Re: Tourettic OCD in 9 year old boy

January 26, 2010

Hi, Ivan. My daughter has been diagnosed with ocd and tourettes.

She is almost 13 and was diagnosed with ocd at 6 yrs old, and a tic

disorder a few months later. She didn't develop the vocal tics for

about another year. She also claims to not have an actual obsession,

but just a " weird " or " bad " feeling or not " feeling right " . I think

this is sometimes called " just right " ocd. We have also been unable

to separate rituals from tics. Her doctor has told us this is common

in a diagnosis of ocd with tourettes or tics. For her, I believe

that her problem is really more tic related, with anxiety thrown in.

I know that she has ocd, as she has some issues with confessing, and

lots of responsibility issues, but I think that these things take a

backseat to the tics, which as I understand it, are pretty much a

physical reaction that can not be controlled. We have done some

habit reversal therapy for tics, with moderate success. My daughter

also takes zoloft, but we did not see a dramatic change in her

behavior/symptoms until we added tenex. It was like a miracle.

While she has had some mild tics over the years, they have been

manageable and fleeting, and her quality of life shot back up to

where it was before this disorder began. She was a little sleepy

when first starting the meds, but she adjusted to that quickly. She

is definitely not sedated. The tenex has actually been helpful also,

in that is counteracts some of the activating effects of the zoloft.

I strongly suggest you give the tenex a try. My daughter takes 3/4

of a 1 mg tablet in the a.m and one at about 6 in the evening. Start

out slow and see what happens. You can always stop the tenex, if it

doesn't seem to be working, but from reading this post, I have the

feeling that it could be very helpful. Good luck to you and your son.

> New member here. My son Jake has been diagnosed with fairly severe

> OCD starting end of Sept '09. (Jake's OCD may have been catalyzed

> by watching his sister go through a disturbing depression at around

> the same time -- which in itself was possibly due to my wife's

> battling a brain tumor. Talk about a domino effect!

>

> Anyway, Jake's OCD is not " classic " in that 1) his repetitive

> behaviors have no discernible " trigger " and can happen anywhere and

> at any time(i.e.: no fears/anxiety about contamination, harm,

> confessing, bad thoughts etc.); 2) He doesn't feel actual

> obsessional anxiety when confronted by the OCD, only feeling

> " weird " , which can last for hours sometimes if he doesn't perform

> the ritual; and 3) his rituals seem to overlap with tic-like

> behavior (throat clearing, pointing while saying " Oh yeah " ) In

> addition, although never formally diagnosed with ASD, Jake may have

> a " touch " of Aspergers.

>

> Jake has tried to engage in ERP therapy without meds, (Brady Case,

> M.D. out of NYU Child Study program in Hackensack) but couldn't.

> When he did seemingly perform the ERP, he said it was only

> " pratice " and not " real life " so that the habituation process

> really never happened. Dr. Case then put Jake on Zoloft about 8

> weeks ago and Jake is currently up to a dose of 150mg. The 150 mg

> has been for about 1 week. We have not seen any imporvement of

> symptoms although we have been told that we need to try an SSRI at

> the responsive dose for 8-10 weeks for OCD.

>

> Mansueto, PhD out of the Washington D.C. area has written

> about a subset of OCD called " tourettic OCD " which seems to fit

> Jake like a glove. Some the treatment implications of tourettic OCD

> is that it generally does not respond as well to SSRIs and it

> generally does not respond as well to classic ERP and the cognitive

> behavior therapy may have to be tweaked.

> Does anyone have kids with this harder-to-treat subtype " tourettic

> OCD " and if so, what treatments have worked? Any providers who

> specialize in this subset in the New York City tri-state area? Our

> treating psych has suggested that we contemplate augmenting the

> Zoloft with either an alpha agonist (Clonidine or Tenex) or an

> atypical antipsychotic in low doses. We really don't want to sedate

> Jake (either augmenting med) or expose him to the potential insulin

> resistance that may accompany the atypical antipsychotics but he is

> really in distress.

