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PubMedDate not supplied

[Epidemiology of obsessive-compulsive disorder in children and adolescents].

Although obsessive-compulsive disorders are rarely found in young subjects seen in infantile psychiatry, anamnestic studies have shown that more than one third of obsessive patients seen at adult age agree that the onset of their disorder dates back to when they were under 15 years of age. The first direct epidemiological study on the prevalence of obsessive-compulsive disorder during adolescence was recently conducted in a New Jersey county, USA. Over 5,500 high school teenagers were asked to fill in a questionnaire dealing with different aspects of mental pathology and 356 of them were selected, on the basis of their answers, to be included in further clinical examinations. Thus, the current prevalence rate of obsessive-compulsive disorder was found to be 1 (+/- 0.5)% of the general adolescent population, and the lifetime prevalence rate, 1.9 (+/- 0.7)%. These results are close to the rates of prevalence observed in the U.S. general adult population during the same period. The obsessive-compulsive cases detected in this investigation showed the same characteristics as the clinical cases usually described, except for the absence of male predominance generally observed in consulting patients; 75% of obsessive patients also presented other associated psychopathological disorders, most often major depression, overanxious disorder and/or bulimia, but only 20% of them had already consulted mental health professionals. This study shows that obsessive-compulsive disorder during adolescence is more frequent than expected, but often remains undiagnosed and untreated.

Adolescent↗
PubMed1993

The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder.

This retrospective case-controlled analysis evaluated treatment response to the serotonin reuptake inhibitor fluvoxamine in patients with obsessive-compulsive disorder (OCD), with or without a comorbid chronic tic disorder. Thirty-three fluvoxamine-treated OCD patients with a concurrent chronic tic disorder were compared with 33 age- and sex-matched OCD patients without chronic tics who had received fluvoxamine treatment in the same setting during the same period of time and in a similar manner. Although both groups of patients demonstrated statistically significant reductions in obsessive-compulsive, depressive, and anxiety symptoms with fluvoxamine treatment, the frequency and magnitude of response of obsessive-compulsive symptoms was significantly different between the two groups. A clinically meaningful improvement in obsessive-compulsive symptoms occurred in only 21% of OCD patients with comorbid chronic tics compared with a 52% response rate in OCD patients without chronic tics. Moreover, OCD patients with a concurrent chronic tic disorder showed only a 17% reduction in Yale-Brown Obsessive-Compulsive Scale scores compared with a 32% decrease in the severity of obsessive-compulsive symptoms in those OCD patients without chronic tics. These results suggest that serotonin reuptake inhibitor monotherapy may be less efficacious for improving obsessive-compulsive symptoms in OCD patients with than without tics. Combined with differences in the clinical phenomenology between these two groups, these treatment response data support the hypothesis that OCD patients with a comorbid chronic tic disorder may be a clinically meaningful subtype.

Adult↗
PubMedDate not supplied

[The Yale-Brown Scale: instrument for assessing the severity of obsessive-compulsive disorders].

The paper presents characteristics and evaluation of the Yale-Brown Scale, its clinical value in assessing severity of obsessive compulsive disorders. The Yale-Brown Scale is a semistructured interview. The scale consists of 10 items, rated from 0 (no symptoms) to 4 (extreme symptoms). There are separate ratings for severity of obsessions and compulsions. The assessment of items is based on the patient's report and the clinician's observations gained during the interview. The studies indicate that the Yale-Brown Scale is a reliable and valid instrument for assessing severity of obsessive compulsive disorder symptoms in patients with obsessive compulsive disorder. This instrument is sensitive enough to changes in symptoms severity; thus, it permits to analyse the efficacy of treatment of OCD. The fact that the total score is not determined by the type of obsessive compulsive symptoms, permits to compare the symptoms severity in patients with different types of obsessions and compulsions and it is suitable to assess the efficacy of treatment of different types of obsessive compulsive disorder.

Adult↗
PubMed2002

Co-occurrence of obsessive-compulsive personality traits in young and middle-aged Japanese alcohol-dependent men.

