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PubMed1990

Specificity of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder. Comparison of fluvoxamine and desipramine.

To evaluate whether serotonin reuptake inhibition is critical to the treatment of obsessive-compulsive disorder, 40 outpatients with a principal diagnosis of obsessive-compulsive disorder were randomized in a double-blind fashion to 8 weeks of treatment with either the serotonin reuptake inhibitor fluvoxamine maleate (n = 21) or the norepinephrine reuptake inhibitor desipramine hydrochloride (n = 19). Fluvoxamine was significantly better than desipramine in reducing the severity of obsessive-compulsive symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale and by the global response rate ("responder" equaling "much improved"). Eleven of 21 patients were responders with fluvoxamine compared with 2 of 19 patients with desipramine. Fluvoxamine, but not desipramine, was also effective in reducing the severity of "secondary" depression. Fluvoxamine-induced improvement in symptoms of obsessive-compulsive disorder was not correlated with the severity of baseline depressive symptoms. This study provides additional evidence that the acute serotonin reuptake properties of a drug are predictive of its anti-obsessive-compulsive efficacy. It is hypothesized that the mechanism of action of serotonin reuptake inhibitors in obsessive-compulsive disorder may be related to chronic treatment-induced adaptive changes in presynaptic serotonin receptor function (eg, autoreceptor desensitization) and/or indirect influences on dopaminergic function (eg, in the basal ganglia).

Adult↗
PubMed1999

A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns].

BACKGROUND: The long-term course of obsessive-compulsive disorder is insufficiently known. We studied the course of this disorder in patients who were followed up for 40 years. METHODS: Patients admitted with a diagnosis of obsessive-compulsive disorder to the Department of Psychiatry, Sahlgrenska University Hospital, Göteborg, Sweden, between 1947 and 1953 were examined by an experienced psychiatrist using a semistructured interview between 1954 and 1956 (n=251). The diagnosis was made according to the criteria of Schneider. A reexamination was performed by the same psychiatrist between 1989 and 1993 (n=122). In another 22 patients, the necessary information was obtained from close informants and medical records. The response rate in surviving patients was 82%. The mean length of follow-up from onset was 47 years. RESULTS: Improvement was observed in 83%, including recovery in 48% (complete recovery, 20%; recovery with subclinical symptoms, 28%). Among those who recovered, 38% had done so already in the 1950s. Forty-eight percent had obsessive-compulsive disorder for more than 30 years. Early age of onset, having both obsessive and compulsive symptoms, low social functioning at baseline, and a chronic course at the examination between 1954 and 1956 were correlated with a worse outcome. Magical obsessions and compulsive rituals were correlated with a worse course. Qualitative symptom changes within the obsessive-compulsive disorder occurred in 58% of the patients. CONCLUSION: After several decades, most individuals with obsessive-compulsive disorder improve, although most patients continue to have clinical or subclinical symptoms.

Adult↗
PubMed2000

A family study of obsessive-compulsive disorder.

BACKGROUND: The causes of obsessive-compulsive disorder (OCD) are as yet unknown. Evidence of familial aggregation is one approach for investigating the role of genetics in the etiology of this condition. The current study was conducted to determine ifOCD is familial and to investigate possible familial subtypes. METHODS: Eighty case probands were identified in 5 specialty OCD clinics and 73 community control probands were identified by random-digit dialing. These probands and their first-degree relatives (343 case and 300 control relatives) were blinded to group and evaluated by psychiatrists and doctoral-level clinical psychologists using semistructured instruments. Final diagnoses were assigned by a blinded-consensus procedure. The results were analyzed using logistic regression by the method of generalized estimating equations. RESULTS: The lifetime prevalence of OCD was significantly higher in case compared with control relatives (11.7% vs 2.7%) (P<.001). Case relatives had higher rates of both obsessions and compulsions; however, this finding is more robust for obsessions. Age at onset of obsessive-compulsive symptoms in the case proband was strongly related to familiality (odds ratio, 0.92; confidence interval, 0.85-0.99) (P = .05); no case of OCD symptoms was detected in the relatives of probands whose age at onset of symptoms was 18 years or older. Probands with tics or obsessive-compulsive personality disorder were not more likely to have relatives with OCD than those without these features. CONCLUSIONS: Obsessive-compulsive disorder is a familial disorder. Obsessions are more specific to the phenotype than are compulsions. Age at onset of OCD is valuable in characterizing a familial subtype.

