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PubMed1997

Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity.

OBJECTIVE: To evaluate the reliability and validity of a semistructured measure of obsessive-compulsive symptom severity in children and adolescents with obsessive-compulsive disorder (OCD). METHOD: Sixty-five children with OCD (25 girls and 40 boys, aged 8 to 17 years) were assessed with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Interrater agreement was assessed by four raters in a subsample (n = 24). Discriminant and convergent validity were assessed by comparing CY-BOCS scores to self-ratings of depression, anxiety, and obsessive-compulsive symptoms. RESULTS: Internal consistency was high, measuring .87 for the 10 items. The intraclass correlations for the CY-BOCS Total, Obsession, and Compulsion scores were .84, .91, and .68, suggesting good to excellent interrater agreement for subscale and total scores. The CY-BOCS Total score showed a significantly higher correlation with a self-report of obsessive-compulsive symptoms (r = .62 for the Leyton survey) compared with the Children's Depression Inventory (r = .34) and the Children's Manifest Anxiety Scale (r = .37) (p = .02 and .05, respectively). CONCLUSIONS: The CY-BOCS yields reliable and valid subscale and total scores for obsessive-compulsive symptom severity in children and adolescents with OCD. Reliability and validity appear to be influenced by age of the child and the hazards associated with integrating data from parental and patient sources.

Adolescent↗
PubMed2005

Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder.

OBJECTIVE: To compare the effectiveness of group cognitive-behavioral therapy (GCBT) and of sertraline in treatment-naïve children and adolescents with obsessive-compulsive disorder. METHOD: Between 2000 and 2002, 40 subjects between 9 and 17 years old were randomized to receive GCBT (n = 20) or sertraline (n = 20). GCBT consisted of a manual-based 12-week cognitive-behavioral protocol adapted for groups, and treatment with sertraline involved medication intake for 12 weeks. Subjects were assessed before, during, and after treatment (at 1, 3, 6, and 9 months after treatment conclusion). Primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale. Repeated-measures analyses of variance were done. RESULTS: Both GCBT and sertraline conditions had significant improvement in obsessive-compulsive disorder symptoms as measured by the Children's Yale-Brown Obsessive-Compulsive Scale after 12 weeks of treatment. After the 9-month follow-up period, subjects in the GCBT condition had a significantly lower rate of symptom relapse than those in the sertraline group. CONCLUSIONS: The treatment with GCBT may be effective in decreasing obsessive-compulsive symptoms in childhood obsessive-compulsive disorder and should be considered as an alternative to either individual cognitive-behavioral therapy or a medication, such as sertraline. Results support the effectiveness and the maintenance of gains of GCBT in the treatment of youngsters with obsessive-compulsive disorder.

Adolescent↗
PubMed1992

Obsessive and compulsive characteristics of alcohol abuse and dependence: quantification by a newly developed questionnaire.

The purpose of the this study was to develop an instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in subjects who abuse or are dependent on alcohol, and to quantify the extent to which drinking-related thought and behavior in these subjects resemble the obsessions and compulsions seen in obsessive-compulsive disorder (OCD). To achieve these goals, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was modified to reflect obsessionality and compulsivity specifically related to heavy drinking rather than to obsessions and compulsions generally. The modified Y-BOCS (Y-BOCS-hd) was administered to 62 subjects satisfying DSM-III-R criteria for alcohol abuse or alcohol dependence and 62 matched normal controls. The data showed that the Y-BOCS-hd is a sensitive and specific instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in alcohol-abusing and alcohol-dependent populations, and that there are specific and quantifiable similarities between these characteristics and the obsessions and compulsions of OCD. The data also indicated that the Y-BOCS-hd may be a useful screening instrument for the presence of alcohol abuse and dependence.

Adult↗
PubMed1989

Obsessive-compulsive symptoms in childhood and adolescence.

