Sunday, September 10, 2017

Stranger Than Fiction: Breakthrough in OCD Treatment



INTRODUCTION:
An unstable IRS auditor (Will Ferrell) who displays similar symptoms to individuals with OCD disorder in which his cycle of obsessions and compulsions are fixated on numbers (i.e. the number of steps he takes to the bus stop to work in the morning, the number of strokes he uses to brush his teeth, how much time it takes him to accomplish tasks which he depends on his wrist watch to give him these numbers such as times).

In the film, "Stranger than Fiction", he hears an author's (Emma Thompson) voice in his head as she narrates every move he makes and thoughts. He soon discovers that he is in fact the ill-fated protagonist of her latest piece of work. While a book-company employee (Queen Latifah) tries to cure the author's case of writer's block, the auditor and a professor (Dustin Hoffman) set out to find the woman and make her change her story.

In a small, preliminary clinical study, the experimental drug rapastinel rapidly reduced symptoms of OCD, although the effect was not long-lasting. The drug was well tolerated, causing none of the dissociative side effects associated with ketamine.
BACKGROUND INFORMATION:
Research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning. Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of both obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or impulses that occur in a continuous loop causing the individual to experience intensified feelings of distress and overall a lack of control. These obsessions are then followed with feelings of fear, disgust, doubt, and the strong urge to do things the ‘just right’ way.

Subsequently, these behaviors, and thoughts interfere if not consume a majority of these individuals lives. They are aware that these thoughts do not make sense but the psychological disorder determines if a person has OCD or simply an obsessive personality trait. The words “obsessing” or “being obsessed” are causally used in the day-to-day life to describe someone who is pre-occupied with a topic, idea, or person. However, being “obsessed” with something does not interfere with living a normal functional life and often times people find pleasure in it. An example would be if a new song came on the radio and you describe yourself to be "obsessed" with it to friends and family, however you continue to function despite this "obsession". 

*Individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms*
Compulsions, the second part of obsessive compulsive disorder, are the repetitive behaviors or thoughts a person uses to neutralize, counteract, or make their obsessions disappear. People with OCD realize that their compulsions are only a temporary solution to cope with the distress they feel and rely on the compulsions as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions.

Not all repetitive behaviors or 'rituals' are compulsions. It is important to look at the function and context of this behavior. [For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over but are positive and functional part of daily life.] Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Compulsions are time consuming and get in the way of important activities the person values. 

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” People tend to have 'compulsive' behaviors, where this type of 'compulsive' refers to a personality trait that a person enjoys whereas individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts.

In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions. To be diagnosed with OCD, the cycle of obsessions and compulsions has to be so extreme that it consumes a lot of time and gets in the way of important activities that the person values. [A]
RESEARCH:
Rapastinel, an experimental drug currently being evaluated for the treatment for major depression and may relieve the symptoms in individuals who struggle with obsessive-compulsive disorder [aka: OCD] quickly and with few side effects allowing for an overall effective viable treatment option/ manner.

NARSAD 2009 and Young Investigator, Carolyn I. Rodriguez, M.D., Ph.D., (2014) from Stanford University School of Medicine reported in ‘The American Journal of Psychiatry’ in December of 2016 their observations in their small proof-of-concept study. A Young Investigator, Helen Simpson, M.D., Ph.D., and Independent Investigator 2010 from Columbia University College of Physicians and Surgeons, was also members of the research team.

Investigating rapastinel has been a primary focus of their studies because it was previously discovered that some OCD patients received rapid relief from their symptoms when they were treated with Ketamine (an anesthetic used to rapidly reduce symptoms of depression). Like other drugs, it has its own side effects which for Ketamine a feeling of detachment from one’s self or patients have reported having an ‘out-of-body’ experience. This brings challenges for use in the general clinics and the board spectrum of psychiatric disorders.

Rapastinel functions in a similar way that ketamine does in that the drug modulates the action of NMDA receptors found in the brain. By docking the ports for the neurotransmitter glutamate (an important region that allows for humans to learn, contain memories, in addition to keeping the synaptic plasticity) has been thought to play a large role in OCD. However, there is a difference between rapastinel and ketamine’s modes of function in that rapastinel was discovered to have a lower risk of dissociative side effects.

It is no surprise that Rodriguez and her colleagues turned to rapastinel in the hopes of finding more effective and fast acting treatment in reducing patients’ obsessions and compulsions without dissociative side effects.
RESULTS:
Each participant was given a single dose of the drug rapastinel. The drug was well tolerated as none of the patients reported dissociative side effects and within hours of treatment the severity of patients’ symptoms declined significantly.

Results of the team’s initial clinical study included 7 participants who have OCD, revealed much promise as the drug reduced obsessions, compulsions, as well as the anxiety and depression that is often paired with OCD patients. Although the effects on these symptoms were fast-acting, they did not last for long periods of time.

When the research team evaluated patients one week after treatment, symptoms were about as severe as they had been prior to treatment. The scientists say important next steps will be testing the effects of repeated dosing and working to develop related drugs that reduce OCD symptoms over a sustained period.


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*Please note! These images are not mine. They were found on various tumblr, pinterest, google image sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~

*Screen caps by: google images

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