00 : 00 / 05: 00 (Preview)

This discussion has ended. Watch the recording on Medflix app,

Obsessive Compulsive Disorder in Children

Mar 03 | 11:30 AM

Until around two decades ago, Obsessive Compulsive Disorder (OCD) was thought to be a relatively uncommon condition. Since then, researchers have made significant progress in comprehending the many components of OCD. It is a disabling and distressing disorder that strikes in the late twenties or early thirties. Symptoms, on the other hand, can occur as early as two years into the first decade. OCD in very young children can be reliably identified, despite the fact that it is uncommon and plagued with diagnostic and therapeutic challenges. Join us as Dr. Manjiri Deshpande, the director of the ICGC-Indlas Child Guidance Clinic, discusses how to manage OCD in children.

[Music] a very warm welcome and good evening to all the doctors medical students and other health care professionals who have joined in further stuff today which is being hosted on netflix my name is dr avantika chaitanya and i'm a pediatric residency applicant i'm super passionate about child health care and i'm also the co-founder of the auto research initiative i will be your host and moderator for this enriching talk about obsessive-compulsive disorder ocd in children ocd is a disorder of the brain and behavior that often happens in childhood ocd causes severe anxiety in those affected ocd involves both obsessions and compulsions that take a lot of time and get in the way of important activities such as school or extracurricular activities developing friendships and even self-care obsessions and intrusive and unwanted thoughts images or urges that occur over and over again that feel outside of the child's control these are unpleasant for the child and typically cause a lot of worry anxiety and distress compulsions are behaviors of the child feels that he or she must do with the intention of getting rid of these obsessive thoughts a child may also believe that engaging in these compulsions may somehow prevent bad things from happening in general ocd is diagnosed when these obsessions and completions become so time consuming that they negatively interfere with the child's daily life to enlighten us further on this topic we have with us today our esteemed speaker dr manjiri deshpande psychiatrist and head in last child guidance senate in mumbai dr manjari completed her tnp psychiatry from vijayawada institute of mental health and neurosciences grim hands following which she pursued her fellowship in child and adolescent psychiatry at birmingham through ntru university in mumbai she worked as a senior resident in tnmc and byl medical college she has done extensive research in the field of child psychiatry which she is passionate about she has done numerous workshops in motivating children and in the areas of stress management emotional intelligence and cognitive behavioral therapy she has also been invited as a faculty in many child psychiatric conferences she conducts workshops and students her students and teachers and also parenting workshops she has written articles and journals on various child psychiatry topics with a keen interest in child and adolescent psychiatry she heads ic chase as lcgc mumbai since its inception and is very keen to reach out and help more families and kids a very warm welcome to you dr manjuri an overdue for the talk so anyway like you said yes ocd is a disabling condition you know i see children as young as seven and eight at times with ocd many times the presentation is not as simple as in adults so in an adult it's generally much easier to diagnose ocd because an adult will come and tell me about that doctor i'm not able to get rid of these thoughts but a child cannot do that so many times a child with ocd is wrongly diagnosed as say oppositional defined disorder or hyperactivity or depression or anxiety so let's find out a little more on how ocd presents differently in children than in adults yeah um my presentation can you just start the first slide yeah so uh yeah i think uh i have you all put it as a poll here yeah so let me see if you all can answer these very very simple and basic questions but let me see how many of y'all get that ocd is caused by punitive that means very strict parenting observing a sibling or a friend who has ocd very strict toilet training all of them or none of them can you all just vote for the answers okay so 25 percent have voted for punitive parenting theo the last part [Music] uh yes mohammed actually in the polls i'll read it out uh so parenting was 25 uh observing a sibling or a friend who has ocd got zero words uh strict toilet training got zero words all uh got sixty two percent worth and none got eleven percent of the words i'm very happy with the eleven uh so the correct answer is none society is not caused by any of the following punitive parenting observing a sibling or symbolic training so yes uh that shows that we need to work you know we understand a little more on ocd these were thought to be possible many years ago many psychiatric psychologists some years ago thought that these could cause even today many times parents say you know i have ocd so is my child observing me and you know developing opd no it's not caused by observing anybody so the correct answer is none so can we go to the next question the following medications are effective in the treatment of ocd acceptance so which of them is not used in ocd chlamy pramin fluoxetine desipramin which is not used which is the wrong answer here you'll have to have chloemipramine fluoxetine desigbramin and flubotomy which of the following is not used in the treatment of ot okay so i think a mixed picture here 22 31 27 18. the correct answer is decipherment reciprocal is not used in the treatment of ocd uh fluoxetine is a very common xsri fluoptamine is also an ssri and chloramine belongs to a ccs group however deathramin is used more in bedwetting and other conditions it is not having any role in the treatment of food so the correct answer here is delicious let's go to the next one the last one the best management of ocd is ssri that is selective serotonin we uptake inhibitors which is the most commonly used class of drugs by psychiatrists in