>

> To say the least we feel overwhelmed and would appreciate any

> experience/wisdom/comments. Sorry for the long post.

>

> Ivan

>

January 27, 2010

Ivan,

I'm so sorry to hear about all your family has been going through. It certainly

does sound like a domino effect. I don't know anything about Tourettic OCD, but

I do know that SSRIs often take longer than a week at an effective dose to show

significant improvement. I imagine you may find someone on the listserve who

can provide information or you might try contacting Dr. Mansueto himself to see

if he can recommend anyone in your area.

I'm glad you found us.

(mom with OCD, 9 yo daughter w/OCD)

>

> Subject: Tourettic OCD in 9 year old boy

> To:

> Date: Tuesday, January 26, 2010, 10:34 PM

> New member here. My son Jake has been

> diagnosed with fairly severe OCD starting end of Sept '09.

> (Jake's OCD may have been catalyzed by watching his sister

> go through a disturbing depression at around the same

> time -- which in itself was possibly due to my wife's

> battling a brain tumor. Talk about a domino effect!

>

> Anyway, Jake's OCD is not " classic " in that 1) his

> repetitive behaviors have no discernible " trigger " and can

> happen anywhere and at any time(i.e.: no fears/anxiety about

> contamination, harm, confessing, bad thoughts etc.); 2) He

> doesn't feel actual obsessional anxiety when confronted by

> the OCD, only feeling " weird " , which can last for hours

> sometimes if he doesn't perform the ritual; and 3) his

> rituals seem to overlap with tic-like behavior (throat

> clearing, pointing while saying " Oh yeah " ) In addition,

> although never formally diagnosed with ASD, Jake may have a

> " touch " of Aspergers.

>

> Jake has tried to engage in ERP therapy without meds,

> (Brady Case, M.D. out of NYU Child Study program in

> Hackensack) but couldn't. When he did seemingly perform the

> ERP, he said it was only " pratice " and not " real life " so

> that the habituation process really never happened. Dr. Case

> then put Jake on Zoloft about 8 weeks ago and Jake is

> currently up to a dose of 150mg. The 150 mg has been

> for about 1 week. We have not seen any imporvement of

> symptoms although we have been told that we need to try an

> SSRI at the responsive dose for 8-10 weeks for OCD.

>

> Mansueto, PhD out of the Washington D.C. area has

> written about a subset of OCD called " tourettic OCD " which

> seems to fit Jake like a glove. Some the treatment

> implications of tourettic OCD is that it generally does not

> respond as well to SSRIs and it generally does not respond

> as well to classic ERP and the cognitive behavior therapy

> may have to be tweaked.

> Does anyone have kids with this harder-to-treat subtype

> " tourettic OCD " and if so, what treatments have worked? Any

> providers who specialize in this subset in the New York City

> tri-state area? Our treating psych has suggested that we

> contemplate augmenting the Zoloft with either an alpha

> agonist (Clonidine or Tenex) or an atypical antipsychotic in

> low doses. We really don't want to sedate Jake (either

> augmenting med) or expose him to the potential insulin

> resistance that may accompany the atypical antipsychotics

> but he is really in distress.

>

> To say the least we feel overwhelmed and would appreciate

> any experience/wisdom/comments. Sorry for the long post.

>

> Ivan

>

> ------------------------------------

>

> Our list archives feature may be accessed at:

http://health.groups.yahoo.com/group//

> by scrolling down to the archives calendar . Our links

> may be accessed at http://health.groups.yahoo.com/group//links

> . Our files may be accessed at

> http://health.groups.yahoo.com/group//files

> .

