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Biomedical subjects

E Hollander

Publications and source records attributed to E Hollander.

At least 19 recordsLinked to original sources
PubMed1997

Anterior cingulate gyrus volume and glucose metabolism in autistic disorder.

OBJECTIVE: This study reports the first paired measurements of glucose metabolism and volume of the anterior cingulate gyrus in autism. METHOD: Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans of seven high-functioning autistic patients and seven sex- and age-matched normal volunteers were coregistered. After the anterior cingulate gyri were outlined on the MRI images, the volumes of the structures were measured and corrected for brain volume. The volumes were then applied to the PET images and metabolic maps were obtained. RESULTS: Right anterior cingulate area 24' was significantly smaller in relative volume, and both area 24 and area 24' were metabolically less active, in the autistic patients than in the normal subjects. CONCLUSIONS: Autism may be characterized by structural and functional alterations in the anterior cingulate gyrus.

Adolescent↗
PubMed1997

Feeling unreal: 30 cases of DSM-III-R depersonalization disorder.

OBJECTIVE: In contrast to the recent surge of interest in other dissociative disorders, DSM-III-R depersonalization disorder has not been thoroughly investigated and characterized. The authors systematically elucidated its phenomenology, comorbidity, traumatic antecedents, and treatment history. METHOD: Thirty adult subjects (19 women and 11 men) were consecutively recruited and administered various structured and semistructured interviews as well as the self-rated Dissociative Experiences Scale. An age- and sex-matched normal comparison group was also recruited. RESULTS: The mean age at onset of depersonalization disorder was 16.1 years (SD = 5.2). The illness had a chronic course that was usually continuous but sometimes episodic. Severe distress and high levels of interpersonal impairment were characteristic. Unipolar mood and anxiety disorders were common, but none emerged as specifically related to the depersonalization. A wide variety of personality disorders was manifested; avoidant, borderline, and obsessive-compulsive were most common. Although not highly traumatized, the subjects with depersonalization disorder reported significantly more childhood trauma than the normal comparison subjects. Depersonalization had been typically treatment refractory; only serotonin reuptake inhibitors and, to a lesser extent, benzodiazepines had been of any therapeutic benefit. CONCLUSIONS: This study supports the conceptualization of depersonalization disorder as a distinct disorder with a characteristic course that is independent of mood, anxiety, and personality symptoms. A subtle relationship may exist between childhood trauma and depersonalization disorder that merits further investigation. The disorder appears to be highly treatment refractory, and prospective treatment trials are warranted.

Adolescent↗
PubMed1997

The neuroanatomy of 5-HT dysregulation and panic disorder.

The advent of highly effective antipanic medications with specific serotonin reuptake inhibition as a mechanism of action has prompted the need for new pathophysiological models of panic disorder. The authors attempt an integration of the emerging basic science literature regarding the neuro-anatomy and physiology of the mammalian central serotonin nervous system, its influence on neural substrates that underlie fear and defense responses, and the clinical literature pertaining to serotonin-related abnormalities in panic disorder. A neuro-anatomical model for the potential sites of action of the specific serotonin reuptake inhibitors in panic disorder is proposed.

Afferent Pathways↗
PubMed1997

A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale.

The authors developed the Yale Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS), a 12-item semistructured clinician-rated instrument designed to rate severity of body dysmorphic disorder (BDD). The scale was administered to 125 subjects with BDD, and interviews with 15 subjects were rated by 3 other raters. Test-retest reliability was assessed in 30 subjects. Other scales were administered to assess convergent and discriminant validity, and sensitivity to change was evaluated in a study of fluvoxamine. Each item was frequently endorsed across a range of severity. Good interrater reliability, test-retest reliability, and internal consistency were obtained. BDD-YBOCS scores correlated with global severity scores but not with a measure of general psychopathology; they were modestly positively correlated with depression severity scores. Three factors accounted for 59.6 percent of the variance. The scale was sensitive to change in BDD severity. The BDD-YBOCS appears to be a reliable and valid measure of BDD severity and is a suitable outcome measure in treatment studies of BDD.

