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hp ocd bcc treatment

OCD: Differential diagnosis and screening questions

Here are the differential diagnoses and screening questions for OCD.

Differential diagnosis

  • The main differential diagnosis is depression and many patients with OCD have comorbid depressive symptoms.
  • Other differentials include phobic disorders, anorexia nervosa, obsessive or anakastic personality and occasionally schizophrenia.
  • The symptoms of OCD are seen in other conditions such as Tourette's syndrome, autism and frontal lobe lesions.
  • Obsessive-compulsive-related disorders (OCRD) and a range of disorders which share characteristics with OCD (e.g. in symptom profile, biology and treatment outcome).
  • OCRDs include body dysmorphic disorder (BDD - concerns of imagined ugliness), hypochondriasis (concerns about imagined illness), eating disorders and impulse control disorders such as trichotillomania (hair pulling).

 Screening questions for OCD*

  1. Do you have frequent unwanted thoughts that seem uncontrollable?
  2. Do you try to get rid of these thoughts and, if so, what do you do?
  3. Do you have rituals or repetitive behaviours that take a lot of time in a day?
  4. Do you wash or clean a lot?
  5. Do you keep checking things over and over again?
  6. Are you concerned with symmetry and putting things in order?
  7. Do your daily activities take a long time to complete?
  8. Do these problems trouble you?
  9. Does this behaviour make sense to you?

Non-psychiatrists who may be referred patients with OCD

Professional
Reason for consultation
GP Anxiety, depression
Dermatologist Chapped hands, eczema, trichotillomania
Cosmetic surgeon Concerns about appearance
Oncologist Fear of cancer
Genitourinary specialist Fear of HIV
Neurologist OCD associated with Tourette's syndrome
Obstetrician OCD in pregnancy
Gynaecologist Vaginal discomfort from douching

*These screening questions were compiled from the following articles:

  • El-Sayegh S, Bea S and Agelopoulos A. "Obsessive Compulsive Disorder: Unearthing a hidden problem". Cleveland Clinic Journal of Medicine (2003) 70, Number 10: 824-840
  • National Collaborating Centre for Mental Health commissioned by the National Institute for Health and Clinical Excellence. "Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder". National Clinical Practice Guideline, Number 31. Published by The British Psychological Society and The Royal College of Psychiatrists, Jan 2006
  • Heyman I, Mataix-Cols D, Fineburg N A. "Obsessive-compulsive disorder". BMJ (2006), 333: 424-429

 

training in the trust

Training at the Trust

Our Trust has a longstanding reputation for the delivery of high quality undergraduate and postgraduate medical education. 

We have over 100 postgraduate doctors in training, including foundation trainees, trainees in general practice (GP), and core and higher specialty trainees in psychiatry. Most services employ at least one trainee. Each trainee has an educational and clinical supervisor.  As well as regular meetings with their educational supervisor, trainees have weekly hourly meeting with their clinical supervisor. In addition, trainees receive training in the workplace and attend local educational programmes.

The Trust is a lead provider of training programmes in core psychiatry training and higher specialty training in general adult and old age psychiatry.  We are a local education provider for other higher specialty training programmes where the lead providers are the South London and Maudsley Foundation NHS Trust (for forensic psychiatry, child and adolescent psychiatry and the psychiatry of learning disability) and UCL Partners (for medical psychotherapy).

In addition, we host GP and foundation training posts on the South West London training programmes.  

Undergraduate medical students are based at St George's University of London, with over 250 per year being taught by our staff. Most Trust services host medical student attachments.

Benefits of training with us

These are some of the benefits of training in the Trust, as identified by our trainees:

  • Clinical experience in a variety of services at a range of sites
  • Experience of a wide range of specialties
  • Experience of different cultures and the impact of this on mental health
  • A variety of on-call experience - in the local community and Emergency Departments, and on the psychiatry inpatient wards
  • A specially tailored induction programme
  • The weekly Academic Programmes
  • The MRCPsych Course for core psychiatry trainees
  • Psychotherapy experience, including a weekly supervision group
  • Trainee social events
  • A mentorship programme for core psychiatry trainees
  • Trainee representation on various Trust committees

Our educational facilities

  • Postgraduate Centres - There are two main Postgraduate Centres within the Trust based at Springfield and Tolworth Hospitals. Each Centre has postgraduate staff who organise the academic programmes and support the local trainees.
  • Library facilities - Library services are provided for all staff to support evidence-based clinical care, education and training, and service development. All Trust staff are automatically members of the libraries.
  • Physical Health Skills Lab - The Physical Health Skills team provides a comprehensive range of training courses in physical health care within the Physical Health Skills Lab, including key mandatory courses for all staff. The aim of the team is to create a centre of excellence in physical skills training for staff. The Lab also has audio-visual equipment for filming that can be used for educational purposes.

