Mount Sinai Establishes New Tic and Obsessive-Compulsive Disorders Division
The Department of Psychiatry at Mount Sinai recently opened a new Division of Tic, Obsessive-Compulsive, and Related Disorders (DTOR) to treat patients and investigate the causes of Obsessive-Compulsive Disorder (OCD), tics and Tourette’s Disorder (TD). As part of the translational research program, faculty and staff will have the capacity to both treat patients and conduct clinical trials within the same space. The offices are located in a renovated space at 1240 Park Avenue, on 96th Street.
Clinical researchers at the DTOR will study obsessive compulsive disorders (OCD) and tic disorders and their relationship to each other using a variety of approaches, ranging from genetic analyses to functional brain imaging. Current studies aim to identify specific genetic factors that play a role in the inheritance of tics, Tourette’s disorder (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 DTOR also aligns with a new category from the upcoming edition of the Diagnostic and Statistical Manual (DSM-5).
“The new division is in the vanguard of academic psychiatry because it embraces the concept that tics and OCD overlap and that these are life cycle disorders, not separate child and adult disorders,” said Wayne Goodman, MD, Chair of the Department of Psychiatry, the Esther and Joseph Klingenstein Professor of Psychiatry, and Chief of the DTOR. “We are among the first centers to put the new organization of DSM-5 into practice in a way that fosters an integrated approach to research and patient care.”
The DSM-5, which will be published in May 2013, provides a common language and standard criteria for the classification of mental disorders. The new edition 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 characterized by compulsive hair pulling, and Hoarding Disorder, which involves excessively collecting objects and other materials. Dr. Goodman serves as an advisor to a national committee that is responsible for this revision. “The DSM-5 is a major departure from the current DSM-IV wherein OCD is classified as an Anxiety Disorder,” he explains.
A variety of treatments are offered at the DTOR, which are tailored to the patient’s diagnosis, age, and severity of symptoms. For most children and adults, medication and cognitive behavioral therapy including exposure and response prevention or habit reversal, are effective interventions. 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. In the most severe and treatment-resistant cases of OCD, Mount Sinai specializes in Deep Brain Stimulation, a cutting-edge neurosurgical procedure that delivers electrical stimulation directly to the brain and is thought to affect behavior by modulating the patterns of neural activity. The DTOR is also investigating a novel medication for adults with treatment-resistant TD that is not available to the public.
“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 of the Obsessive-Compulsive and Related Disorders Program and Professor of Psychiatry.
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 type of tic disorder, is identified by repetitive involuntary movements and vocalizations, and affects approximately one percent of the U.S. population.
“Approximately one-third of children with Tourette’s disorder continue to suffer from severe symptoms in adulthood, and most Tourette’s patients also present with other psychiatric disorders including OCD and ADHD,” adds Barbara Coffey, MD, MS, Director of the Tics and Tourette’s Clinical and Research Program and Professor of Psychiatry.