Adolescent↗
PubMed2007

Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder.

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

Adolescent↗
PubMed2003

Obsessions and compulsions in anorexia nervosa subtypes.

OBJECTIVE: Obsession and compulsions in anorexia nervosa (AN) patients are often confused with the preoccupations and rituals that are characteristic of obsessive-compulsive disorder (OCD). We examined the type and frequency of characteristic OCD obsessions and compulsions in a large sample of AN patients. METHOD: In personal interviews with 324 AN patients, we assessed lifetime histories of eating disorder symptomatology and obsessive-compulsive behaviors with valid semistructured interviews. Checklist category sums on the Yale-Brown Obsessive Compulsive Scale were compared between AN and OCD subjects using generalized estimating equations. RESULTS: Lifetime obsessions and compulsions occurred in 68% of the AN restricting type and in 79.1% of the AN binge/purge type. The AN subgroups did not differ from OCD controls in frequency of obsessions in the symmetry and somatic categories or in the compulsion categories of ordering and hoarding. In all other categories, the AN subgroups had a significantly lower frequency compared with the OCD controls. DISCUSSION: Some common phenotype characteristics shared by most AN and OCD patients suggest these disorders may share common brain behavioral pathways. However, the lack of complete overlap indicates they most likely have different loci of pathology within those pathways.

Adult↗
PubMed1999

[Clozapine and obsessive-compulsive symptoms in schizophrenia. A case history of one patient].

In the examination in question, the case history of a patient who had exhibited serious obsessive-compulsive symptoms since the age of 14 is described. It is not an independent obsessive-compulsive disorder, but a case of schizophrenia masked by obsessive-compulsive symptoms. During therapy for the schizophrenic symptoms with clozapine, which set in at the age of 31, neither psychotic symptoms nor obsessive-compulsive symptoms worth mentioning can be found at the 1-year catamnesis. Whereas the literature increasingly points to obsessive-compulsive symptoms being a side-effect of clozapine medication, usually in the clinical indication area of chronic schizophrenic psychoses, as far as the author knows, this describes a rare case of improvement of obsessive-compulsive symptoms using clozapine after first suffering from a schizophrenic disorder. The meaning of differential diagnostics of obsessive-compulsive phenomena for adequate pharmacotherapy is discussed using the example of the individual case.

Adolescent↗
PubMed1994

Personality traits in subclinical and non-obsessive-compulsive volunteers and their parents.

Theorists from a variety of perspectives have asserted that obsessive compulsives are more risk-aversive, perfectionistic and guilt-ridden than non-obsessive compulsives, and that these characteristics are central features of the disorder. Furthermore, several have hypothesized that the parents of obsessive compulsives are characterized by risk-aversion, perfectionism, and high levels of criticism. Little research exists which corroborates these hypotheses, however. The present investigation examined these hypotheses among subclinical obsessive compulsives. In two different samples, subclinical obsessive compulsives were found to be more risk-aversive, perfectionistic, and guilt-ridden. Subclinical obsessive compulsives also perceived their parents to be more overprotective. The findings regarding other parental traits were less clear. There was some support for the hypothesis that the parents of subclinical obsessive compulsives are more risk-aversive, and that fathers are more critical and perfectionistic.

Female↗
PubMed1995

The structure of obsessive-compulsive symptoms.

In the present study, the structure of obsessive-compulsive symptoms was investigated by means of the Padua Inventory (PI). Simultaneous Components Analysis on data from obsessive-compulsives (n = 206), patients with other anxiety disorders (n = 222), and a non clinical sample (n = 430) revealed a five-factor solution. These factors are: (I) impulses; (II) washing; (III) checking; (IV) rumination; and (V) precision. Forty-one items were selected as measure of these factors. The reliability for the five subscales, assessing each of the five factors, was found to be satisfactory to excellent. Four subscales (washing, checking, rumination and precision) discriminated between panic disorder patients, social phobics and normals on the one hand and obsessive compulsives on the other. The Impulses subscale discriminated between obsessive-compulsives on the one hand and normals on the other, but not between obsessive-compulsives and social phobics or panic patients. Some evidence in support of the construct validity was found. The Padua Inventory-Revised (41-items) appears to measure the structure of obsessive compulsive symptoms: The main types of behaviours and obsessions as seen clinically are assessed by this questionnaire, apart from obsessional slowness.