We investigated 61 patients (38 boys and 23 girls) under 18 years of age with obsessive-compulsive symptoms seen in the Department of Psychiatry, Nagoya University Hospital, from 1982 until 1986. In this period, a total of 1293 patients under 18 years of age visited the clinic. The percentage of patients with obsessive-compulsive symptoms was 5%. The earliest onset of symptoms was at age 3 years, and the average age of onset was 11.6 years. We found no particular tendency in terms of the number of siblings and the birth order of the patients. Obsessive traits were the fundamental personality traits of patients. Moreover, according to the other characteristics of personality, the patients were subdivided into schizothymic, viscous temperament, and cyclothymic. Parents of the patients were more apt than usual to have obsessive-compulsive personalities. Psychiatric disturbances and occupations were also investigated. Incidents related to school situations commonly triggered obsessive-compulsive symptoms. The most frequently noted obsessive thought was dirt phobia, and the most common compulsive behavior was washing. School refusal and violence at home were especially common as associated symptoms of obsessive-compulsive symptoms. We also describe the treatment regimen and the outcomes of the patients.

Adolescent↗
PubMed1992

Oculomotor performance in obsessive-compulsive disorder.

OBJECTIVE: Neuroimaging studies have shown abnormalities of the frontal cortex and basal ganglia in persons with obsessive-compulsive disorder. Since lesions in the frontal cortex and basal ganglia areas affect performance on goal-guided saccadic eye movements, this study investigated the relation between the diagnosis of obsessive-compulsive disorder and oculomotor performance. METHOD: Eleven patients with the clinical diagnosis of obsessive-compulsive disorder and 14 normal subjects were assessed with respect to their performance on both visual-guided and goal-guided oculomotor tasks. Fixation performance was also measured. RESULTS: The group with obsessive-compulsive disorder had a very significantly greater error rate and a significantly greater rate of inaccurate saccades on the goal-guided antisaccade task, whereas they were not different from the normal group in reaction time, saccadic velocity, and accuracy on the visual-guided saccade task. The distribution of error rates for the patients with obsessive-compulsive disorder was broad, with more than one-half outside the range of the normal group. Most of the abnormal findings were among male patients. CONCLUSIONS: The results support the hypothesis of a relationship between impaired performance on goal-guided saccadic eye movement tasks and the diagnosis of obsessive-compulsive disorder, but they also suggest a gender-related subgroup within the group with obsessive-compulsive disorder.

Basal Ganglia↗
PubMed1997

Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study.

OBJECTIVE: This study examined the 1-year temporal stability of a National Institute of Mental Health Diagnostic Interview Schedule (DIS) lifetime diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area (ECA) study. METHOD: In that study, 20,862 individuals, aged 18 years and over, at five sites were evaluated by lay interviewers using the DIS (wave 1). All of those who were available 12 months later were reinterviewed (wave 2). In the present study, the temporal stability of wave 1 obsessive-compulsive disorder diagnoses at wave 2 was examined, as well as relationships with comorbid diagnoses. The consistency of reports of "new-onset" illness was also examined. Factors contributing to these measures were evaluated. RESULTS: The temporal stability of the diagnosis of obsessive-compulsive disorder was very low. Subjects with a stable diagnosis of obsessive-compulsive disorder had a higher rate of both obsessions and compulsions, an earlier age at onset, and more comorbid anxiety, affective, and alcohol abuse/dependence disorders at initial assessment. The originally reported 1-year incidence estimates for obsessive-compulsive disorder primarily reflect data from subjects at wave 2 who reported the onset of symptoms as preceding the wave 1 interview. Older and less-educated subjects had significantly higher error rates in reporting onset. CONCLUSIONS: The DIS diagnosis of obsessive-compulsive disorder has poor validity, leaving the true incidence and prevalence of the disorder unknown. Older and less-educated subjects require special attention in the design of instruments for use with community samples.

Adolescent↗
PubMed1997

Symptoms of obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder encompasses a broad range of symptoms that represent multiple psychological domains, including perception, cognition, emotion, social relatedness, and diverse motor behaviors. The purpose of these analyses was to evaluate the correlational relationships of the symptoms of obsessive-compulsive disorder. METHOD: This study examined the 13 a priori categories used to group types of obsessions and compulsions in the Yale-Brown Obsessive Compulsive Scale symptom checklist in two independent groups of patients with obsessive-compulsive disorder (N = 208 and N = 98). A principal-components factor analysis with varimax rotation was performed, followed by a series of other exploratory analyses. RESULTS: The two data sets yielded nearly identical results. Four factors--obsessions and checking, symmetry and ordering, cleanliness and washing, and boarding--emerged in each data set, in total accounting for more than 60% of the variance. CONCLUSIONS: Obsessive-compulsive disorder is a multidimensional and etiologically heterogeneous condition. The four symptom dimensions identified in this study are largely congruent with those identified in earlier reports. These factors may be of value in future genetic, neurobiological, and treatment response studies.