> Our list advisors are Gail B. , Ed.D.(http://www.ocdawareness.com ),

Tamar Chansky, Ph.D.( http://www.worrywisekids.org ), and Dan Geller, M.D. (

> http://www.massgeneral.org/doctors/doctor.aspx?ID=18068

> ). You may ask a question of any of these mental health

> professionals by inserting the words " Ask Dr.(insert name) "

> in the subject line of a post to the list. Our list

> moderators are Castle, Judy Chabot, BJ Closner, and

> Barb Nesrallah. Subscription issues or

> suggestions may be addressed to Louis Harkins, list

> administrator, at louisharkins@...

> . Our group and related groups are listed

> at http://health.groups.yahoo.com/group/ocdsupportgroups/links

> . IOCDF treatment providers list may be viewed at

http://www.ocfoundation.info/treatment-providers-list.php

> .

> NLM-NIH Drug Information Portal may be viewed at

>

http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp?APPLICATION_NAME=drugporta\

l

> . IOCDF recommended reading list may be accessed at

http://www.ocfoundation.org/Books.aspx . IOCDF

> glossary of terms may be accessed at http://www.ocfoundation.org/glossary.aspx

> . IOCDF membership link may be accessed at

http://www.ocfoundation.net/membership/ . Drugs.com

> pill identification wizard may be accessed at

http://www.drugs.com/imprints.php . Mayo Clinic

> Drug and Herb Index may be accessed at

http://www.mayoclinic.com/health/drug-information/DrugHerbIndex

> .

January 27, 2010

Ivan,

Have you explored the possibility of PANDAS? My dd's ocd is exactly as you

describe Jake's. She feels a need to repeat (till it feels normal) but has

no obsession to go with it. Our last psychologist suggested PANDAS and I

began researching it this fall, after seeing my dd suffer off and on for 3

years. When I read " Saving Sammy " , I was convinced as her behaviors were so

similar to his. We've since started her on Augmentin XR as well as

Zithromax and her symptoms are slowly abating over time. It's been 2.5

months since she started them. She has gone from crisis mode to enjoying

many parts of her day. She still struggles daily with reassurance questions

and some repeating behaviors but the improvement has been drastic and I'm

convinced that one day she'll be cured.

I keep harping about it on this board when new members join because I'd hate

for anyone to miss checking out this possibility. A great place to research

and ask questions is www.latitudes.org

Often SSRIs do not work for kids with PANDAS. PANDAS can also cause

attention issues and these kids have a difficult time working through

exposures.

Please look into it.

January 30, 2010

--

Thanks for the response. I'm so happy for you and your daughter that she's doing

much better. Questions: Did your daughter try exposure-response prevention

therapy at any time, either before or after the meds? If so, did the meds help

her engage in this therapy? You mentioned habit-reversal therapy as not being

much of a help. Was this attempted before or after the meds? How long has your

daughter been on Tenex? How long do you plan on keeping her on the Tenex?

Thanks again,

Ivan

-------------- Original message from Quattlebaum :

--------------

> Hi, Ivan. My daughter has been diagnosed with ocd and tourettes.

> She is almost 13 and was diagnosed with ocd at 6 yrs old, and a tic

> disorder a few months later. She didn't develop the vocal tics for

> about another year. She also claims to not have an actual obsession,

> but just a " weird " or " bad " feeling or not " feeling right " . I think

> this is sometimes called " just right " ocd. We have also been unable

> to separate rituals from tics. Her doctor has told us this is common

> in a diagnosis of ocd with tourettes or tics. For her, I believe

> that her problem is really more tic related, with anxiety thrown in.

> I know that she has ocd, as she has some issues with confessing, and

> lots of responsibility issues, but I think that these things take a

> backseat to the tics, which as I understand it, are pretty much a

> physical reaction that can not be controlled. We have done some

> habit reversal therapy for tics, with moderate success. My daughter

> also takes zoloft, but we did not see a dramatic change in her

> behavior/symptoms until we added tenex. It was like a miracle.

> While she has had some mild tics over the years, they have been

> manageable and fleeting, and her quality of life shot back up to

> where it was before this disorder began. She was a little sleepy

> when first starting the meds, but she adjusted to that quickly. She

> is definitely not sedated. The tenex has actually been helpful also,

> in that is counteracts some of the activating effects of the zoloft.