Adult↗
PubMed1995

Factor structure of the Yale-Brown Obsessive-Compulsive Scale: a two dimensional measure.

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS: Goodman, Price, Rasmussen, Mazure, Fleischman, Hill, Heninger & Charney, 1989a, b, Archives of General Psychiatry, 46, 1006-1016), a widely used measure of obsessions and compulsions, is typically used by summing the items to yield a global measure of symptom severity. However obsessive-compulsive disorder (OCD) is characterized by two distinct groups of symptoms (i.e. obsessions and compulsions), and so it was hypothesized that OCD, as assessed by the Y-BOCS, may be two dimensional. In other words, the items assessing obsessions may be factorially distinct from the items assessing compulsions. A confirmatory factor analysis (CFA) was conducted using responses from 83 OCD patients to determine whether OCD as assessed with the Y-BOCS is unidimensional or forms two distinct dimensions. Results supported a two-factor solution, and suggest that items assessing obsessions should be scored as one subscale, and items assessing compulsions scored as a separate subscale. Depression, as assessed by the Beck Depression Inventory, (Beck, Ward, Mendelsohn, Mock & Erbaugh, 1961, Archives of General Psychiatry, 4, 561-571), was correlated with both subscales. Trait anxiety, as assessed by the State-Trait Anxiety Inventory (Speilberger, 1983, Manual for the State-Trait Anxiety Inventory (Form Y). Palo-Alto, CA: Consulting Psychologists Press), was correlated with the obsessions subscale but not with the compulsions subscale.

Adolescent↗
PubMed2005

Why are some obsessions more upsetting than others?

Little is known about why certain obsessional thoughts are more upsetting than others for people with obsessive compulsive disorder (OCD). Obsessional thought content often seems arbitrary to sufferers. The current study examined three possible reasons why particular thoughts would be especially upsetting for individuals, based on suggestions put forth by cognitive theories of obsessional thoughts. Twenty-eight individuals with a principal diagnosis of OCD completed questionnaires and interviews at two different periods of time on (1) their most upsetting current obsession and (2) their least upsetting current obsession. Results suggested that more upsetting obsessions were evaluated as more meaningful or significant than less upsetting obsessions, and more upsetting obsessions contradicted valued aspects of the self to a greater degree. All examples of current obsessions, both most and least upsetting, arose in the context of life concerns or issues. Results support cognitive theories in that the strength and nature of appraisal appears to be linked with the distress associated with a thought, and more upsetting thoughts are those that have implications for a person's sense of self.

Adult↗
PubMed2006

Obsessive-compulsive spectrum disorders: a multidimensional approach.

One advantage of conceptualizing two disorders as related lies in the possibility that a similar treatment is effective for both conditions. The approach taken in this paper is somewhat different, however. The authors have argued that although a particular psychobiologic process may be relevant to OCD and obsessive-compulsive conditions, it may be disrupted indifferent ways in various conditions that fall along a spectrum. If so, differ-ent obsessive-compulsive spectrum disorders may well require different treatments. Thus, although OCD and trichotillomania can be conceptualized in terms of the pathologic release of motor programs, they may require rather different treatment approaches. Furthermore, in the absence of a detailed understanding of the psycho-biology of OCD and related disorders, conceptualizations of obsessive-compulsive spectrum disorders can remain only preliminary in nature. The involvement of cortico-striatal circuitry in OCD suggests that obsessive-compulsive spectrum disorders may be characterized by involvement of these paths. Striatal circuits mediate many different functions (including reward processes), however, and are involved in many disorders. Similarly, the involvement of serotonergic neurotransmitters in OCD suggests that these neurotransmitters are central to defining spectrum disorders.Again, however, serotonin plays a role in many functions (including impulse control) and mediates many different disorders. Much work remains to be done to delineate optimally the obsessive-compulsive spectrum of disorders. Nevertheless, significant progress has been made. Empiric data demonstrate involvement of cortico-striatal circuitry in a number of putative obsessive-compulsive spectrum disorders [43]. Similarly, data demonstrate that a selective response to serotonin-reuptake inhibitors is seen in a range of these different spectrum disorders. As further progress is made in understanding the cognitive-affective neuroscience of OCD and related conditions, constructs about obsessive-compulsive spectrum disorders will become increasingly sharp.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2001

Distinguishing obsessive features and worries: the role of thought-action fusion.

