Obsessive Compulsive Disorders Clinic
The Obsessive Compulsive Disorders Clinic is a multidisciplinary specialty clinic that is a part of the larger Anxiety Disorders Clinic at LPPI. The OCD Clinic provides evaluation and treatment for adults and children with obsessive compulsive disorder (OCD), tic disorders (including Tourette Syndrome), trichotillomania, compulsive skin picking (dermatotillomania), compulsive hoarding, and body dysmorphic disorder. The OCD clinic also provides consultation, second opinions, and treatment recommendations for mental health providers in the community.
Carol A. Mathews MD directs the OCD clinic. Other faculty and staff in the OCD clinic include Steve Lieske, MD, PhD; Caroline Hollnagel, PhD; and Maria Pease, MD.
Psychiatric Evaluations and Consultations
All individuals entering the clinic are initially seen by an evaluation team that consists of one or more psychiatric residents or child psychiatry fellows, together with and under the direct supervision of an attending psychiatrist. These evaluations are 90 minutes to 2 hours in length, and include a feedback session outlining the diagnostic impressions and treatment recommendations. If the individual was referred by a community mental health provider or other clinician, the evaluation summary and treatment recommendations are sent back to the referring clinician. If appropriate, the individual may choose to obtain ongoing treatment through the OCD clinic. Alternatively, if the individual does not already have a mental health provider, we may also provide referrals to community providers with the relevant expertise.
Individualized medication management is available for OCD and related disorders. Medication visits are conducted as needed, and can range from 20 to 45 minutes.
We provide individual and group therapy targeted at minimizing OCD and anxiety symptoms. Both individual and group modalities are centered around the principles of cognitive behavioral therapy (CBT), although other approaches are also used as needed. In both cases, the therapy is tailored to meet the specific needs of the individual. Family members can be included in the therapy as appropriate, at the discretion of the individual and his/her therapist. Group therapy is generally conducted with 6-8 participants and one to two facilitators. Groups are ongoing, with entry points monthly. Participants begin with a commitment to complete 20 sessions, with the option to continue for an additional 20 sessions as appropriate. Assessments to monitor progress are performed periodically.
The OCD clinic, in the context of the ADC, has the capacity to provide specialized pharmacogenetic assessments for individuals who have not responded to multiple medication trials, or who experience intolerable side effects to medications. This assessment consists of obtaining a genetic profile of the major genes that metabolize the most commonly prescribed psychiatric drugs to determine if the specific genetic variation carried by the individual influences their reaction to particular medications, allowing for a more individualized and targeted approach to medication management. Note that insurance does not usually pay for pharmacogenetic evaluations.
Deep brain stimulation for OCD
Deep brain stimulation (DBS) has recently received approval from the FDA for chronic, severe, treatment resistant OCD. Individuals who are interested in DBS must have a psychiatrist in the community that they are working with, have failed several trials of medications and CBT, and be disabled by their symptoms. Our DBS program consists of a comprehensive assessment to evaluate appropriateness for DBS, in conjunction with the referring psychiatrist, implantation of the device by the neurosurgical team, and ongoing follow-up specifically related to programming and monitoring the DBS device. Individuals who are interested in the DBS program must be at least 18 years of age, be medically stable, and have a psychiatrist who is willing to work with the DBS team prior to and following surgery. See here for complete list of inclusion and exclusion criteria.
Parkinson's Treatment Could Work For OCD, Too
When appropriate, we provide neuropsychological evaluations aimed at identifying particular cognitive strengths and weaknesses that may be relevant to diagnosis or treatment planning. For example, in children with OCD and attentional problems, neuropsychological testing can identify specific areas of strength and weakness that can be used to advocate for appropriate accommodations at school. Note that neuropsychological testing is conducted for ADC patients only and is done through internal referrals by the treating clinician.
The OCD clinic is a tertiary care specialty clinic within an academic center, and as such, its members are actively engaged in research aimed at better understanding the presentation and causes of anxiety disorders, as well as at improving and expanding available treatment options. There are a number of active research programs connected to the OCD clinic, including studies on the transmission of anxiety disorders within families, the genetics of OCD, the genetics of Tourette Syndrome, neurocognitive studies of compulsive hoarding, and phenomenological studies (for example, studies on the link between OCD and other neuropsychiatric disorders such as ADHD). OCD clinic patients and their families are encouraged, but not required, to participate in our ongoing research studies.
How to Make an Appointment
To make an appointment in the OCD clinic, please call 415-476-7500.