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Biomedical subjects

L Baer

Publications and source records attributed to L Baer.

At least 19 recordsLinked to original sources
PubMed1992

Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder.

We used the Structured Interview for DSM-III Personality Disorders to diagnose DSM-III personality disorders systematically in 55 patients with obsessive-compulsive disorder in the active-treatment cell of a controlled trial of clomipramine hydrochloride. Patients with a cluster A personality disorder had significantly higher obsessive-compulsive disorder severity scores at baseline, and the number of personality disorders was strongly related to baseline severity of obsessive-compulsive disorder symptoms. At the conclusion of the 12-week study, we found no significant difference in treatment outcome with clomipramine between those patients with at least one personality disorder and those with no personality disorders. However, the presence of schizotypal, borderline, and avoidant personality disorders, along with total number of personality disorders, did predict poorer treatment outcome. These variables were strongly related to having at least one cluster A personality disorder diagnosis, which was also a strong predictor of poorer outcome. Implications of these findings are discussed.

Adult↗
PubMed1992

Dissociative symptoms in patients with obsessive-compulsive disorder.

To clarify the relationship between dissociative symptoms and obsessive-compulsive disorder (OCD), 100 patients with OCD were assessed with standardized instruments measuring symptoms of OCD, dissociation, and depression. Diagnoses of personality disorders and dissociative disorders were made using structured interviews. Compared with a previous study, OCD patients had dissociation scores slightly higher than normal controls and comparable to patients with other anxiety disorders. Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.

Adult↗
PubMed1992

Changes in DSM-III-R axis II diagnoses following treatment of obsessive-compulsive disorder.

Seventeen patients with obsessive-compulsive disorder and concomitant personality disorders were treated with pharmacologic and/or behavioral therapy and reassessed after 4 months. Nine of the 10 patients who responded to treatment for obsessive-compulsive disorder no longer met criteria for a personality disorder. Of the seven nonresponders, five continued to meet criteria for a personality disorder.

Adult↗
PubMed1992

Personality disorders in obsessive compulsive disorder.

Standardized structured interview personality scales are now available that provide better reliability than clinician interview, but are still imperfect. These scales diagnose DSM III-R personality disorders, which are more illness-oriented than Freudian notions. Use of these scales has found that the majority of patients with OCD have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD, and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. The prevalence of this personality disorder as modified in DSM-III-R (making it easier for a patient to qualify for this personality disorder diagnosis) appears to be higher, although still present in a minority of patients with OCD. Obsessive compulsive personality disorder (along with the other cluster B and C personality disorders) has not been reported to have a consistent relation to treatment outcome. There is evidence that in some cases, obsessive compulsive personality disorder may be secondary to OCD. Swedo et al hypothesized that some children may develop compulsive personality traits as an adaptive mechanism to deal with OCD. This hypothesis is in accord with our finding that OCD often predates compulsive personality disorder and that mixed personality disorder may develop over time, possibly secondary to OCD. We found in our sample of 96 adult patients with OCD that the presence of mixed personality disorder was more likely with longer duration of OCD, suggesting that patients who do not have premorbid personality disorders may develop significant personality traits (especially avoidant, compulsive, and dependent), which may be related to behavioral and life-style changes that are secondary to OCD. This hypothesis is strengthened by our finding that patients with one of these personality disorders at baseline tended to no longer meet criteria for them following successful treatment of their OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia (e.g., in three male identical twin pairs concordant for OCD but discordant for schizophrenia or schizoaffective disorder, the nonpsychotic co-twins all had schizotypal personality disorder), is the only consistent personality disorder predictor of poorer outcome in OCD. These traits may help explain other proposed poor predictors of treatment outcome such as overvalued beliefs, poor compliance, and chaotic family situations.(ABSTRACT TRUNCATED AT 400 WORDS)

Comorbidity↗
PubMed1991

Cingulotomy for refractory obsessive-compulsive disorder. A long-term follow-up of 33 patients.

To evaluate the feasibility of cingulotomy as a treatment for patients with intractable obsessive-compulsive disorder, we evaluated the records of all 35 patients with this diagnosis who had undergone one or more such procedures at Massachusetts General Hospital, Boston, during the last 25 years. Retrospectively, all but two of these patients met DSM-III-R criteria for obsessive-compulsive disorder. Six patients were deceased; four by suicide. Questionnaires were sent to the remaining 27 patients with obsessive-compulsive disorder; 17 patients returned the questionnaire and another agreed to an interview without completing the forms. Sixteen of these 18 patients participated in a telephone interview, and patient reports were corroborated by an informant in 10 cases. Despite the presence of some side effects, such as easily controlled seizures (9%) and transient mania (6%), the results of this investigation support the use of cingulotomy as a potentially effective treatment for patients with severe and disabling obsessive-compulsive disorder. With the use of very conservative criteria, we estimated that at least 25% to 30% of the patients benefited substantially from this procedure. Similar results were found in a preliminary prospective study of four patients who recently underwent cingulotomy after state-of-the-art preoperative treatments had failed.

Adult↗
PubMed1990

Standardized assessment of personality disorders in obsessive-compulsive disorder.

We assessed 96 patients with obsessive-compulsive disorder for DSM-III personality disorder diagnoses with a standardized interview instrument (Structured Interview for the DSM-III Personality Disorders). Fifty patients (52%) met criteria for at least one personality disorder, with mixed, dependent, and histrionic personality disorders most frequently diagnosed. Compulsive personality disorder was diagnosed in only 6 patients (6%), 5 of whom had had onset of obsessive-compulsive symptoms before the age of 10 years, indicating that DSM-III compulsive personality disorder is not invariably a premorbid condition for the development of obsessive-compulsive disorder. Schizotypal personality disorder, at 5%, was found to be less common than in past samples, reflecting differences in either assessment methods or sampling.