Obsessions are a key feature of obsessive-compulsive disorder (OCD), and chronic worry is the cardinal feature of generalized anxiety disorder (GAD). However, these two cognitive processes are conceptually very similar, and there is a need to determine how they differ. Recent studies have attempted to identify cognitive processes that may be differentially related to obsessive features and worry. In the current study we proposed that (1) obsessive features and worry could be differentiated and that (2) a measure of the cognitive process thought-action fusion would distinguish between obsessive features and worry, being strongly related to obsessive features after controlling for the effects of worry. These hypotheses were supported in a sample of 173 undergraduate students. Thought-action fusion may be a valuable construct in differentiating between obsessive features and worry.

Adult↗
PubMed2001

Sexually dimorphic relationship of a 5-HT2A promoter polymorphism with obsessive-compulsive disorder.

BACKGROUND: In an earlier analysis of 73 subjects from this study, the reduced activity catechol O-methyltransferase variant was shown to be associated with obsessive-compulsive disorder in men only. We hypothesized that the 5-HT2A promoter polymorphism, -1438G>A, previously associated with anorexia nervosa, would be more abundant in women with obsessive-compulsive disorder. METHODS: One hundred and one Caucasian obsessive-compulsive disorder patients (48 women, 53 men) and 138 control subjects (77 women, 61 men), were genotyped. DSM-III-R psychiatric diagnoses were assigned based on the SCID-I. RESULTS: As hypothesized, the -1438A allele frequency was higher in obsessive-compulsive disorder women (.57) than female control subjects (.42) (p =.015). The genotype frequencies were also significantly different (p =.020). Allele frequencies did not differ between male obsessive-compulsive disorder patients (.44) and male control subjects (.41). CCONSLUSIONS: We have found that a 5-HT2A promoter polymorphism is associated with obsessive-compulsive disorder in women but not in men, strengthening the argument that there may be fundamental gender differences in the genetic susceptibility to obsessive-compulsive disorder.

Adult↗
PubMed2000

Proton spectroscopic imaging of the thalamus in treatment-naive pediatric obsessive-compulsive disorder.

BACKGROUND: Neurobiological abnormalities in the thalamus, particularly the dorsomedial nucleus of the thalamus, are believed to be involved in the pathophysiology of obsessive-compulsive disorder. Although obsessive-compulsive disorder commonly arises in childhood and adolescence, no prior study has examined the thalamus in pediatric obsessive-compulsive disorder patients. METHODS: In this study, N-acetyl-aspartate, a putative marker of neuronal viability, creatine/phosphocreatine, and choline levels were measured in the lateral and medical subregions of the left and right thalami using a multislice proton magnetic resonance spectroscopic imaging sequence in 11 treatment-naive, nondepressed obsessive-compulsive disorder outpatients, 8-15 years old, and 11 case-matched control subjects. RESULTS: A significant reduction in N-acetyl-aspartate/choline and N-acetyl-aspartate/(creatine/phosphocreatine + choline) was observed in both the right and left medial thalami in obsessive-compulsive disorder patients compared with control subjects. The N-acetyl-aspartate/choline and N-acetyl-aspartate/(creatine/phosphocreatine + choline) levels did not differ significantly between case-control pairs in either the left or the right lateral thalamus. Reduction in N-acetyl-aspartate levels in the left medial thalamus was inversely correlated with increased obsessive-compulsive disorder symptom severity. CONCLUSIONS: These findings provide new evidence of localized functional neurochemical marker abnormalities in the thalamus in pediatric obsessive-compulsive disorder. Our results must be considered preliminary, however, given the small sample size.

Adolescent↗
PubMed2001

Dreams in obsessive-compulsive disorder: an analysis of semantic and emotional content compared to controls.