> I strongly suggest you give the tenex a try. My daughter takes 3/4

> of a 1 mg tablet in the a.m and one at about 6 in the evening. Start

> out slow and see what happens. You can always stop the tenex, if it

> doesn't seem to be working, but from reading this post, I have the

> feeling that it could be very helpful. Good luck to you and your son.

>

> > New member here. My son Jake has been diagnosed with fairly severe

> > OCD starting end of Sept '09. (Jake's OCD may have been catalyzed

> > by watching his sister go through a disturbing depression at around

> > the same time -- which in itself was possibly due to my wife's

> > battling a brain tumor. Talk about a domino effect!

> >

> > Anyway, Jake's OCD is not " classic " in that 1) his repetitive

> > behaviors have no discernible " trigger " and can happen anywhere and

> > at any time(i.e.: no fears/anxiety about contamination, harm,

> > confessing, bad thoughts etc.); 2) He doesn't feel actual

> > obsessional anxiety when confronted by the OCD, only feeling

> > " weird " , which can last for hours sometimes if he doesn't perform

> > the ritual; and 3) his rituals seem to overlap with tic-like

> > behavior (throat clearing, pointing while saying " Oh yeah " ) In

> > addition, although never formally diagnosed with ASD, Jake may have

> > a " touch " of Aspergers.

> >

> > Jake has tried to engage in ERP therapy without meds, (Brady Case,

> > M.D. out of NYU Child Study program in Hackensack) but couldn't.

> > When he did seemingly perform the ERP, he said it was only

> > " pratice " and not " real life " so that the habituation process

> > really never happened. Dr. Case then put Jake on Zoloft about 8

> > weeks ago and Jake is currently up to a dose of 150mg. The 150 mg

> > has been for about 1 week. We have not seen any imporvement of

> > symptoms although we have been told that we need to try an SSRI at

> > the responsive dose for 8-10 weeks for OCD.

> >

> > Mansueto, PhD out of the Washington D.C. area has written

> > about a subset of OCD called " tourettic OCD " which seems to fit

> > Jake like a glove. Some the treatment implications of tourettic OCD

> > is that it generally does not respond as well to SSRIs and it

> > generally does not respond as well to classic ERP and the cognitive

> > behavior therapy may have to be tweaked.

> > Does anyone have kids with this harder-to-treat subtype " tourettic

> > OCD " and if so, what treatments have worked? Any providers who

> > specialize in this subset in the New York City tri-state area? Our

> > treating psych has suggested that we contemplate augmenting the

> > Zoloft with either an alpha agonist (Clonidine or Tenex) or an

> > atypical antipsychotic in low doses. We really don't want to sedate

> > Jake (either augmenting med) or expose him to the potential insulin

> > resistance that may accompany the atypical antipsychotics but he is

> > really in distress.

> >

> > To say the least we feel overwhelmed and would appreciate any

> > experience/wisdom/comments. Sorry for the long post.

> >

> > Ivan

> >

>

January 30, 2010

Hi BJ--

I appreciate your response and I hope that your son is doing better. You

mentioned that it took about 6 months for his meds to reach a helpful level.

What meds/doage was he on? Jake has been on Zoloft for about 10 weeks now, and

he his psych dr. has slowly increased him to where is now on 150 mg (this dosage

for about 2 weeks). We really have not seen an improvement, and he still cannot

enage in the ERP therapy.

Take care,

Ivan

-------------- Original message from " svdbyhislove " :

--------------

Welcome, Ivan.

I'm not familiar with Tourettic OCD, but remember reading that Tourettes and

OCD, often go hand in hand. At one point, a psychologist diagnosed our son with

Tourettes, but I'm still not sure if that was correct, since those with OCD

often can have tics that come and go. Someone in here once shared the criteria

for Tourettes. Seems like they said the tics have to be ongoing for at least a

year in order for it to be considered Tourettes, which hasn't been the case for

our son.

