Search PubMed⌕ Search

Biomedical subjects

E Hollander

Publications and source records attributed to E Hollander.

At least 127 records · Page 7Linked to original sources
PubMed1992

Body dysmorphic disorder. Diagnostic issues and related disorders.

This article reviews diagnostic issues about body dysmorphic disorder and discusses its relationship to other disorders. Diagnostic and symptomatic overlap with obsessive-compulsive disorder is explored; associated features, course of illness, presumed etiology, and treatment outcome are compared; and similarities and differences are reviewed. Other illnesses with similar features, such as anorexia nervosa, social phobia, and the disorders associated with cosmetic surgery are mentioned. These findings are discussed in light of the development of DSM-IV diagnostic criteria.

Adolescent↗
PubMed1992

Open trial of intravenous clomipramine in five treatment-refractory patients with obsessive-compulsive disorder.

In a preliminary trial, five oral-clomipramine-refractory patients with obsessive-compulsive disorder (OCD) were treated openly with 14 intravenous clomipramine infusions each. Using standardized assessments, three patients were rated as much improved, one as unchanged, and one as minimally improved. Statistically significant improvements were noted on both the Yale-Brown Obsessive Compulsive Scale and the NIMH Global OCD scores. No patient discontinued treatment because of side effects. Although the results are provocative in that three of five patients were much improved at the end of the protocol, conclusions about preferential efficacy for the intravenous route must await a placebo-controlled trial.

Administration, Oral↗
PubMed1992

Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias.

BACKGROUND: Paraphilias and related disorders have recently been thought of as sexual addictions. However, it has also been argued that these disorders are sexual compulsions. The question arises as to whether these disorders and obsessive compulsive disorder respond in the same way to pharmacotherapy. METHOD: We retrospectively reviewed outcome in 13 patients who presented with sexual symptoms and were treated with serotonin reuptake blockers. Symptoms were divided into paraphilias, nonparaphilic sexual addictions, and sexual obsessions. RESULTS: Paraphilias had the least improvement, while sexual obsessions had the best response to medication. CONCLUSION: Paraphilias and related disorders may be less responsive than sexual obsessions or compulsions to serotonin reuptake blockers. Perhaps paraphilias and related disorders are on the impulsive rather than the compulsive end of the spectrum of obsessive compulsive disorders. Controlled trials are, however, necessary to replicate these preliminary findings.

Adolescent↗
PubMed1992

Treatment outcome of obsessive compulsive disorder with comorbid social phobia.

BACKGROUND: Treatment of obsessive compulsive disorder (OCD) with serotonin reuptake blockers has been demonstrated effective in 50% to 60% of patients in open and placebo-controlled studies. However, some reports indicate that comorbid Axis II psychopathology, including avoidant personality disorder, and deficiency of social skills could be predictors of a poor response to treatment in OCD patients. METHOD: A retrospective review elicited 12 patients who met DSM-III-R diagnostic criteria for both OCD and social phobia and were treated in our clinic last year with adequate trials of serotonin reuptake blockers or MAOIs. RESULTS: Only 3 (27%) of the 11 patients treated with serotonin reuptake blockers had a substantial improvement of OCD symptoms. Among them, only 1 (11%) of 9 patients with generalized subtype of social phobia versus 2 (100%) of 2 patients with the nongeneralized subtype responded to serotonin reuptake blockers. Four (80%) of 5 patients with comorbid generalized social phobia receiving phenelzine had marked improvement of OCD symptoms. In general, response of social phobia occurred parallel to that of OCD. CONCLUSION: Comorbid generalized social phobia seems to be associated with a poor response to serotonin reuptake blockers in OCD patients. Deficient social skills, as well as distinct biological mechanisms, may be involved. MAOIs might be an effective alternative medication in refractory cases. Larger and controlled studies are needed to define the implications of the association of OCD and social phobia.

Adult↗
PubMed1992

Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania.

BACKGROUND: There is some overlap in the phenomenology and treatment response of trichotillomania, Gilles de la Tourette's syndrome (TS), and obsessive compulsive disorder (OCD). Neuroleptics may play a role in the treatment of TS as well as refractory OCD, and the question arises whether this also holds for trichotillomania. METHOD: Patients with trichotillomania were treated in open clinical practice with serotonin reuptake blockers. When symptom resolution was incomplete or symptom relapse occurred, low-dose pimozide was added. RESULTS: In six out of seven patients, the addition of pimozide to a serotonin reuptake blocker led to an improvement in hair pulling. In patients who were able to tolerate their medication, this response was sustained. CONCLUSION: Augmentation of serotonergic agents with dopamine blockers may play a role in the treatment of trichotillomania. Further controlled trials of pimozide augmentation in trichotillomania are needed.

Adult↗
PubMed1992

Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers.

