Caitlin Whyte (Host): This is Community Connect, presented by Tampa General Hospital. I'm Caitlin Whyte. And joining me is Dr. William Hudson, a child and adolescent psychiatrist at Tampa General Hospital. Dr. Hudson, welcome to the show.

Dr. William Hudson: Thank you.

Host: Can you start by telling us a little bit about your medical specialty and what types of conditions you treat, and also how you treat them as a child and adolescent psychiatrist?

Dr. William Hudson: Absolutely. So, I am a child and adolescent psychiatrist by training, meaning that I went to medical school and then did a specialty training, residency in General Psychiatry, and then subspecialty training specifically in Child and Adolescent Psychiatry.

On top of that, Psychiatry predominantly is about the medication management of mental health conditions, conditions of thought. That being said, part of being a psychiatrist is determine when it's appropriate to use medications, when it's not appropriate to use medications or in combination with other treatments such as psychotherapies.

Host: Now, we hear the terms Tourette's and OCD used in conversation, but what should people really know about those conditions?

Dr. William Hudson: So starting with OCD, I think a lot of people throughout the term in conversation, "Oh, my OCD made me do this. My OCD made me maybe clean my room." And that's not really, really accurate. That's more about a personality trait. That's something about who you are, that you want to be clean, you want to be organized. And what you said was OCD is really like an inner drawing to help you be who you are. What obsessive compulsive disorder is, is that's referring to these sticky, intrusive thoughts that are what we call ego dystonic. Meaning that this is not who you are. These thoughts are not who you are, and they're just kind of clouding your mind.

So OCD, it's more prevalent, it's more obvious to others when it's involving ritualistic behavior, something that other people can see, such as a hand washing routine that's repeated many, many times per day, and also much longer than the 20 seconds that would be recommended by the CDC. These rituals could be minutes or hours even. But it could also be internal. It could have these unpleasant thought loops of having to think about a certain thing or having to count a certain number of things. And there's always this sensation that something really bad will happen if you don't complete this mental exercise or this physical ritualistic behavior.

 OCD can be very distressful, very debilitating, especially if some of these rituals, the examples I just gave, are taking hours to complete, and school is being missed, work is being missed because of that. So, that is OCD in a nutshell. And that's what we are treating with a combination of therapy and/or medications.

Then, Tourette's is another one that I think is relatively misunderstood. Most people hear Tourette's and they think of somebody shouting curse words or sexually taboo words out in public. And that's called coprolalia. And that is probably the most infamous and stigmatized symptom of Tourette's. But it's only happening in about 10% of individuals who experience Tourette's. What it's better described as is a syndrome or condition of tics. And tics are involuntary, non-purposeful, often sudden movements of muscle groups, and sometimes that muscle groups involves the throat or the vocal cords, and therefore unintended sounds or vocalizations come out, and that gives rise to motor and vocal tics. So, Tourette's is a condition in which individuals experience both types of these tics for a year or more, on or off. We always want to emphasize that people experiencing tics, these are not purposeful, these are not intentional in any way. Most tics themselves are not harmful in and of themselves, but the social and emotional impact of having these involuntary movements or sounds can be very stressful. And that's why we work so hard to reduce the frequency and intensity of tics through both medications and/or therapy.

Host: Now, you practice at the Rothman Center for Pediatric Neuropsychiatry. Can you share more about this particular facility and what sets it apart from others?

Dr. William Hudson: Absolutely. So, we are a division of the Pediatric Department at the University of South Florida Morsani College of Medicine. So, we treat predominantly children and young adults, but we can see individuals throughout the lifespan. Our specialties include the Tourette syndrome we just discussed, obsessive compulsive disorders and similar anxiety disorders, trichotillomania or hair pulling; skin excoriation disorder, which is skin or nail picking; and other related anxiety disorders. These are our specialties because they have a common neuro-anatomical underpinning. But also, they have a very similar treatment modality, especially in terms of how it's treated with therapy, specifically exposure response prevention therapy.

So, it's a great team we have down at our office in St. Petersburg, Florida. On the therapy side, we have six PhD psychologists at any time, three of whom are attending. They are professors at the University of South Florida, and about three at any time or in their final years of subspecialty training after receiving their PhD in Psychology. And then, on my side of the clinic, there's myself as a child psychiatrist and medical director. We have a nurse practitioner, Rosalinda Tiongco, working under me as well. And then, the Child Psychiatry fellows from the University of South Florida, again, in their final years of subspecialty training, they also rotate through our site.