Our son's current psychologist also thinks he might have mild Aspergers. It can

be hard to sort it all out sometimes. Especially when the disorders can share

traits.

It does seem that often treating kids who are comorbid can be much more

complicated.

I can share with you that the last time our son was put on meds, it took 6

months for him to reach a level that was helpful to him. But, we did notice

improvements along the way too. Are you noticing any improvement at all?

I thought the same as , that you could be dealing with some " just right "

OCD, when you describe that he doesn't have the typical anxiety attached. Our

son had some OCD that was like that. It actually seemed the easiest for him to

overcome with the ERP.

We had health issues in our family too, that were anxiety producing. It's

horrible when you already have a kid pre-wired with an anxiety disorder, in a

situation that is stressful. It just seems to make everything worse. I hope your

wife is recovering and okay now.

I can imagine that you are overwhelmed. It is the worst when they are really

suffering.

Have you found anything that helps him? For instance our son was able to

distract himself sometimes, with video games, his computer, or even TV, to get a

small break from the constant bombardment of thoughts.

Please keep in touch and let us know how things are going. I hope the medication

kicks in soon and you start to see an improvement. We usually noticed a

difference, from a med increase, within 2-3 weeks.

BJ

>

> New member here. My son Jake has been diagnosed with fairly severe OCD

starting end of Sept '09. (Jake's OCD may have been catalyzed by watching his

sister go through a disturbing depression at around the same time -- which in

itself was possibly due to my wife's battling a brain tumor. Talk about a domino

effect!

>

> Anyway, Jake's OCD is not " classic " in that 1) his repetitive behaviors have

no discernible " trigger " and can happen anywhere and at any time(i.e.: no

fears/anxiety about contamination, harm, confessing, bad thoughts etc.); 2) He

doesn't feel actual obsessional anxiety when confronted by the OCD, only feeling

" weird " , which can last for hours sometimes if he doesn't perform the ritual;

and 3) his rituals seem to overlap with tic-like behavior (throat clearing,

pointing while saying " Oh yeah " ) In addition, although never formally diagnosed

with ASD, Jake may have a " touch " of Aspergers.

>

> Jake has tried to engage in ERP therapy without meds, (Brady Case, M.D. out of

NYU Child Study program in Hackensack) but couldn't. When he did seemingly

perform the ERP, he said it was only " pratice " and not " real life " so that the

habituation process really never happened. Dr. Case then put Jake on Zoloft

about 8 weeks ago and Jake is currently up to a dose of 150mg. The 150 mg has

been for about 1 week. We have not seen any imporvement of symptoms although we

have been told that we need to try an SSRI at the responsive dose for 8-10 weeks

for OCD.

>

> Mansueto, PhD out of the Washington D.C. area has written about a

subset of OCD called " tourettic OCD " which seems to fit Jake like a glove. Some

the treatment implications of tourettic OCD is that it generally does not

respond as well to SSRIs and it generally does not respond as well to classic

ERP and the cognitive behavior therapy may have to be tweaked.

> Does anyone have kids with this harder-to-treat subtype " tourettic OCD " and if

so, what treatments have worked? Any providers who specialize in this subset in

the New York City tri-state area? Our treating psych has suggested that we

contemplate augmenting the Zoloft with either an alpha agonist (Clonidine or

Tenex) or an atypical antipsychotic in low doses. We really don't want to sedate

Jake (either augmenting med) or expose him to the potential insulin resistance

that may accompany the atypical antipsychotics but he is really in distress.

>

> To say the least we feel overwhelmed and would appreciate any

experience/wisdom/comments. Sorry for the long post.

