Mount Sinai has officially opened a new center to treat and research tic and obsessive-compulsive disorders (OCD) in individuals of all ages. The opening coincides with a significant revision in the psychiatry field's manual of mental disorders, which will now recognize OCD with its own category, rather than classifying it as an anxiety disorder.
The center is operated by a new Division of Tic, Obsessive-Compulsive, and Related Disorders (DTOR), created by the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. The center is located in renovated space at 1240 Park Avenue on 96th Street, where a team of psychiatrists and psychologists see patients in a new clinical space. The patients also have access to ground-breaking clinical trials progressing just down the hall.
Obsessive-compulsive disorder (OCD) and tic disorders are known to be associated in many ways, including overlap of symptoms, genetic vulnerabilities, and neurobiological underpinnings. Both OCD and tic disorders may be associated with other problematic symptoms, such as mood, anxiety and behavioral difficulties, that need to be taken into account in comprehensive treatment planning.
"DTOR is in the vanguard of academic psychiatry because it embraces the concept that tic disorders and OCD frequently overlap and that these are life cycle disorders, not separate child and adult disorders," said Wayne Goodman, MD, Chairman of the Department of Psychiatry at Mount Sinai and Chief, DTOR. "We are among the first medical centers to put this important concept into practice in a way that improves patient care and research. DTOR also anticipates changes in the upcoming DSM 5 manual, which makes OCD, currently listed under anxiety disorders, a separate mental disorder category."
DTOR will offer treatments tailored to the individual's unique diagnosis, age and severity of his/her symptoms. The clinical team also seeks to identify any additional clinical or environmental factors that may contribute to symptom severity or treatment effectiveness in order to provide the most comprehensive and sensitive care.
Adjacent to the new clinical space, DTOR researchers will study OCD and tic disorders and their relationship to each other using a variety of approaches, ranging from genetic analyses to functional brain imaging. Adults with treatment-resistant Tourette's disorder (TD) will have access to a clinical trial of a promising medication currently used to treat seizures.
Other studies underway at Mount Sinai aim to identify specific genetic factors that play a role in the inheritance of tics, TD, and OCD; to evaluate changes in levels of a neurotransmitter called GABA in the brain of patients with TD; and to investigate changes in brain networks related to TD and OCD.
"The ultimate goal of our studying rare genes and their link to specific OCD and/or tic disorders is to identify new targets for treatment, whether pharmacological or behavioral, " says Dorothy Grice, MD, Chief, Obsessive-Compulsive and Related Disorders Program.
OCD, which is characterized by recurrent, unwanted and distressing thoughts (obsessions) and repetitive behaviors (compulsions), affects one to two percent of the U.S. population. TD, the most complex among the tic disorders, is identified by repetitive involuntary movements and vocalizations, and affects approximately one percent of the U.S. population.
Barbara Coffey, MD, MS, Director of the Tics and Tourette's Clinical and Research Program, gives one example of these co-existing disorders: "Approximately one-third of children with Tourette's disorder continue to suffer from moderate to severe symptoms in adulthood, and most Tourette's patients also present with other psychiatric disorders including OCD and ADHD."
In many children with OCD or tics, two different forms of cognitive behavioral therapy—either exposure and response prevention or habit reversal, respectively—are often effective interventions. Medical therapy is another option for some patients. In the most severe and treatment-resistant cases of OCD, a neurosurgical procedure called Deep Brain Stimulation (DBS) may be considered.
DTOR's clinical faculty of psychiatrists and psychologists includes world renowned specialists: Dr. Goodman; Dr. Coffey; and Dr. Grice.
New DSM 5 Category
Due out in May 2013, DSM-5, which provides a common language and standard criteria for classification of mental disorders, will include a separate category of disorders that contains OCD and so-called related disorders such as Body Dysmorphic Disorder, which involves repetitive body checking, Trichotillomania, which is compulsive hair pulling, and Hoarding Disorder. Dr. Goodman is an advisor to a national committee responsible for this revision, which is a major departure from the current DSM-IV wherein OCD is classified as an Anxiety Disorder.
The Mount Sinai Medical Center.