Adult↗
PubMed2001

Cognitive correlates of obsessive and compulsive symptoms in Huntington's disease.

OBJECTIVE: The authors' goal was to examine the frequency and type of obsessive and compulsive symptoms in Huntington's disease. METHOD: The Yale-Brown Obsessive Compulsive Scale was used to assess obsessive and compulsive symptoms in 27 patients with Huntington's disease. The neuropsychological test performance of the 14 patients with at least one obsessive symptom and the seven patients with at least one compulsive symptom was compared with the performance of the patients without such symptoms. RESULTS: More than half of the patients with Huntington's disease endorsed obsessive or compulsive symptoms on the Yale-Brown scale. Patients with obsessive or compulsive symptoms showed significantly greater impairment on neuropsychological tests measuring executive function than those without such symptoms. CONCLUSIONS: Basal ganglia pathology in Huntington's disease may contribute to production of obsessive and compulsive symptoms and to executive performance deficits in these patients.

Analysis of Variance↗
PubMed2003

Quality of life in OCD: differential impact of obsessions, compulsions, and depression comorbidity.

OBJECTIVE: An anxiety disorder severely affects the sufferer's quality of life (QOL), and this may be particularly true of those with obsessive-compulsive disorder (OCD). This study examines the differential impact of obsessions, compulsions, and depression comorbidity on the QOL of individuals with OCD. METHOD: Forty-three individuals diagnosed with OCD according to DSM-IV criteria and experiencing clinically significant obsessions and compulsions completed measures of QOL, obsessive-compulsive symptom severity, and depression severity. RESULTS: Obsession severity was found to significantly predict patient QOL, whereas the severity of compulsive rituals did not impact on QOL ratings. Comorbid depression severity was the single greatest predictor of poor QOL, accounting for 54% of the variance. CONCLUSIONS: Given the importance of these symptoms, treatments that directly target obsessions and secondary depression symptoms in OCD are warranted. However, replication of these findings in a prospective cohort study is required, because although the the current study's cross-sectional design allows for the examination of the associations among obsessions, depression, and QOL, it cannot establish their temporal framework (that is, causal relations).

Adolescent↗
PubMed1982

A comparative psychometric study of anorexia nervosa and obsessive neurosis.

Similarities between anorexia nervosa and obsessive-compulsive disorder have been described by a number of authors but few empirical investigations have been reported. In the current study, 15 female anorexics were compared with 14 age-matched female obsessives on a variety of psychometric tests, psychiatrist's ratings and self-rating scales. Obsessives and anorexics obtained similarly high obsessive symptom and trait scores on the Leyton Obsessional Inventory LOI). Both groups were rated by the psychiatrist as similarly obsessive, and there were no significant group differences in self-ratings of obsessive symptoms. Both groups were characterized by high levels of neuroticism and anxiety and low levels of extraversion. In the anorexic group the 6 abstainers had higher resistance scores on the LOI and higher extraversion scores on th MPI than the 9 bulimics. Findings are discussed with reference to the "sorcerer's apprentice" syndrome which appears to characterize both the obsessive and the anorexic.

Adolescent↗
PubMed2006

Obsessive-compulsive disorder in Tourette syndrome.

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.

Adolescent↗
PubMed1994

Thought suppression and obsession-compulsion.

It was argued that obsession-compulsion might affect the consequences of thought suppression. A group of 35 female students who were first submitted to thought suppression and then to an expression instruction were compared with a group of 38 female students submitted twice to an expression instruction. The emotional character of a target story read by subjects was systematically varied between subjects, and obsession-compulsion was included as a third between-subjects factors. No evidence of rebound or of initial enhancement was found when reported story-related thoughts were compared across instructional conditions. There was an interaction between obsession-compulsion and initial instruction on attempts to avoid target thoughts during the first period. Contrary to expectations obsession-compulsion was related to fewer attempts at suppression in the suppression and more in the expression conditions. Similarly, there was a trend for obsession-compulsion to be related to more frequent target thoughts in the expression and less in the suppression conditions. These findings are discussed in relation to the role of perceived responsibility in obsession-compulsion for thought as a determinant of thought processes of obsessive-compulsive people.