>

> Ivan

>

January 30, 2010

Kerry--

I hope your daughter is doing much better. Jake's OCD with tics did seem to

have a sudden onset but then again, he observed his sister go thpough a very

distubing major depression at around the same time. Jake's strep titers came

back normal, although some other members suggested that a negative titer doesn't

necessarily rule out PANDAS. Interestingly, Jake, in 2005, 2006 and 2007, had a

rapid and severe facial and head cellulities where half of his face literally

" blew up " and he had to be agressively treated with antibiotics. These

infections all ocurred in September of each year and September (in 2009) is

when we started to notice his OCD/tic symptoms. What I'm not sure of is if this

can still be PANDAS or some other autoimmune attack of his brain when the last

known infection ocurred 2 years beofre his sudden OCD/tics.

Thanks,

Ivan

--------- Tourettic OCD in 9 year old boy

To:

Date: Wednesday, January 27, 2010, 3:34 AM

New member here. My son Jake has been diagnosed with fairly severe OCD starting

end of Sept '09. (Jake's OCD may have been catalyzed by watching his sister go

through a disturbing depression at around the same time -- which in itself was

possibly due to my wife's battling a brain tumor. Talk about a domino effect!

Anyway, Jake's OCD is not " classic " in that 1) his repetitive behaviors have no

discernible " trigger " and can happen anywhere and at any time(i.e.: no

fears/anxiety about contamination, harm, confessing, bad thoughts etc.); 2) He

doesn't feel actual obsessional anxiety when confronted by the OCD, only feeling

" weird " , which can last for hours sometimes if he doesn't perform the ritual;

and 3) his rituals seem to overlap with tic-like behavior (throat clearing,

pointing while saying " Oh yeah " ) In addition, although never formally diagnosed

with ASD, Jake may have a " touch " of Aspergers.

Jake has tried to engage in ERP therapy without meds, (Brady Case, M.D. out of

NYU Child Study program in Hackensack) but couldn't. When he did seemingly

perform the ERP, he said it was only " pratice " and not " real life " so that the

habituation process really never happened. Dr. Case then put Jake on Zoloft

about 8 weeks ago and Jake is currently up to a dose of 150mg. The 150 mg has

been for about 1 week. We have not seen any imporvement of symptoms although we

have been told that we need to try an SSRI at the responsive dose for 8-10 weeks

for OCD.

Mansueto, PhD out of the Washington D.C. area has written about a subset

of OCD called " tourettic OCD " which seems to fit Jake like a glove. Some the

treatment implications of tourettic OCD is that it generally does not respond as

well to SSRIs and it generally does not respond as well to classic ERP and the

cognitive behavior therapy may have to be tweaked.

Does anyone have kids with this harder-to-treat subtype " tourettic OCD " and if

so, what treatments have worked? Any providers who specialize in this subset in

the New York City tri-state area? Our treating psych has suggested that we

contemplate augmenting the Zoloft with either an alpha agonist (Clonidine or

Tenex) or an atypical antipsychotic in low doses. We really don't want to sedate

Jake (either augmenting med) or expose him to the potential insulin resistance

that may accompany the atypical antipsychotics but he is really in distress.

To say the least we feel overwhelmed and would appreciate any experience/wisdom/

comments. Sorry for the long post.

Ivan

January 30, 2010

Hi, Ivan. He is currently on 60 mg of Celexa, which doesn't sound like much

compared to the 150 mg of Zoloft, but the mgs per dosage is not the same for the

two meds. For Celexa, that is considered the max (according to some docs).

It took 6 months for him to stabilize on the meds and reach maximum benefit

because we took it slowly, trying to find the right dosage without over

medicating. As we were slowly raising the dosage (usually 10 mg at a time) we

saw improvements all along. It got gradually better. Sometimes it was minute

improvements, so we would have to up it again. We usually waited for 3-4 weeks,

after an increase, to see how he responded. Then when he got to 60 mg, we sat

there for a while to see how he did. He was doing ERP therapy through most of

that too, so was receiving the benefit of that too. Eventually, the two

together worked.

I was just reading in Aureen Wagner's book that if they reach maximum dosage, it

is recommended that they wait for 4-6 weeks before deciding the medication is

not working.

