESEARCH

• Multiple Schools of Medicine have embarked on clinical trials and studies to try and understand the complexity of OCD. Yale School of Medicine, UCLA School of Medicine, and Stanford University School of Medicine to name a few.

• Yale School of Medicine founded the Yale OCD Research

Clinic in the mid 1980s by Drs. Wayne Goodman and Dennis Charney, the Clinic fostered the development of the fields standard instrument for rating symptom severity.

CLINICAL TRIALS• The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), as well

as the first clinical trials demonstrated the efficacy of the medications that are now standard treatments for the disorder – SSRIs and neuroleptics.

• The Obsessive Compulsive Foundation, a leading education and advocacy organization for patients with OCD, was founded in large part by participants in these early research trials.

• UCLA School of Medicine has performed brain imaging studies to view the metabolic differences between brains with normal control and the OCD brain.

CEREBRAL GLUCOSE METABOLIC RATE IS HIGHER IN THE OCD BRAIN

TREATMENT

Cognitive Behavior Therapy (CBT)

CBT is effective treatment for OCD. About 7 out of 10 people will benefit from either CBT or medication. For CBT to work, a patient must actively participate in the treatment. Unfortunately, about 1 in 4 OCD patients refuse to do CBT.

There are different kinds of CBT, but the one that works the best for OCD is a kind called Exposure and Response Prevention, or ERP. The “Exposure” in ERP refers to confronting thoughts, images, objects and situations that make a person with OCD anxious. With ERP, a person has to make the commitment to not give in and do the compulsive behavior until they notice a drop in their anxiety. In fact, it is best if the person stays committed to not doing the compulsive behavior at all. The natural drop in anxiety that happens when you stay “exposed” and “prevent” the “response” is called habituation.

MEDICATION• Medication is also an effective treatment for OCD. About 7 out of 10 people with

OCD will benefit from either medication or CBT. For the people who benefit from medication, they usually see their OCD symptoms reduced by 40 – 60%.

• The treatment for most OCD patients should involve the combination of CBT/ERP with medication.

• ANTIDEPRESSANTS/SSRIs• Most drugs that help OCD are known as antidepressants or Selective Serotonin

Reuptake Inhibitors (SSRIs). SSRIs work by blocking a receptor in the brain that absorbs the chemical serotonin. Serotonin is known to influence mood, but the exact way SSRIs improve mood isn’t clear. Depression often results from OCD.

• Doctors can treat both OCD and depression with the same medication. Eight of these antidepressants (SSRIs) worked well in studies:

Fluvoxamine (Luvox) Fluoxetine (Prozac)Sertraline (Zoloft) Paroxetine (Paxil)Citalopram (Celexa) Clomipramine (Anafranil)Escitalopram (Lexapro) Venlafaxine (Effexor)

MEDICATION AUGMENTATION

• NEUROLEPTICS• Neuroleptics are antipsychotic medications. Antipsychotic medications are

used to augment current treatments. In general, scientific evidence strongly supports the use of antipsychotic medications as useful augmentation drugs for adults whose OCD symptoms have not responded to standard treatments.

• Although antidepressants/SSRIs are the standard medical treatment for OCD, it has been suggested that adding antipsychotics for the people who do not adequately respond to these drugs is helpful in improving OCD symptoms. Antipsychotic medications such as Risperdal (Respiridone), Zyprexa (Olanzapine) or Seroquel (Quetiapine) affect levels of the neurotransmitter dopamine. Problems with the dopamine system have been implicated in OCD.

CONCLUSIONS• OCD is a debilitating disorder that disrupts the life of the person with

OCD. It effects their relationships, both personal and professional.

• OCD is a serious disorder and should not be taken lightly.

• People with OCD suffer and it is important to take the steps necessary to relieve OCD symptoms.

• More and more strides are being made to help those suffering from OCD.

• Those who have OCD are not alone. Don’t wait years and suffer in silence. Many people have the disorder and with help are very productive members of society.

References• Images of Monk and OCD

http://www.bing.com/images/search?q=images+of+monk%27s+ocd&id=59C903F217ACFA744482E57A66FDD32DB145E4AF&FORM=IQFRBA#view=detail&id=59C903F217ACFA744482EF0FE0790A9435A803DA&selectedIndex=11

• Pearlman, E. (n.d.). Actor Tony Shalhoub Takes on Obsessive Compulsive Disorder. Retrieved from WebMD: http://www.webmd.com/anxiety-panic/features/actor-tony-shalhoub-takes-on-obsessive-compulsive-disorder

• Images of Famous People with OCD. (n.d.). Retrieved from http://www.bing.com/images/search?q=Famous+People+Diagnosed+with+OCD&Form=IQFRDR

• Psychiatry, M. (2009, February). Rapid Effects of Brief Intensive Cognitive-Behavioral Therapy on Brain Glucose Metabolism in Obsessive-Compulsive Disorder. Retrieved from US National Library of Medicine National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893580/

• Understanding the Facts/Obsessive Compulsive Disorder. (n.d.). Retrieved from Anxiety and Depression Association of America: http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

• Perles, K. (2010, November 11). Types of Obsessive Compulsive Disorder Characteristics. Retrieved from http://www.healthguideinfo.com/living-with-ocd/p95040/

• Bell, J. (n.d.). Cognitive Behavior Therapy (CBT) and Medications for OCD. Retrieved from International OCD Foundation: http://www.ocfoundation.org/CBT.aspx

• Owen Kelly, P. (2010, August 24). Augmentation is an Effective OCD Medication Strategy. Retrieved from About.com Obsessive Compulsive Disorder: http://ocd.about.com/od/treatment/a/augmentation.htm