general cbt which is cognitive behavior therapy alone combined cbt plus ssris and family therapy i'm asking about the best management so all i use of course but what is the best way to treat ocd is it by just medication is it just by therapy is it a combination of therapy plus medication or is it family therapy excellent very nice answer so thank you to the 75 yes you are right it is combined ssris plus cbt so combination of course family therapy is also used however the correct answer is combined cbp and i will talk about that a little by little so in case one pastor else a 15 year old boy complains of repeated thoughts of blurting out obscene words at people fear of hitting someone while in a crowd so he hasn't actually done it he just has a fear that he will say some obscene words to somebody or hit somebody while in a crowd he tries to resist these thoughts by avoiding contact with people and by praying to lord ganesha seven times so he has to say that friend seven times in order to rid himself of the inside he has become slow in his work and lost interest in his studies offline another case a 15 year old child l studying in standard grade then came with his parents just you know your body exams are very close but this is a recent case that came to me they began observing some changes in him in the last few months he was repeating some of his actions so they said when he's putting on his line dress he will put it on take it off put it on again close the door open the door again so repeating some of his actions becoming slower in general his book in his written book there were too many cancellations so the teachers who were correcting his papers when he was giving test papers were complaining that there are too many cancellations in general he was becoming irritable once when his mom shouted at him seeing his school work he completely broke down and said he needed help and he wanted to go to a country the boy opened up to me saying that the last few months while writing he feels that he has made a mistake so he would have to erase and start rewriting and due to this he was unable to complete his paper and he was very stressed because his board exams are closed but he would have to wear his nitrous in a particular way and if it went wrong he had to redo it multiple times till it felt correct his compulsion increased in the evening and this was also affecting his sleep over the last few months he started losing interest in his hobbies he was sad most of the time felt very helpless he told me that he was trying his best to resist his thoughts because he understood that they are not correct but it was not helping him there was a family history of ocd in the mother so this is how complex the idea of giving this case was it presented as a very very difficult case because the first thing the parents told me was he's not completing his papers his books have too many cancellations so he doesn't want to study he's become slow that means he's become lazy so their attribution for his current behavior was completely different till it was actually diagnosed as ocd after a lot of sessions with the parents did they realize that it's actually ocd and not that those child voluntarily is doing any of this so now coming to the core topic what is the prevalence how common is it now i'm specifically discussing about childhood am i a little better my voice i mean can people hear me yeah i can hear it okay yeah i hope so so the estimates of prevalence range from one percent in children and two percent in adolescence so it's not very common however studies have shown us that children as young as five or six ten have full blown ocd so it's very very difficult to diagnose in that young physique i think the youngest that i have diagnosed in my clinic is about eight years ago between 30 to 50 of adults with ocd report that their symptoms started during or before mid-adolescence that means even if i see a case of adult ocd now when i face fashion symptoms and i ask women when did the symptoms start they actually say that the symptoms started in autologous however they never really understood that it was a condition or they gave it some other name so what exactly is obsession and what is compatible so obsessions are the current and persistent thought impulse or an image so in this case in the first case that i gave you he had an impulse of hitting somebody he had a thought that he would blurt out something there are people who say that there is a repeated image for a repeated image of see a sexual figure or a god figure props in their mind it can even be a repeated cue so i had a child who used to say there was a song that he loved and you know repeatedly it used to come in his mind and discover study they are not simply excessive buddies so we all worry at night have i closed the door have i put off the gas etc but that's a simple worry generally goes away with time these are not simply excessive there are attempts to suppress or neutralize so the person tries very hard like this boy said doctor i was trying very hard to get rid of that so there are attempts to suppress them and most important they are a product of these are her mind so if somebody says that they are not my thoughts somebody is planting it in my head the diagnosis would change i would then think of another diagnosis probably psychotic spectrum probably something like a physique so here specifically i ask the patient is somebody planting this or are these your own thoughts and their child or idolatry says no they are my own thoughts nobody's planting them in compulsions there are repetitive motor behaviors or mental heads so somebody washes their hands ten times that is a behavior mental act like the first case he was praying to blood ganesha so it is a mental act it's a mental compulsion because nobody can see it so it can be something that is seen or something that is non-sleep and the compulsion is aimed at preventing or reducing the distress so i'm getting very anxious because of my obsession in order to reduce my anxiety i will engage in a compulsion right what are the forms of obsession so a doubt form means in what way does it present a doubt that means an inclination not to believe that a completed task has been accomplished satisfactorily