Adolescent↗
PubMed1990

A double-blind, placebo-controlled study of oral acyclovir in postherpetic neuralgia.

Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice.

Acyclovir↗
PubMed1990

Oral physostigmine as treatment for dementia of the Alzheimer type: a long-term outpatient trial.

Six patients with dementia of the Alzheimer type (DAT), treated with oral physostigmine and followed from 9 to 27 months (mean +/- SD, 17.8 +/- 7.3 months), were matched for sex, age, initial degree of dementia, and length of follow-up with six control patients who did not receive oral physostigmine. The small sample size precluded drawing definite conclusions about overall efficacy; however, three in the physostigmine group did not deteriorate during the course of follow-up while all of the controls deteriorated although the difference was nonsignificant. The data generated in these patients provides evidence of the safety of long-term trials of oral physostigmine. The possible role of cholinesterase inhibition in retarding the progression of DAT is discussed.

Administration, Oral↗
PubMed1990

Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy.

Since it will be some time until data will be available comparing clomipramine and fluoxetine for the treatment of patients with obsessive-compulsive disorder (OCD), a meta-analysis of previous studies was performed in an attempt to gain some information about comparable efficacy and side effects of these two commonly used agents. In 31 OCD patients receiving clomipramine in a controlled trial and 72 OCD patients receiving fluoxetine openly, both drugs appeared effective, with clomipramine having a somewhat larger effect than fluoxetine. Different side effect profiles may have a bearing on patient selection.

Clomipramine↗
PubMed1990

Sertraline in obsessive-compulsive disorder: a double-blind comparison with placebo.

Many agents that affect the brain's serotonergic system appear to be at least partially effective in the treatment of patients with obsessive-compulsive disorder. However, in this 10-week double-blind trial in which 10 patients received sertraline and nine received placebo, sertraline was ineffective according to four measures of obsessive-compulsive symptoms. The authors discuss the implications of these preliminary findings for the serotonergic theory of obsessive-compulsive disorder and the need to explore the role of other neurochemical systems in this disorder.

1-Naphthylamine↗
PubMed1990

A controlled trial of fluvoxamine in obsessive-compulsive disorder: implications for a serotonergic theory.

Thirty-eight patients with primary obsessive-compulsive disorder participated in a 10-week, double-blind, placebo-controlled trial of the potent, selective serotonin reuptake inhibitor fluvoxamine. Fluvoxamine was significantly better than placebo on two of three measures of improvement in obsessive-compulsive symptoms. The authors also compared studies of the serotonergic agents fluvoxamine, sertraline, fluoxetine, and clomipramine and found that a greater effect size was associated with less serotonergic specificity and that some ability to affect other neurotransmitter systems may be a necessary but not sufficient requirement for antiobsessional activity. These data lend only partial support to a serotonin hypothesis of obsessive-compulsive disorder.

1-Naphthylamine↗
PubMed1990

Ten-year follow-up of worksite hypertension control programs.

We have analyzed the control of hypertension and the demographics of 898 actively treated (AT) (visits within past 12 months) and inactive patients (IAT) (no visit for at least 12 months) in six worksite hypertension programs established in 1977. Results were analyzed using Student's t test and correlation coefficients. Patients are treated at the worksites by a nurse-physician team using a stepped-care protocol. In the AT group (n = 436), the mean age was 52 +/- 0.5 years, initial blood pressure (BP) was 152 +/- 1/97 +/- 0.5 mm Hg, and current BP was 136 +/- 0.7/86 +/- 0.04 mm Hg (p less than 0.001). Of the 436 patients, 194 were men and 242 were women (217 Caucasian and 156 black). In the IAT group (n = 462) mean age was 51 +/- 0.5 years, initial BP was 154 +/- 1/99 +/- 0.5 mm Hg, and last BP was 138/88 +/- 0.4 mm Hg (p less than 0.001). Of these, 171 were men and 291 were women (238 Caucasian and 171 black). No differences in initial and current BP were noted when comparing the AT with the IAT group. The percent of Caucasian (43%) and blacks (36%) men in the AT group was similar to those in the IAT group (37%). Control of hypertension at worksites where blacks predominate was similar to sites where Caucasians predominate. We conclude that worksite control of hypertension over a 10-year period maintains approximately 50% of the initial population under treatment. Control rates greater than 80% to less than 90 mm Hg diastolic are present despite heterogeneity in demographics.

Black People↗
PubMed1989

Open trial of fluoxetine in obsessive-compulsive disorder.

A 12-week open trial of fluoxetine in 61 obsessive-compulsive disorder patients significantly improved depressive and obsessive-compulsive symptoms. Baseline depression scores were not related to improvement on two obsessive-compulsive scales. The results reinforce the hypothesis of serotonergic abnormalities in obsessive-compulsive disorder.

Adult↗
PubMed1988

Use of a portable computer program to assist behavioral treatment in a case of obsessive compulsive disorder.

This case study describes the development and use of a portable computer program to assist in behavioral treatment of obsessive compulsive disorder. A 58-year-old female with a 37-year history of compulsive checking rituals, who had mild improvement following 36 months of standard behavioral techniques and pharmacotherapy, showed improved compliance with behavioral treatments of exposure and response prevention following use of the portable computer program. Computer records indicated marked reductions in frequency of checking rituals and a 91-week follow-up indicated that treatment effects were maintained at home where the patient had resumed using the laptop computer. She had stopped using the pocket computer outside the home, and there her checking rituals had returned to baseline levels.

Behavior Therapy↗