Treatment Refractory OCD (Treatment Resistant OCD) rTMS, DBS, Gamma knife & Psychosurgery for OCD
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- Опубліковано 18 вер 2024
- Treatment Resistant OCD (Treatment Refractory OCD) Approach and Management. rTMS, DBS, Gamma knife & Psychosurgery for OCD
Despite advancements in pharmacotherapeutic and behavioral interventions, a substantial proportion of patients with obsessive-compulsive disorder (OCD) continue to have disabling and treatment-refractory illness. This video focuses on novel promising research treatment tried across the world such as rTMS, DBS, Gamma Knife and neurosurgical approach.
Evidence-based guidelines recommend selective serotonin reuptake inhibitors and/or behavior therapy as first-line treatments for obsessive-compulsive disorder (OCD). However, around 40%-60% do not respond adequately to either treatment. Around 30% of such patients respond to augmentation with antipsychotics. It has been estimated that around 10%-20% of OCD patients are refractory to all available pharmacological and psychological treatments. Many of these patients have chronic, severe, and disabling symptoms causing significant social and economic burden. Neurosurgical treatments have a role in this population, that is, patients with chronic and severe OCD, who are refractory to available noninvasive treatment strategies.
The advent of stereotactic surgical techniques and advances in neuroimaging in the last few decades have greatly enhanced the specificity and accuracy of targeting in brain surgeries. This is in stark contrast to the earlier procedures such as prefrontal leukotomy and lobotomy, for which the term “psychosurgery” has unfortunately become synonymous with. Contemporary neurosurgical procedures involve either creation of small lesions in the order of millimeters (ablative surgery) or implantation of electrodes in very specific subcortical regions for neuromodulation (deep brain stimulation [DBS]). Refinements of targets based on the experience and understanding of neurobiology have improved the safety and efficacy of these procedures
Neurosurgical interventions, including ablative procedures and deep brain stimulation (DBS), have emerged as potential treatment options in this population. Given the invasiveness and limited evidence, these procedures have been performed in carefully selected patients with severe, chronic, and treatment-refractory illness. Along with informed consent, an independent review by a multidisciplinary team is mandated in many centers. Both ablative procedures and DBS have been found to be helpful in around half the patients, with improvement observed months after the procedure. Various targets have been proposed for either procedure, based on the dominant corticostriatal model of OCD. There is no strong evidence to recommend one procedure over the other. Hence, the choice of procedure is often based on the factors such as affordability, expertise, and reversibility of adverse effects. Surgery is not recommended as a standalone treatment but should be provided as part of a comprehensive package including medications and psychotherapeutic interventions. Available evidence suggest that the benefits of the procedure outweigh the risks in a treatment-refractory population. Advances in neurosurgical techniques and increasing knowledge of neurobiology are likely to bring about further progress in the efficacy, safety, and acceptability of the procedures.
This video will focus on the current status of treatment resistant/refractory OCD, neurosurgical treatment for OCD, providing an overview on clinical aspects including patient selection, consent/review process, a brief description of contemporary surgical procedures, and postoperative follow-up.
I am a clinical psychologist. I like to work with ocd. But feel bad when they begin to argue. In the current scenario people are not coming with family members. They are taking appointments directly and not sharing caregiver information. Do share a video for people like this. So that we can share.
Thank you very much for your suggestion
I will definitely do a video on the issue you have raised
Respected Sir,
When OCD isn't responding to treatment for a long time(4 Years), should NIMHANS be preferred or should the treatment be continued from the nearest Psychiatrist because feasibility of regular followup may be an issue?
Both are valid point.
Please discuss with your treating doctor regarding CBT / ERP therapy sessions
Is severe anxiety symptoms of OCD??? Kindly reply. Thanks
Needs evaluation in-person by a psychiatrist
@@SureshBadaMath thanks sir, can i have your email address?
Thank you sir 🙏
Welcome
Very useful sir
I am glad it was useful
Thank you Professor. Though I am psychology background. I could get the granular knowledge of OCD treatments and their strategies. I am confident that, I gained the knowledge of medical terminology and treatment efforts on OCD.
Hi sir
Welcome
All the Best
Thanks a lot sir .. Can pls make a video on CBT technique used for OCD
It is already there. Released two months back
Check this out
ua-cam.com/video/l6-kV6IOgEQ/v-deo.html
Is there any data available about number of OCD patients underwent GK around the world? How many cured? How many not? How many have side effects and what type of side effects?
Sorry no such data is available across the world or even in India
You may find this scientific article useful pubmed.ncbi.nlm.nih.gov/35110917/#:~:text=Conclusion%20GKRS%20is%20a%20safe,severe%20OCD%20cases%20fared%20poorer.
