Behavioral Health Bulletin
Issue 3, February 2022
In this issue we focus more on anxiety disorders, specifically obsessive compulsive disorder (OCD). Read on to learn about overcoming barriers with OCD, OCD during the pandemic, and reaching remission in adults with OCD.
Suspected Anxiety in a Pediatric Patient at the Next Mind Matters ECHO
 
During our upcoming Mind Matters ECHO on Wednesday, February 9, Dr. Carol Wurzel will share a case of a 13-year-old patient with symptoms of anxiety and depression for whom she is seeking a differential diagnosis and diagnostic clarification. Dr. Vanessa Litoff will then present on psychotherapy for anxiety management. Both presentations will be followed by group discussion and Q&A.
 
Interested in attending? Register here.
 
Are You Interested in Presenting a Patient Case?

Do you have a case related to a suspected or diagnosed anxiety disorder that gives you pause, raises questions, or you think is otherwise suited to quality discussion among your peers that you would like to present at an upcoming Mind Matters meeting?

Patient Behavioral Health Education Series
 
Cigna is offering the following series of webinars to help those in need of information and answers on autism, eating disorders, behavioral issues in children, and substance use disorder. The series is available to anyone in search of help. Even your patients with no connection to Cigna are welcome to participate.
 
Q1 2022 Webinars
 
February 22, 2022
 
March 10, 2022
 
March 16, 2022
 
March 17, 2022
 
March 22, 2022
Behavioral Health Tip of the Month
Overcoming Barriers with OCD
 
Obsessive-Compulsive Disorder includes obsessions (unwanted, intrusive thoughts, images, or impulses that feel beyond a person’s control) and compulsions (any thought or behavior intended to reduce anxiety). Some strategies to help overcome barriers to treatment:

Validate & Normalize
Anxieties and fears are often connected to the most valued aspect of a person’s life. Patients are not alone in what they’re experiencing and it’s not a representation of their character or who they are.

Build Awareness
Acknowledge symptoms as OCD to improve patient understanding of their experience and discuss actions and treatment options.

Instill Hope
Exposure and Response Prevention (ERP) and medications (SSRIs) are effective treatments for OCD.

The MSHP Behavioral Health Blog
A Holistic Approach to Suicide Prevention: Screening Limitations and Implications for Primary Care Providers

Predicting which patient will complete suicide has proven to be extremely difficult, as no statistical method to identify these patients has been found that would improve treatment.[1] While a variety of screening tools exist, screeners lack adequate specificity and sensitivity, and reliance upon them may result in false reassurance for false negatives, and unnecessary interventions for false positives. About half of all patients who die by suicide denied any suicidal ideation or behaviors at their last visit and about half of all completed suicides are by patients identified as “low risk.”[2] Given this reality, what can providers reasonably do to mitigate suicide risk among their patients?

[1] Large, et al. 2011 Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients. Acta Psychiatr Scand 2011: 124: 18–29 DOI: 10.1111/j.1600-0447.2010.01672. LeFevre, M.L. (2014). Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 160, 719–726.
Behavioral Health in the Literature
Remission in Adults with OCD

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. This paper investigates whether extending the course increased overall remission rates and which patient factors predicted remission. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.
Suicide Prevention is Preventive Care
Working Together Toward Zero Suicides

To aid you in our shared goal of zero suicides, here are actionable strategies to help you identify and manage patients who may be experiencing suicidality:
Behavioral Health in the COVID-19 Era
OCD and Anxiety in the COVID-19 Pandemic

The pandemic has caused substantial public health burden and widespread anxiety. The adverse mental health effects caused by COVID-19 may be particularly acute for individuals with obsessive-compulsive disorder (OCD). Negative effects of COVID-19 were more strongly linked to contamination and responsibility for harm symptoms than for other symptom dimensions. The self-identified OCD group also reported heightened concerns about COVID-19 compared to a community control sample.
Diversity, Equity, and Inclusion
 
A new group within the Department of Psychiatry has taken up the challenge of righting historic wrongs and making mental health care more diverse, equitable, and inclusive. Learn more.
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