Courses

All trainees will have a dedicated postgraduate training programme for their specialty. In addition, we run two multidisciplinary academic programmes which are open to all Trust staff and some specialties also run-specialty specific academic programmes.

Trainees can apply for study leave and funding to revise for postgraduate exams and to attend external training.

Simulation training

Simulation training is led by an experienced consultant and supervisor. All trainees undertake simulation training in a number of areas, including risk assessment and the management of medical emergencies. Trainees also have the opportunity to take part in simulation-based projects, such as the production of training videos, and to act as trainers for other staff.

Teaching opportunities

All Trust trainees get the opportunity to take part in teaching and training of other staff and students. In particular, we have close links with St George's University of London and over 250 medical students spend time training in the Trust every year.

We encourage our trainees to undertake training in teaching and presentation skills. We also ensure that all our higher specialty trainees undertake the training required to become an educational supervisor, as soon as they take up their first consultant post.

Management and leadership training

We encourage trainees to develop their management and leadership skills throughout their training. There are opportunities to undertake specific training and to participate in service improvement projects and audits within the Trust.

Research opportunities

We encourage trainees to gain research skills and experience. This can include participation in research projects, writing up projects for publication and poster presentations, and increasing skills in critical appraisal. Experienced clinical academics can support trainees in undertaking research and we have many examples of successful research publications and presentations by trainees in the Trust.

Trainee representation

We encourage trainee representation and involvement throughout the Trust. In particular, trainees are members of the Trust Medical Staff Committees and the Postgraduate Medical Education Committee. We also run a regular Trust-wide Trainees Forum to allow issues of interest to trainees to be discussed with Trust senior management.

Support for trainees

All trainees have access to support services both within and outside the Trust, including the Trust Staff Support Service and the London-wide Professional Support Unit.

mental health and exercise

Mental health and exercise

Physical health problems can often affect your mental health. The mind can’t function unless your body is working properly and the state of your mind affects your body. To work properly, your body needs regular exercise

Physical activity has many benefits, not only to you physical wellbeing but also for your mental well being.

Exercise can help in the treatment and prevention of many illnesses including Type II diabetes and osteoporosis. It also helps reduce the likelihood of contracting some cancers and can improve the immune system as well as lessening the likelihood of developing problems with memory and dementia.

Remember - Any exercise is better than none but don’t overdo it.  Build more physical activity into your life gradually, and remember to enjoy yourself.

How can physical activity help?

Physical activity and exercise can also help you to:

  • lose weight, especially fat
  • lower your heart rate and blood pressure so your heart doesn’t have to work so hard
  • reduce risk of heart diseas and improve circulation
  • reduced risk of falls and injuries from falls in older people
  • improve feeling of well being, reduce stress and feel more relaxed due to release of endorphins
  • improve concentration and focus increase energy levels
  • improve quality of sleep decrease anxiety and depression. -

Why should you take up exercise?

People take up exercise for many reasons:

  • For enjoyment – if you don’t know what you might enjoy, try a few different things
  • For social reasons - The companionship involved can be just as important as the physical activity
  • For the psychological benefits - it can help you to feel more competent, or capable and give you a sense of control over your life For physical health benefits
  • It can also help to boost your self confidence.

Top tips for increasing your activity level

Exercise doesn’t have to mean leggings, lycra, gyms or aerobics. There are many other ways to increase your activity levels.

  • Walking is free. - Take the dog to make it more interesting or take part in an organised walking group
  • Park at the far end of the car park
  • Get off the bus one stop earlier and walk
  • Use stairs instead of escalators or lifts
  • Exercise with others to make it more fun and sociable
  • Take part in more structured exercise
  • Try a new hobby like gardening or DIY

 

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