so i have a doubt did i put off the gap did i close the door and this repeatedly comes in my mind this boy feels did i wear my clothes in the particular perfect way or not thinking what will happen of the future a seemingly endless thought change usually pertaining to future events or metaphilosophical god why is the sky blue you know so this metaphor there is no answer to that but this thought will repeatedly resonate in the child's mind and impulse like this boyfriend a powerful urge to carry out an action which may be socially disruptive or even assaulted i feel like hitting somebody he would say he wouldn't get or a fear a fear of losing self-control so i fear that i might blurt out an obscene world i fear that i might say a very wrong word to somebody or i might cut or i might abuse something an image like i said might just be an image a persistence before the mind's eye or something usually others may view a few or a game or a song these are the forms of what is there are two types of compulsions so one is yielding so that means i feel if i touch my table my hand is dirty i will wash my hands there is a direct connection because washing off hands will make me make my hands feel so i have yielded to my obsession versus that boy feels that another boy feels that because i have attached something dirty i have to say a prayer so there is no direct connection between his compulsion and between his obsession so that's called a controlling compulsion so yielding is when you can trace back to the obsession and understand the reason controlling his back you're facing back and trying to figure out why is he praying but you cannot get a connection that will be a controlling comfort what are the common ocd symptoms in children specifically in obsession contamination which increased big time during forward of course harm to self or others aggressive teams very very common in adolescent succession sexual themes again very common in adolescence religiosity excess religiosity you know keep praying keep praying etc forbidding thoughts sexual thoughts may be a time system symmetry you know i need my you know cover to be exactly like this if it is like this i get disturbed need to tell me to ask or need to confess this is very common in younger children so when the child says mama what is like you know what is my name the mother has to say the name and she has to say it in that particular way otherwise the child doesn't be satisfied and the mother has to say it seven times example to make the child feel better the mother says it five times it's not enough you need to tell me to ask for me to contact in compulsion like i said there will be yielding and controlling so the yielding ones are washing cleaning repeating like this boy hand checking touching you know some kids have this compulsion of touching they'll come and touch counting every now and then ordering holding with just collecting materials is often a mental compulsion so it's a controlling compound obsessive thoughts and washing most often it's the most common symptom in 85 of cases we generally see obsessive thoughts and washing repealing rituals needing to be perfect you know perfectionism i want my room in this particular way otherwise i get irritated checking in about 46 percent ordering arranging and symmetry in 17 takes four to six months there is a study that was that move that we takes four to six months before the parents become aware of the symptoms so parents won't become aware that i'll try to hide it or the parents have given some other names this kind of secretiveness leads to long time before the diagnosis so they don't come as soon as they are facing the problem they'll come only after some months and it will become superior in these sexual and religious obsessions especially kind of you know sexual and religious obsessions are very common in teenagers and one particular symptom which differs from adult ocd these symptoms change so i had a case every two three months her obsession would change in adult ocd the obsessions and compulsions remain relatively stable but in childhood ocd there is a common known fact that the symptoms will change over time so every exacerbation they may present with a different patient what are the symptoms in school withdrawal from activities and friends so they don't want to make they don't want to do the things they're withdrawing from magical thinking this means you know if i tap my hand three times if i clap three times today i will do well in my face you know some kind of unrelated thing if i do this it will help you to do this there is no connection between the two in some ways like a superstition but this is more related to it it's a little difficult to explain how to differentiate between the loop re-reading and rewriting repetitively looking for neatness holes in the paper which is again common in three things especially those when you're bored they have this habit of re-eating these items repetitive behavior fear of doing wrong or having done wrong these are the symptoms that can be used too then i uh you're on medical school so i'm sure all of you so my presentation won't be completely let's take a little bit about this but though this belongs to neurology there is a close connection with pandas and ocd so neurologists treat pandas but when i see a child with ocd i have to rule out pandas first ocd or tech disorder so in this pediatric concept in young childhood episodic course and associated with a positive infection initially so many times if i asked the parent was he ill before these symptoms started or the parents were saying it all began with a viral infection he was all right he started having a poor [Music] neurological abnormalities so this is what we have to rule out before starting our health then sometimes some symptoms of ocd can be induced by certain medications like amphibians which are drugs that we take for very few antipsychotics some of our antipsychotics this is something that you need to ask the parent is the child or any prompter disorder which makes it even more that difficult to diagnose ocd because adhd is very visible the opposition defined that means that behavioral recovery is so accurate that the ocd will not be seen or noticed anxiety disorders many of these