Adult↗
PubMed1998

A comparison study of body dysmorphic disorder and obsessive-compulsive disorder.

BACKGROUND: Body dysmorphic disorder, a preoccupation with an imagined or slight defect in appearance, is classified as a somatoform disorder, but has been hypothesized to be related to obsessive-compulsive disorder. A reflection of this hypothesis, body dysmorphic disorder is included in the Yale-Brown Obsessive Compulsive Scale symptom checklist, and its transfer to the anxiety disorders' section was considered for DSM-IV. However, the similarities and differences between body dysmorphic disorder and obsessive-compulsive disorder have received little investigation. METHOD: We compared patients with DSM-IV body dysmorphic disorder (N = 53), obsessive-compulsive disorder (N = 53), or both disorders (N = 33) in terms of demographic features, clinical features, comorbidity, and family history. We also assessed the rate of body dysmorphic disorder among 62 of these subjects initially diagnosed with obsessive-compulsive disorder. RESULTS: 14.5% (9 of 62) of subjects initially diagnosed with obsessive-compulsive disorder had comorbid body dysmorphic disorder. The 2 disorders did not differ significantly in terms of sex ratio; most other demographic, course, and impairment variables; illness severity; or lifetime frequency of most associated disorders in probands or first-degree relatives. However, subjects with body dysmorphic disorder were less likely to be married and more likely to have had suicidal ideation or made a suicide attempt because of their disorder. They also had an earlier onset of major depression and higher lifetime rates of major depression, social phobia, and psychotic disorder diagnoses, as well as higher rates of substance use disorders in first-degree relatives. CONCLUSION: Body dysmorphic disorder appears to be relatively common among patients with obsessive-compulsive disorder. While the 2 disorders have many similarities, they also have some differences and should be differentiated in clinical and research settings.

Adult↗
PubMed1999

Olanzapine addition in obsessive-compulsive disorder refractory to selective serotonin reuptake inhibitors: an open-label case series.

BACKGROUND: Despite the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder, a significant number of patients show no or only partial remission of symptoms. Some evidence exists to suggest that risperidone augmentation can be helpful in treating this refractory group. The efficacy of other atypical antipsychotic agents, such as olanzapine, in augmenting SSRIs in refractory obsessive-compulsive patients has yet to be systematically investigated. METHOD: A series of 10 patients with DSM-IV obsessive-compulsive disorder showing significant residual symptoms following an adequate SSRI trial (12 weeks) were given open-label olanzapine augmentation for a minimum of an additional 8 weeks. Treatment response was assessed using the Yale-Brown Obsessive Compulsive Scale and the Clinical Global Impressions scale. RESULTS: Nine of the 10 patients in this series treated with olanzapine and an SSRI completed the 8-week augmentation trial. Of these, 4 demonstrated a complete remission or major improvement in obsessive-compulsive symptoms, 3 had partial remission, and 2 experienced no benefit. Nine patients experienced minimal adverse effects, primarily sedation, which did not interfere with continuing treatment. One patient discontinued olanzapine owing to excessive sedation. CONCLUSION: The results of this preliminary, open-label trial suggest that olanzapine may be effective in augmenting ongoing SSRI treatment for a portion of patients with obsessive-compulsive disorder refractory to SSRI treatment. Larger, placebo-controlled trials appear warranted to investigate the clinical efficacy and tolerability of olanzapine augmentation of SSRI treatment in SSRI-refractory obsessive-compulsive disorder.

Adult↗
PubMed2001

[The psychopathology of severe obsessive-compulsive disorder: Zwangskrankheit and primary obsessional slowness].