 So, the great thing about the Rothman Center is by having Psychology and Psychiatry under the same roof, we are able to treat individuals with either or both modalities. Because most conditions in mental health do best when you have both of those treatments combined. But some people aren't ready for one or the other initially. Sometimes a child is okay with taking the medicine but doesn't want to participate in therapy right away. Parents aren't comfortable with the ideas of medicine, at least initially, and want to start with therapy. So, we're able to work with people, whatever's most comfortable to them, and whatever can be most effective for them.

Host: And do you all do research as well at the Rothman Center?

Dr. William Hudson: We do. We are a site for clinical trials, for investigational medications. So, we treat Tourette's, for example, with medications that are currently available in the market. There's definitely a lot of room for opportunity for newer medicines that have either more effect and/or better side effect profile than what's out there currently.

 We just completed a clinical trial for ecopipam, which is a medicine to treat Tourette syndrome with a novel mechanism of action. And it's always exciting when there's a new mechanism of action because that means that individuals who didn't do well with currently available medicines, they may do better with a medicine that has a new mechanism. It also means that you could potentially combine this new medicine with other medicines in the past and treat the problem with multiple mechanisms at the same time for better effect. So, that was a clinical trial in phase III that recently closed.

We do have another clinical trial for a medicine for Tourette's syndrome we hope to open and in start enrolling patients in the coming months. That is gemlapodect or jem-luh-PO-dekt, I've heard it said multiple ways. Again, another medicine to treat Tourette's syndrome and with another novel mechanism of action different from ecopipam, different from anything else on the market. So, another exciting possibility for the treatment of Tourette's syndrome.

We're also soon hoping to open a clinical trial for a medicine to treat irritability and aggression in autism. Currently, there's only two medications on the market that have that FDA approval, risperidone and aripiprazole. This would be a third potential medicine in that family, lumateperone. It's not a completely different mechanism of action, but the way in which this medicine works and the way it binds to certain receptors in the brain and elsewhere in the body, it's different enough that it has a really attractive potential to being either better and/or more tolerated than the two that are currently on the market.

So, those are the two clinical trials we have coming online in the coming months. So if anybody is interested in those specifically, they're welcome to call us at our intake line, 727-828-6420. And that's for anybody who wants to consider working with us or being a patient at the Rothman Center. The same phone line goes directly to our front office, and we can take it from there.

Host: Wonderful. And my last question for you, Doctor, when prepping for this podcast, I was looking up the Rothman Center and saw a lot of the acronyms, PANDAS and PANS come up while doing my search. Can you tell us what those are?

Dr. William Hudson: Absolutely. So, PANDAS is a term for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. So, this was a, very rare disorder discovered in the late '90s, in which individuals who have recently had a strep throat infection will suddenly develop tic symptoms or obsessive compulsive disorder symptoms, like we just described a little bit earlier. And by suddenly, I mean, nearly overnight or within 24 to 48 hours. It's a very sudden, very dramatic presentation.

PANS is pediatric autoimmune neuropsychiatric syndrome. That's a newer term that kind of broadens the definition of PANDAS to also include the possibility of food avoidance or sudden food intake restrictions as one of the other symptoms that can occur suddenly, almost overnight. And PANS was chosen as a term because it also broadens the possibility of other entities besides strep infections as the cause of these conditions.

So again, we'd like to emphasize that these conditions are pretty rare and have a very abrupt onset. Sometimes it's hard to figure out if the OCD or the tic symptoms are caused by this or or what we would call, I guess, regular or typical OCD and tics, which we don't as well understand the mechanism of how those start. And it's kind of confounding because a lot of people get strep throat throughout childhood. So, sometimes these symptoms could be related, sometimes not. But that's what we're here to do. If there's any questions of this, people are welcome to give us a call, and we'll set up an evaluation, an appointment to discuss this.

PANDAS, PANS, it gives us the opportunity to use additional or different medication approaches for the treatment. But also, typical treatments and typical medications for tics and OCD, they also work regardless of the cause. So, it's something that gives us another opportunity to find an avenue for treatment.

Host: That has been Dr. William Hudson. For more information, please visit tgh.org. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect presented by TGH on your favorite podcast platform. I'm Caitlin Whyte, and this is Community Connect, presented by TGH. Thanks for listening.