Adult↗
PubMed1996

m-Chlorophenylpiperazine challenge in borderline personality disorder: relationship of neuroendocrine response, behavioral response, and clinical measures.

We have previously found that a subgroup of patients with impulsive personality disorders respond to m-chlorophenylpiperazine (m-CPP) administration with a distinctive spacy/high behavioral reaction and with increased cortisol responses. In this report we analyzed the relationship between behavioral and neuroendocrine responses to m-CPP in an enlarged sample of patients with borderline personality disorder (BPD). We also assessed the association of behavioral and neuroendocrine responses with clinical symptoms and with m-CPP blood levels. We found that in BPD patients the presence of a spacy/high behavioral response was significantly associated with increased prolactin and cortisol responses to m-CPP. In BPD patients increased m-CPP levels were significantly associated with neuroendocrine hypersensitivity and with a spacy/high behavioral response, while in controls increased m-CPP levels were not significantly associated with neuroendocrine hypersensitivity but were significantly associated with dysphoric behavioral responses. Taken together with previous work on m-CPP in obsessive-compulsive disorder, these results are partially consistent with the hypothesis that compulsive and impulsive symptoms fall at opposite ends of a phenomenologic and neurobiologic spectrum.

Adult↗
PubMed1996

Fluvoxamine versus clomipramine for obsessive-compulsive disorder: a double-blind comparison.

The efficacy and tolerability of fluvoxamine (100-300 mg/day) and clomipramine (100-250 mg/day) were compared in a randomized, double-blind, parallel-group study of 79 patients with obsessive-compulsive disorder (OCD) without coexisting major depression. After a 2-week placebo lead-in period, patients were randomized to fluvoxamine (37 patients) or clomipramine (42 patients) for 10 weeks. Efficacy was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive scale, and Patient and Clinical Global Improvement scales. Hamilton Rating Scale for Depression scores and somatic symptoms were also assessed. Seventy-eight percent of fluvoxamine patients and 64% of clomipramine patients completed the study. At the end of treatment, 56% of fluvoxamine patients were classified as responders (> or = 25% decrease in Y-BOCS score), compared with 54% of clomipramine patients. Both groups showed steady improvement throughout the study; no statistically significant differences were observed between the groups for any efficacy variable at any time. A similar percentage of patients in both groups withdrew because of adverse events. No serious adverse events related to drug occurred with either drug. Insomnia, nervousness, and dyspepsia were more statistically frequent with fluvoxamine; dry mouth and postural hypotension were more frequent with clomipramine. In this study, fluvoxamine and clomipramine were equally effective in reducing OCD symptoms over a 10-week treatment period but displayed different side effect profiles.

Adolescent↗
PubMed1996

Specificity of neuropsychological impairment in obsessive-compulsive disorder: a comparison with social phobic and normal control subjects.

Specificity of neuropsychological dysfunction in obsessive-compulsive disorder (OCD) was assessed by comparing neuropsychological performance in 65 OCD patients, 17 social phobic patients, and 32 normal control subjects. Although both patient groups showed visual constructional impairment relative to normal subjects, only patients with social phobia showed executive dysfunction. Nonconcurrent state anxiety did not correlate with neuropsychological performance. Among anxiety disorders, neuropsychological dysfunction may not be specific to OCD, but the functions implicated may differ across patient groups.

Adolescent↗
PubMed1996

Impulsivity and serotonergic function in compulsive personality disorder.

This study compared serotonergic function, as assessed by prolactin response to fenfluramine, in males with compulsive personality disorder, males with noncompulsive personality disorders, and normal control subjects. The two patient groups did not differ in age, depression status, suicide history, or comorbid borderline personality disorder. However, compulsive personality disorder patients had significantly greater impulsive aggressive scores than the noncompulsive patients and significantly blunted prolactin responses compared with the non-compulsive patients and normal control subjects. In the combined patient group, total compulsive personality disorder traits correlated positively with impulsive aggression score and inversely with prolactin response. These results support the hypothesis that impulsive and compulsive symptoms do not simply lie at opposite ends of a phenomenological and neurobiological spectrum, but rather have a complex intersection and may both correlate with serotonergic dysfunction.