In investigation obsessive-compulsive phenomena, it is important to not only regard them as a kind of symptomatology extending across a variety of diagnostic categories on the basis of faint similarities of symptoms from the cross-sectional point of view, but also to take into account how the psychopathology of a nuclear form of severe obsessive-compulsive disorder (OCD) is different from a neurotic form from the vertical-sectional point of view. In this paper, the psychopathological features of 3 cases of Zwangskrankheit and primary obsessional slowness, which are considered to be nuclear forms of severe OCD, are reported. We suggest that 'obsessive-compulsive pseudophobia' lies behind Zwangskrankheit, and 'obsessive-compulsive depersonalization' lies behind primary obsessional slowness. In both disorders, a peculiar form of avoidance behavior, called 'pathological access to safety signal' was observed in which dangerous situations were avoided by taking no other action other than a determined one. Thus never making a mistake was stressed in their actions which is a feature of adherence to extra-orderliness. Therefore, a patient with Zwangskrankheit lives a restricted life according to strict rules characteristic of ritualization of one's whole life, while a patient with primary obsessional slowness acts according to the principle of miticulousness. Thus we considered that this kind of avoidance behavior is the result of a loss of safety signal not by the existence of a danger signal. In a neurotic form of OCD, patients may attempt to superficially restore the safety signal by avoiding the danger signal. In comparing the psychopathology of OCD with agoraphobia, avoidance behavior involves space in the latter, while it is an act in the former. Obsessive-compulsive pseudophobia and obsessive-compulsive depersonalization are hypothesized to be the background of symptoms of a neurotic form of OCD, but since the patients do not experience them as phenomena and so cannot take them into the field of consciousness, then they are likely to feel them, literally 'obsessive-compulsive.'

Adult↗
PubMed2002

[Obsessive doubts by contrast].

Obsessive doubts by contrast, along with traditional obsessions, refer to a kind of obsessive states, for which contrast content presentations provide a basis for obsession appearance accompanied by irresistible drive for walking off a psychogenic situation. Obsessive doubts by contrast are formed due to a conflict between equally attractive but incompatible wishes. The content of contrast throught is not absurd but reflects a real traumatizing situation. A study of 28 patients revealed they have psychasthenic accentuation as a personal feature in common. Obsessive doubts by contrast may develop both in the terms of affective disorders and schizotypical disorder (slow progredient schizophrenia). They have current character and in a number of cases transform into other obsessive-phobic states.

Adult↗
PubMedDate not supplied

[Obsessive-compulsive symptoms in schizophrenia during treatment with clozapine and conventional antipsychotic drugs].

INTRODUCTION: We compare the prevalence of obsessive-compulsive symptoms in schizophrenic patients in treatment with clozapine and those who receive classic antipsychotic drugs. METHOD: Outpatients with schizophrenia treated with clozapine (n = 56) or classic antipsychotic drugs (n = 54) at the Honorio Delgado-Hideyo Noguchi Specialized Institute in Mental Health (Lima-Peru), were evaluated for the presence of obsessive-compulsive symptoms by means of the Obsessive-Compulsive Disorder Module of Structured Clinical Interview for DSM-IV and Yale-Brown Obsessive-Compulsive Symptoms Checklist. RESULTS: 46.4 % of patients treated with clozapine presented obsessive-compulsive symptoms while this occurred in 20.4 % of those with classic antipsychotic drugs (p = 0.005). In addition, 21.4 % of patients with clozapine and 13 % of those treated with classic antipsychotics presented obsessive-compulsive disorder according to DSM-IV criteria (p = 0.31). CONCLUSION: In schizophrenic patients, treatment with clozapine is associated with a higher rate of obsessive-compulsive symptoms than treatment with classic antipsychotic drugs.

Adult↗
PubMed1991

[Clinical characteristics and typology of the obsessive-compulsive disorder in slowly-progressing recurrent schizophrenia with the onset in childhood and adolescence].

As many as 56 patients suffering from slow-progredient attack-like schizophrenia running its course with the predominance of obsessions in the clinical picture were examined and followed up for 3 to 5 years. At the moment of the examination the patients' age ranged from 8 to 15 years. It has been established that during slow-progredient attack-like schizophrenia in children and adolescents, obsessions occur in the structure of "large" obsessive syndromes characterized by polymorphism of psychopathological disorders and always including remarkable affective symptomatology. Six types of obsessive conditions were distinguished, each of which was marked by a definite stereotype of the disease natural history and correlated with the degree of the process progress. Among the types of obsessive conditions described, depressive ones with obsessions (three types) led on the whole to less pronounced alterations of the personality than obsessive-anxious ones, particularly anxious-hypochondriac attacks after the completion of which there formed relatively more profound personality changes.

Adolescent↗