BACKGROUND: Preclinical and clinical studies suggest that yohimbine facilitates sexual behavior and may be helpful in the treatment of male impotence. A single case report suggests that yohimbine may be used to treat the sexual side effects of clomipramine. This study evaluated yohimbine as a treatment for the sexual side effects caused by serotonin reuptake blockers. METHOD: Six patients with either obsessive compulsive disorder, trichotillomania, anxiety, or affective disorders who suffered sexual side effects after treatment with serotonin reuptake blockers were given yohimbine on a p.r.n. basis in an open clinical trial. Various doses of yohimbine were used to determine the ideal dose for each patient. RESULTS: Five of the six patients experienced improved sexual functioning after taking yohimbine. One patient who failed to comply with yohimbine treatment had no therapeutic effects. Side effects of yohimbine included excessive sweating, increased anxiety, and a wound-up feeling in some patients. CONCLUSION: The results of this study indicate that yohimbine may be an effective treatment for the sexual side effects caused by serotonin reuptake blockers. Future controlled studies are needed to further investigate the effectiveness and safety of yohimbine for this indication.

Adult↗
PubMed1991

Noradrenergic function in obsessive-compulsive disorder: behavioral and neuroendocrine responses to clonidine and comparison to healthy controls.

To evaluate noradrenergic (NE) function in obsessive-compulsive disorder (OCD), behavioral, physiological, and neuroendocrine responses to the alpha 2-adrenergic agonist clonidine were examined in 18 patients with OCD and 10 healthy subjects. Subjects received single i.v. doses of 2 micrograms/kg of clonidine administered under double-blind, placebo-controlled, random-assignment conditions. Following clonidine, but not following placebo, patients transiently experienced a significant reduction of obsessions and compulsions. Significant drowsiness and a reduction in anxiety were also noted, but the antiobsessional effect appeared independent of the soporific and antianxiety effects. Growth hormone (GH), cortisol, and 3-methoxy-4-hydroxyphenylglycol responses to clonidine did not differentiate patients from healthy controls. Blood pressure and pulse in response to clonidine did not differ between groups. Improvement in OCD symptoms after clonidine significantly correlated with GH response to clonidine, suggesting specific noradrenergic mediation. This finding lends only partial support for a primary defect of noradrenergic function in OCD.

Adolescent↗
PubMed1991

Effects of chronic fluoxetine treatment on behavioral and neuroendocrine responses to meta-chlorophenylpiperazine in obsessive-compulsive disorder.

To investigate the effect of fluoxetine on serotonergic sensitivity in obsessive-compulsive disorder (OCD), the partial serotonin agonist metachlorophenylpiperazine (mCPP) was compared to placebo under double-blind conditions in six patients with OCD before and during treatment with fluoxetine. Readministration of oral mCPP (0.5 mg/kg) after at least 12 weeks of fluoxetine treatment did not increase obsessive-compulsive (OC) symptoms, in contrast to exacerbation of OC symptoms produced by mCPP before treatment. Chronic fluoxetine treatment resulted in a significant increase in prolactin and cortisol response to mCPP. This may be accounted for, however, by substantially increased plasma mCPP levels during fluoxetine treatment. Chronic fluoxetine treatment diminished the behavioral sensitivity to mCPP and did not diminish, but may have partially normalized, the neuroendocrine response to mCPP in patients with OCD. These adaptive homeostatic effects may reflect fluoxetine's antiobsessional mechanism.

Adult↗
PubMed1991

A pilot follow-up study of childhood soft signs and the development of adult psychopathology.

A subgroup of subjects (4 of 12) with childhood soft signs and adolescent anxiety-withdrawal disorders were followed up into adulthood and assessed for soft signs and psychiatric diagnoses. These subjects continued to have soft-sign abnormalities and most had adult anxiety or affective disorders, including obsessive-compulsive disorder (OCD). In contrast, control subjects with childhood soft signs but no adolescent anxiety disorders had fewer soft signs at follow-up and no discrete adult anxiety or affective disorders, but they did have obsessive-compulsive symptoms that did not meet criteria for OCD.

Adolescent↗
PubMed1991

Hypochondriasis and obsessive compulsive disorder: overlaps in diagnosis and treatment.

BACKGROUND: Hypochondriasis is a disorder for which there are no established effective treatments. Hypochondriacs, in their obsessions about illness, compulsions to check with others, and failure to be reassured, share many features in common with those who have obsessive compulsive disorder (OCD). METHOD: The authors present a case series of six patients with DSM-III-R hypochondriasis, five of whom also had a history of OCD. Two of the six agreed to be treated with doses of fluoxetine typically used to treat OCD. RESULTS: Both patients, one of whom had no past history of OCD, showed a marked improvement in hypochondriacal symptoms. CONCLUSION: These findings suggest that a subgroup of patients with hypochondriasis may be particularly responsive to serotonin reuptake blockers.

Adult↗
PubMed1991

Treatment of social phobia with drugs other than benzodiazepines.

Social phobia is emerging as an important cause of psychiatric morbidity. Reasons for this are described, as are clinical issues of importance to social phobia, including the extensive associated distress and disability. The use of phenelzine, atenolol, buspirone, fluoxetine, and moclobemide are described. Diagnostic and transcultural aspects of social phobia are described.

Adolescent↗