Psychiatry

Our Services

Our multidisciplinary team—including many leaders in their fields—takes a collaborative approach to personalizing care plans to treat obsessive-compulsive disorder (OCD), tics, and Tourettes syndrome. We start by performing in-depth assessments and diagnostic evaluations. We then provide evidence-based treatments, such as behavioral therapies and medication consultations, to help relieve the symptoms and address the underlying causes.

Tics, OCD, and Related Disorders Program

A tic is a repetitive motion, usually in the face, that you cannot control. If you or a loved one has an obsessive-compulsive disorder (OCD), tic, or Tourette syndrome, Mount Sinai can help. Our team performs an in-depth evaluation to diagnose your condition. Then we develop a comprehensive and personalized treatment plan for you or your loved one. We used the most advanced treatments, supported by the latest research. We may use behavioral therapies, medical treatments, or both.

Psychotherapy for OCD

The behavioral therapies we use most often include:

  • Exposure and response prevention (ERP or ExRP): Considered the gold standard for treating OCD, this approach targets the uncomfortable and distressing OCD thinking processes. We want to help our patients get rid of the repeated compulsions as well as the worries and fears that go along with them. ERP involves confronting fearful thoughts without performing the rituals linked to them. First, we map out all the OCD symptoms and the fears that are linked to them. We use ERP in an incremental way, starting with the least difficult ones up to the more difficult. Our therapist is there at all times. We also give patients homework so that they practice outside of the treatment sessions. This approach makes treatment move more quickly. Over time, patients learn to separate the obsessions and the anxiety. We call this process habituation. For ERP to be effective, patients cannot perform OCD behaviors during the therapy. This may be difficult, but it is also very effective.
  • Mindfulness: This approach helps patients learn to accept themselves and their condition. It enables patients to live in the moment, rather than worry about the future. It may involve writing scripts, imagining fearful thoughts, or using motivational techniques. Patients may use cognitive therapy at the same time.
  • Other Talk Therapies: Some patients benefit from discussing their feelings and thoughts about how their lives have been affected by living with OCD. We often use this type of therapy after ERP or medication treatment has helped control the active symptoms.

For your convenience, we offer psychotherapy sessions both on site, and with home visits as a part of our treatment services.

Medications for OCD

The most effective medications in the treatment of OCD are serotonin reuptake inhibitors (SRIs). At Mount Sinai, we tend to use a type of SRIs called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, sertraline, and fluvoxamine. Serotonin is a chemical messengers, called a neurotransmitters. It helps nerve cells (neurons) to communicate with each other. We also use SSRI medications to treat depression; studies have shown that they work well whether the OCD patient is depressed or not. Clomipramine is an older SRI medication that helps with OCD. We sometimes use it along with SSRI treatment.

Deep Brain Stimulation for OCD

If medication does not help, we can use deep brain stimulation (DBS). DBS is a state-of-the-art surgical procedure that we use with Parkinson’s disease and tremors. It uses electrical impulses to control symptoms. It works with several neurological, neuropsychiatric, and psychiatric disorders. The U.S. Food and Drug Administration has approved use of DBS for patients who aren’t helped by other approaches. DBT involves implanting electrodes in certain regions of the brain. Then we stimulate those electrodes. Research shows that this treatment can reduce the frequency and severity of OCD symptoms.

Tics and Tourette Disorder

Diagnosing tics, including Tourette disorder, can be difficult. We start by doing a comprehensive evaluation and medical history. We ask about early development, educational and occupational histories, social development, medical conditions, and previous treatments. We may also do a physical exam and imaging such as magnetic resonance imaging, a computed tomography scan, an electroencephalogram, or blood tests. If necessary, we may do a formal neuropsychological evaluation. This tests tells us about the patient’s learning style and cognitive development. Next we develop a personalized treatment plan. We use a variety of advanced treatments. These may include cognitive behavioral therapy and medication.

Treatments for Tics and Tourette Disorder

Our team offers a variety of approaches to treat active symptoms. The most common approaches are:

  • Comprehensive Behavioral Intervention for Tics (CBIT): This form of cognitive behavioral therapy targets active and difficult tic symptoms. It does not use medication. CBIT can decrease tic severity and intensity. It also gives you other, more acceptable movements or sounds to replace tics that are disruptive.
  • Individual psychotherapy: Talk therapy can help patients cope with Tourette disorder. Psychotherapy and general therapeutic talk therapy allows patients discuss and explore their feelings and thoughts. It helps them think about how their lives have been affected by Tourette syndrome. Sometimes, family therapy approaches can be helpful as well.
  • Other psychotherapies: Some Tourette patients experience anxiety, mood, or non-tic behaviors. We may suggest other types of psychotherapy to help. Examples might include dialectical behavioral therapy or therapies that address mood symptoms or improved interpersonal communication.

Medications for Tics and Tourette Disorder

We use several types of medication to reduce tic symptoms. The most common are:

  • Pimozide and haloperidol are approved by the FDA to treat Tourette syndrome. We use these drugs in low doses.
  • Medications designed to treat high blood pressure: Some alpha adrenergic agonists, such as guanfacine and clonidine, can have help with tics.
  • Neuroleptic medications: Medications such as aripiprazole and ziprasidone are antipsychotic medications that can help treat tics. We use these medications in low doses.

With any of these medications, we monitor you regularly for side effects and to make sure we are using the best dosage. We want to help you return to your regular routine.