OBJECTIVE: We sought to investigate the content of the dreams of obsessive-compulsive outpatients in the light of the following postulate: if dreams play a role in the processing of information and mental storage of events of the day, the dream recollections of obsessive-compulsive disorder (OCD) patients should present evidence of diurnal obsessive or ritual themes. METHOD: On seven successive mornings, immediately after awakening in their home environment, 10 nondepressed OCD patients and 11 controls recorded their recollections of the night's dreams on an audiotape. After randomization of dreams, two judges were asked to carry out a blind evaluation of the emotional characteristics perceptible in these dreams and the presence of obsessive or ritual themes. RESULTS: 47 dreams were collected in the OCD group and 55 in the control group. No differences were found between the two groups regarding anxiety, sadness, the theme of failure, or the presence of obsessive or ritual themes. About 60% of OCD patients and 73% of the control group recounted dreams expressing anxiety, sadness, or failure. Most surprisingly, in the control group as well as in the OCD group, about one-third of subjects presented obsessive or ritual themes in their dreams. CONCLUSION: These data suggest that there is no evident link between diurnal mental activity and the morning recollection of nocturnal dreams regarding anxiety, failure, sadness, and obsessive-compulsive themes.

Adult↗
PubMed2001

Obsessive-compulsive disorder and separation anxiety co-morbidity in early onset panic disorder.

BACKGROUND: This study was undertaken to examine the relationship between anxiety co-morbidity and age of onset of panic disorder. METHODS: Age of onset of panic disorder and co-morbid anxiety disorders were assessed among 201 panic disorder probands with childhood separation anxiety disorder, obsessive-compulsive disorder, obsessive-compulsive symptoms, social phobia and specific phobia as part of a clinician-administered lifetime diagnostic interview. A generalized linear model was used to test the association between each anxiety co-morbidity and age of panic disorder onset while simultaneously controlling for the potential confounding effects of sociodemographic characteristics and other psychiatric co-morbidity. RESULTS: Earlier onset of panic disorder was found in patients with co-morbid obsessive-compulsive disorder, obsessive-compulsive symptoms and separation anxiety disorder, but not simple phobia or social phobia. Patients with both childhood separation anxiety disorder and obsessive-compulsive disorder had an even earlier panic onset than those with either childhood separation anxiety disorder or obsessive-compulsive disorder. CONCLUSIONS: The association between anxiety co-morbidity and earlier onset of panic disorder is specific to obsessive-compulsive disorder and childhood separation anxiety disorder.

Adolescent↗
PubMed1989

Sexual history, attitudes and functioning of obsessive-compulsive patients.

An exploratory investigation of sexual history, attitudes and functioning was conducted with 44 obsessive-compulsive outpatients seeking behavioral therapy. Prior to treatment, patients completed a life history questionnaire which requested information about personal and parental attitudes toward sex, current sexual functioning, sexual obsessions, and sexual history. Pretreatment measures of obsessive-compulsive symptomatology revealed a severely obsessional group who were moderately depressed and introverted. Obsessive-compulsives did not appear to differ from normative samples in sexual history or attitudinal variables. One-third of the present sample reported obsessions related to sexual themes. Symptomatology interferred with sexual satisfaction, particularly for those concerned with bodily secretions. Sexual dysfunction, however, was relatively uncommon. Categorizing patients according to the type of obsession (bodily secretion vs. other obsession) or their religious affiliation (Catholic vs. non-Catholic) yielded no differences with respect to sexual history, attitudes and treatment outcome. Some association of early sexual experiences with current sexual dysfunction was observed.

Adult↗
PubMed2004

Are responsibility attitudes related to obsessive-compulsive symptoms in schoolchildren?

In spite of a growth in cognitive conceptualizations of obsessive-compulsive symptoms, relatively little has been done to extend such concepts to childhood. This study investigated the relationship between responsibility attitudes and obsessive-compulsive symptoms in normal children. A measure of responsibility attitudes in children was constructed on the basis of Salkovskis' Responsibility Attitudes Scale. This measure (Responsibility Attitudes Scale for Children) was administered together with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory to a sample of two hundred and two 10-14-year-old schoolchildren in Iceland. The responsibility measure correlated moderately and similarly with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory. In a hierarchical regression analysis predicting Leyton Obsessive Inventory Child Version scores, age and gender were entered in the equation first, followed by Children's Depression Inventory scores and, finally, Responsibility Attitudes Scale for Children scores. It was shown that Responsibility Attitudes Scale for Children scores added significantly to the prediction of Leyton Obsessive Inventory Child Version over and above the other variables. It is concluded that the study of the role of responsibility attitudes in children's obsessive-compulsive symptoms is at least promising.

Attitude↗