For some, they have to try different medications because one won't work for

them, but another does. We were lucky that the first one we tried, worked.

It's all so individual, unfortunately. Wouldn't it be nice if there were

concrete answers that worked for everyone. <sigh>

I know it is really rough during that wait. I'm so sorry you are in that place.

We've been there more than once and it is the worst!

Is there anything you can do to help distract him? Electronics helped our son,

sometimes. Video games, his computer, even the TV would help sometimes. I got

pretty good at Kart. <grin> We even played marathons of board games to

try to keep his mind occupied, while waiting day after day for the meds to

finally kick in. On the especially rough days, he would sometimes need to take

Klonipin too, to cope. So many days I felt like I could finally breath again,

when he would go to sleep. I knew his mind was at rest and I could relax a

little.

I hope the med kicks in for you soon.

BJ

> >

> > New member here. My son Jake has been diagnosed with fairly severe OCD

starting end of Sept '09. (Jake's OCD may have been catalyzed by watching his

sister go through a disturbing depression at around the same time -- which in

itself was possibly due to my wife's battling a brain tumor. Talk about a domino

effect!

> >

> > Anyway, Jake's OCD is not " classic " in that 1) his repetitive behaviors have

no discernible " trigger " and can happen anywhere and at any time(i.e.: no

fears/anxiety about contamination, harm, confessing, bad thoughts etc.); 2) He

doesn't feel actual obsessional anxiety when confronted by the OCD, only feeling

" weird " , which can last for hours sometimes if he doesn't perform the ritual;

and 3) his rituals seem to overlap with tic-like behavior (throat clearing,

pointing while saying " Oh yeah " ) In addition, although never formally diagnosed

with ASD, Jake may have a " touch " of Aspergers.

> >

> > Jake has tried to engage in ERP therapy without meds, (Brady Case, M.D. out

of NYU Child Study program in Hackensack) but couldn't. When he did seemingly

perform the ERP, he said it was only " pratice " and not " real life " so that the

habituation process really never happened. Dr. Case then put Jake on Zoloft

about 8 weeks ago and Jake is currently up to a dose of 150mg. The 150 mg has

been for about 1 week. We have not seen any imporvement of symptoms although we

have been told that we need to try an SSRI at the responsive dose for 8-10 weeks

for OCD.

> >

> > Mansueto, PhD out of the Washington D.C. area has written about a

subset of OCD called " tourettic OCD " which seems to fit Jake like a glove. Some

the treatment implications of tourettic OCD is that it generally does not

respond as well to SSRIs and it generally does not respond as well to classic

ERP and the cognitive behavior therapy may have to be tweaked.

> > Does anyone have kids with this harder-to-treat subtype " tourettic OCD " and

if so, what treatments have worked? Any providers who specialize in this subset

in the New York City tri-state area? Our treating psych has suggested that we

contemplate augmenting the Zoloft with either an alpha agonist (Clonidine or

Tenex) or an atypical antipsychotic in low doses. We really don't want to sedate

Jake (either augmenting med) or expose him to the potential insulin resistance

that may accompany the atypical antipsychotics but he is really in distress.

> >

> > To say the least we feel overwhelmed and would appreciate any

experience/wisdom/comments. Sorry for the long post.

> >

> > Ivan

> >

>

January 31, 2010

Ivan:

Did they say what caused the facial celluities? It appears the most common cause

of it is strep or staph infections. It still sounds like PANDASÂ to me. I'll

keep you posted on whether or not the antibiotics work. As far as I know my

daughter has not had any strep infection since the OCD came out. She did have a

Chicken pox vaccine on 12/1/ and the tics started shortly thereafter. From what

I understand, the antibiotics may still work even though we now have been

dealing with this for over a year and are just starting antibiotics and

steroids.

Kerry Â

From: ivanchai2 <i.diamondatt (DOT) net>

Subject: Tourettic OCD in 9 year old boy

To: @ yahoogroups. com