Adult↗
PubMed1996

Obsessive-compulsive and spectrum disorders: overview and quality of life issues.

Although obsessive-compulsive disorder (OCD) is among the most common of all psychiatric disorders, the diagnosis is frequently overlooked unless specific screening questions are asked by the treating physician. The obsessive thinking and compulsive behaviours that primarily characterize OCD can be found in other obsessive-compulsive "spectrum" disorders as well. These disorders affect a sizable percentage of the U.S. population and have thus become an increasing public health problem. Preliminary results from our comprehensive survey of OCD sufferers found significant impairments in quality of life and substantial costs associated with the morbidity and treatment of OCD. This is of particular interest to the primary care practitioner since these patients often present initially to primary care physicians, and early diagnosis and appropriate treatment can substantially improve outcome.

Adolescent↗
PubMed1996

Diagnosis, neurobiology, and treatment of pathological gambling.

Pathological gambling is a disabling disorder that affects at least 2 1/2 million Americans and their families. Although pathological gambling has been characterized as an impulse control disorder, it has also been associated with compulsivity. Essential features of pathological gambling include constantly recurring gambling behavior that is maladaptive, in that personal, familial, and/or vocational endeavors are disrupted. Affective disorders and substance abuse often co-occur. Incidence of suicidality is extremely high. Despite the fact that this disorder is a widespread public health problem, few controlled studies of causes or treatment have been conducted. Preliminary neurobiological studies implicate serotonergic dysfunction in pathological gamblers. Treatment with serotonin reuptake inhibitors, such as clomipramine and fluvoxamine, may be effective in treating this disorder. Well-defined and controlled clinical trials in large samples of pathological gamblers are needed.

Adolescent↗
PubMed1996

Obsessive-compulsive disorder-related disorders: the role of selective serotonergic reuptake inhibitors.

Obsessive-compulsive spectrum disorders comprise a unique category of related disorders with important diagnostic, aetiological and therapeutic implications. This group of disorders may overlap with obsessive-compulsive disorder (OCD) in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to selective anti-obsessional behavioural and pharmacotherapies. OCD-related disorders can be viewed along a continuum with risk avoidance on the compulsive end and risk seeking at the other. This dimension may be defined within a framework which relates hyperfrontality and increased serotonergic sensitivity with compulsive disorders and hyperfrontality and low presynaptic serotonergic levels with impulsive disorders. Most biological models of OCD-related disorders stress the importance of serotonin in their pathophysiology and these disorders have also been shown to be preferentially responsive to selective serotonergic reuptake inhibitors (SSRIs). This paper reviews the management of the OCD spectrum and the evidence for efficacy of the SSRIs and the differential treatment responses of the compulsive and impulsive disorders with regard to therapeutic dosage, response lag time and maintenance of symptom remission.

Humans↗
PubMed1996

Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey.

OBJECTIVE: The quality of life and pharmaco-economic aspects of obsessive-compulsive disorder (OCD) have received relatively little research attention to date. We aimed to gather preliminary data on these in a South African patient sample. DESIGN: A survey of members of the Obsessive-Compulsive Disorder Association of South Africa was undertaken by means of a detailed self-report questionnaire. RESULTS: Results of the survey suggest that OCD causes significant morbidity, leading to clear distress and Interference with academic, occupational, social and family function. Unfortunately, correct diagnosis and appropriate treatment have been delayed in many patients, and the financial costs of such incorrect management are likely to be considerable. CONCLUSION: Much further work needs to be done by the medical profession and by interested consumers to raise awareness about OCD and to provide information about its management. In South Africa, it is particularly Important to undertake such psycho-education at a primary health care level and to impact on patients of low socio-economic status.

Activities of Daily Living↗