kids have anxiety produced as a result one important concept that you must understand parents siblings etc whoever is at home participate in others that means you [Music] so i keep repeating i keep yielding it and i keep giving that answer to myself i let him wash his hands for one hour two hours because i know that will help my channel you think that you are helping the child the parents think that they are helping their child so this is called family accommodation where some of these answering them not limiting their time consuming power so this is something that we need to keep in mind we have to get an idea of what the family is doing at home and then help them in some places that's why family therapy is needed because you need to also explain to the family of what they can do what is not obvious so development three-year-olds they is i have a three-year-old and many times you know i as a child are obviously over diagnosed when i keep thinking my child is going to grow up and become more serious because he has he does show some behaviors elaborate bedtime rituals he wants to think in a particular way would want him you know perfectly has an obsession for cleanliness you know if anything is little dirty also wants to wipe it immediately but that's the developmental thing i'm quite sure with it and i hope repetitiveness will show these kind of obsessive compulsive behaviors but that is part of their normal development most of them will but it's not causing any severe discomfort so we have some of them who were anxious being anxious that's why you know so again coming to the last part what is the treatment how do you treat it so like i said before in motor club answer this question correctly the combination of two things cognitive behavior therapy and medicine so i'll tell you a little about both of them not too much in detail but a little lucky so if you do pbt alone what happens cbt is definitely effective and it is a durable treatment for ocd however if we go for medication alone however much you tell parents that the drug cannot be stopped without medical advice most of them the chances has [Music] work extremely and you need at least 10 to 12 weeks at the highest toleration however we know that there is box you know again we take into account the benefits where most of us would willingly start all ssris are equally effective the choice [Music] [Music] is that on certain drugs they have given a warning that says that there is a risk and that this is uh for a heavier sinuses so they say ssris have a black cross bonding because it can induce suicidal risk in children yes so actually yeah that's you know a dilemma because here we use safari to treat depression but however the black box bonnie is that esoteric themselves can include uh suicidal ideas again it's a black box warning tool we generally go by pencil straight so if a child already has these we [Music] you can switch between various drugs you can augment again what very simple to understand that means you expose the person to the desire you expose it so it suffers and i'll give you an example of the patient who says you know once i touch the table i think i will develop the way we started we will slowly expose the patient through the fear of this like something will actually make him is is [Music] situations again one important concept is is oh my god or any medicine [Music] there is young children [Music] is thank you very much dr manchi for that comprehensive and exhaustive talk on ocd i believe as you said most times ocd and children might be misdiagnosed which actually ends up leading to a delay in treatment that's causing more anxiety to both parents and the child himself for herself and also the role of family accommodation and reinforcing sickness which is actually going to lead to a poor outcome was something new and different which i'm sure like most of us were not aware so once again thank you so much ma'am for this wonderfully enriching talk uh do we have any questions amongst the audience members uh if if i like there are a couple of questions can i read them repeatedly five to six times before going to sleep is that an ocd symptom see again i have to check what are the other things [Music] questions uh the next question is by dr sharon who's asking if treatment is appropriately started by what age will you be able to see the controlling of symptoms of ocean like what is this [Music] that's if you're doing both pbt and [Music] right and uh my doctor sunil is asking is there any indication of any herbal medicine for ocd has there any have there been any studies who won't say yes or no because obviously a lot is asking what are the common sexual thoughts which are considered to be ocd so in sexual parts normally you know a picture or you know as though they you are with somebody else having excess sexual urges in their mind wanting somebody else imagining different kinds of meditation foreign if a patient is minor and if parents refuse pharmacotherapy for the child so can cbt just cptp enough for an ocd uh child or do we have to start pharmacotherapy we obviously can't cause point uh and one last question uh what is the relationship of phobia with ocd is there any relationship between the two um [Music] so i don't think we have any more questions so thank you so much dr manjari for that really informative talk i think all of us have learned way more annocity on in children especially than what we knew one hour ago so thank you so much

BEING ATTENDED BY

Dr. Murtuza Zozwala & 760 others

SPEAKERS

dr. Manjiri Deshpande

Dr. Manjiri Deshpande

Consultant Psychiatrist and Head at Indlas Child Guidance Clinic and Indlas Mind Clinic

+ Details
dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

+ Details
dr. Manjiri Deshpande

Dr. Manjiri Deshpande

Consultant Psychiatrist and Head at Indlas Ch...

+ Details
dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

+ Details

About Medflix

Medflix is a new platform by PlexusMD, India's most active and trusted doctor community. On Medflix, you can discover live surgeries, discussions, conferences and courses from some of the top doctors and institutions across the world. Join clubs in your areas of interest and access hundreds of amazing live discussions everyday.