Respected Professor
Is Deep Transcranial Magnetic Stimulation for OCD currently available in Nimhans?
It is available for research purposes only
DTMS for OCD is still under evaluation (research) across the world
Thanks sir for your kind information
Sir plz create a lecture on NDPS ACT
Hello sir, I have refractory OCD with physical sensations and obsession. I am currently in NIMHANS for treatment, help me if you can
Please follow the instructions given by the treating team at NIMHANS, they are the experts in OCD
Sir i m hving ocd and shizoprenia sir I m c onsulting dr joy ranjan ram nimhans dr sir can u help me to remove my past😭😭😭😭
Sir Anxiety,depression,OCD,ke diagnostic ke liye blood me serotonin level ka koi test hota he kya?,agar hota he to Kitna level normal hota he ?
There are no such tests available to diagnose OCD at present across the world
Thanks alot for the video sir. On similar lines could you please guide about treatment resistant schizophrenia, treatment resistant depression, treatment resistant bipolar disorder. Thank you sir
Sure
Thanks alot sir
@@SureshBadaMath
Sir I have sezofenia also OCD
Thanks for explanation, unfortunately I live in Brazil, nobody doctor here think as sir, all only know to pass me medicine. I would like that sir could me operate me, but it is a dream.
👍👍
Sir, can You give me any Body dysmorphic disorder guideline? Or any gold standard link?
Please find this guidelines-journals.lww.com/intclinpsychopharm/fulltext/2021/03000/body_dysmorphic_disorder__a_treatment_synthesis.1.aspx
Thanks.sir.
Is there any option to consult you by online media from Bangladesh?
Sir, any ayurvedic supplements helpful in OCD in your experience only ?
I don’t know about Ayurvedic treatment in OCD. I am trained and qualified in Allopathy
Please consult an ayurvedic doctor for your question and treatment
@@SureshBadaMath thank you sir
Sir I have taken 20 sessions of rtms still now I have not seen improvement and i also have trichotittomania what I should do now iam fully hopeless. Tdcs should be used while rtms or after rtms.pls suggest me
Please discuss with your treating doctor
I should not comment without knowing complete history, symptoms, past history, medical history, diagnosis and treatment details
I request you kindly discuss with your treating physician
I have been suffering from 5 years.My first appointment is at NIMHANS opd section on dated 24/11/2021.I am very confused How should I approach with doctors.
Please visit this website for more information
nimhans.ac.in/psychiatry-2/psychiatry-specialty-clinics-psychiatry/
Sir, I am taking paroxetine 62.5 mg, topiramate 100 mg in divided dose, nexfolin(acetylcystine 600mg calcium l methylhydrofolate methylcobalmin) mirtazapine 30 mg risperidone+trihexyphenydyl 2mg Doctor has said. I have ocd and depression. My problem is I am stuck in one incident which has happened to me. I just want to forget one incident that's it. Plz suggest me something 🙏🙏🙏
Please consider adding cognitive behavior therapy along with ongoing medications. Choose a clinical psychologist, who is well versed with CBT treatment in ocd
Ashish are you feeling better today? 🙏🏿
Dr I am OCD patient. I want to meet you Dr please 🙏🏻🙏🏻
Please find the required information at this
NIMHANS OCD Clinic
ocdclinic-nimhans.com/information/
NIMHANS OCD Clinic services
ocdclinic-nimhans.com/service/
NIMHANS OCD Clinic Specialist
ocdclinic-nimhans.com/our-team/
ocdclinic-nimhans.com/contact-us/
Sir ECT can effective in resistant OCD?
No
But sir medicine and psychotherapy , rtms ka 30 sessions sab kuch try kar liya , Nimhans main bhi 1 month varti tha main oha bhi koyi Kam nahi huia... Bad main hamara eha per AIIMS kalyani main dekhane ka bad admit kar liya...oha bhi pahale koyi Kam nahi ho raha tha...kuch din bad mujhe ECT dene ka plan Kiya...uske bad 5 ECT session lene ke bad improve fell kar pa raha tha main...total 14 ECT sessions dene ke baad wo lok discharge kar diya ..ghar ake kuch din accha tha per kuch din bad firse problem hone laga....ab main kiya Karu sir?
Can ocd patient view your video or its for dr only I'm OCD patients
It is for doctors
Sir, is human long term memory capacity unlimited?
Sir im psychiatrist, can we get ur email I'd
If we want to discuss some thing clinically and for academic development
Please send your email address. I will contact you
I'm regular follower and listener of ur videos ..it's worth listening, I feel grateful, you r best source of our professional development
Very well explained sir
Could you please provide your email to contact you...