Hello,
I was last here in August when our daughter was hospitalized after a spike in her health anxiety OCD had her going to the ER several times a week in fear that she might be having a heart attack or pulmonary embolism (she is 24 and severely overweight but otherwise in good physical health). She subsequently spent nine days in residential care, but we pulled her out early because they seemed to be messing up her medications.
Since then she has been at home but is now wondering if she should be back in residential care. Her psych provider has stepped her up to 80 mg/day of Prozac; she is also getting buspirone and (hopefully on a temporary basis) clonazepam. Her symptoms were much lessened for about a month from late September to late October, but have since gotten worse again—she speculates that she was initially getting a lot of help from the clonazepam but that she has habituated to it—and her frequent ER trips have resumed. She has also taken to singing or humming frequently to reassure herself that she is breathing well.
Lynn says that she understands that the ER visits do not help in the long run, but that in between visits her anxiety builds and does not abate, and that eventually she feels compelled to choose between going to the ER and waiting to see if she is going to die. She was doing I-CBT with a therapist for a couple of months, but has now put it on hold because she was not finding it to help much; she feels too vulnerable to handle ERP at present.
On Tuesday she will be talking with her psych provider about a possible return to residential care, and also about possible further increases in her Prozac dosage (to 100 or 120.) We recently read a briefing prepared by a Dr Hudak at the University of Pittsburgh; he suggests that such high doses of Prozac are often needed to address treatment-resistant OCD. He also says that it can take 12-16 weeks to get the desired effect even at what turns out to be an effective dosage. I have encouraged Lynn to try to be patient while we continue to explore her medication options (augmentation with clomipramine or one of the atypical antipsychotics are also possibilities) but she understandably has difficulty with that prospect.
Mostly I am posting this just to share, but would also welcome some comment on the possibility of her returning to residential treatment. Lynn might well benefit from the additional structure that she would get from residential. She is also attracted to residential as an option because she thinks it would guarantee that someone would be on hand if she DID have a major medical event—this would reduce her distress and her impulse to go to the ER, but it seems to me as if it would be an accommodation of the OCD rather than a treatment, and perhaps just as much so as the ER visits. We are also concerned that this could again disrupt the continuity of her medication treatment.
In this context, can any of you recommend a residential program within 40-50 miles of Washington DC that might be appropriate for her? (No, we are not considering the Johns Hopkins $3000/day “Retreat”!). We are not necessarily looking for OCD-specific therapy offerings at the moment--although Lynn does want to do therapy work on her current underlying anxieties about adulthood and life direction, which she believes are making her OCD worse—but would like to be confident that she goes someplace that would manage her medication well and that has competent and compassionate staff. (For better or worse, Lynn is also pretty resistant to the idea of going into a program that puts a heavy emphasis on physical fitness.)
Finally, wondering if we should also/instead be seeking a consultation with a higher level OCD medical specialist at this point—maybe someone at Johns Hopkins, the Cleveland Clinic, or the Mayo Clinic—who might be able to provide more guidance on Lynn’s medication choices and possible residential care options.
All comments welcomed.
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