BACKGROUND: Previous studies may have underestimated the potential importance of the prevalence of obsessive-compulsive traits among persons with alcoholism. Although many studies have examined the characteristics of young alcoholics compared with middle-aged alcoholics, none has compared the prevalence of obsessive-compulsive traits in young and middle-aged alcoholics. METHODS: This study compared the prevalence of obsessive-compulsive traits (Leyton Obsessional Inventory) and depressive symptoms (Zung Self-Rating Depression Scale) among young (n=41) and middle-aged (n=34) hospitalized Japanese male alcoholics and in young (n=28) and middle-aged (n=25) nonalcoholic subjects. RESULTS: Both young and middle-aged male alcoholics reported more obsessive-compulsive personality traits and depressive symptoms than their comparison groups. However, the alcoholic subjects' obsessive-compulsive personality traits were not related to their level of depressive symptoms. CONCLUSIONS: Young and middle-aged male Japanese alcoholics have more obsessive-compulsive personality traits than nonalcoholic males of similar ages. Their alcohol-related psychological and behavioral characteristics may derive, in part, from their obsessive-compulsive symptoms.

Adult↗
PubMed1999

[Clinical typology of contrast content obsessions in borderline mental diseases].

40 patients were observed (16 men, 24 women, mean age 27 years) with the obsessions of the contrast contents (14-homocidophobia, 18-suicidophobia, 8-combined homo- and suicidophobia). Two types of contrast obsession (CO) were recognized: contrast phobias with anxiety about possibility to commit autodestructive or criminal actions and contrast obsessions with anxious doubts about committing either violence or murder. CO of first type were determined by the fear of lack of self-control and possibility to commit autodestructive or criminal actions. Such obsessions are accompanied by bright images, massive somato-vegetative symptomatology and rapid formation of avoidance behaviour. CO of second type are characterized by pathologic doubts about committing violence or murder and accompanied by strong desire to check again and obsessive self-analysis. CO of first type belong to the spectrum of anxious-phobic disorders and are phobic in their nature; within acute phobic fit, similar in manifestations to a panic attack; they are associated with other phobic disorders and manifest like phobic depressions. On the contrary, CO of second type are true obsessive phenomena, and isolated, combine with obsessions of the repeated control, and with different types of depressions only in half of the cases.

Adolescent↗
PubMed2000

Obsessive and compulsive symptoms in schizophrenia: clinical and neurocognitive correlates.

Although research suggests that the presence of obsessive and compulsive symptoms in schizophrenia is associated with graver levels of psychosocial dysfunction, it is unclear whether it is also related to clinical features of illness. Accordingly, the present study compared the symptom levels and neurocognitive function of participants with schizophrenia who had and did not have significant obsessive or compulsive symptoms. Analyses of variance revealed that participants with significant levels of either obsessive or compulsive symptoms (N = 21) had higher levels of positive and emotional discomfort symptoms on the Positive and Negative Syndrome Scale (PANSS) and performed more poorly on the Wisconsin Card Sorting Test, a measure of executive function, than participants without obsessions or compulsions (N = 25). ANCOVAs controlling for level of obsessions also revealed that participants with significant levels of compulsions (N = 12) in particular had higher levels of negative and positive symptoms on the PANSS than participants without compulsions (N = 34). The impact of obsessive-compulsive phenomena on the course and outcome of schizophrenia is discussed.

Adult↗
PubMed2000

The relationship between types and severity of repetitive behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder.

BACKGROUND: This study investigated which categories of obsessive-compulsive and Tourette-related behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder (OCD) without tics are experienced as most severe across the study groups and what the differences are in symptom distribution between the study groups. METHOD: Fourteen subjects with both Tourette's disorder and OCD, 18 subjects with Tourette's only, 21 subjects with OCD (no tics), and 29 control subjects were studied using a semistructured interview designed to equally assess Tourette- and OCD-related behaviors according to DSM-III-R criteria. Each reported repetitive behavior was evaluated on the presence of anxiety and on goal-directedness. Anxiety-related items were categorized as obsessions or compulsions and non-anxiety-related items as impulsions. Severity of each reported item was assessed with respect to time per day consumed and amount of distress and interference induced by the item. Following these criteria, each reported item was classified as a symptom, a subthreshold symptom, or just as being present. RESULTS: Across the study groups, obsessions were experienced as more severe than (Tourette-related) impulsions and compulsions. Within the study groups, patients with both Tourette's disorder and OCD reported more symptomatic Tourette-related impulsions, such as mental play, echophenomena, and impulsive or self-injurious behaviors; less overall symptomatic obsessions; and less symptomatic washing than patients with OCD (no tics). The differences among individuals with Tourette's with or without OCD reflected differences in symptom severity rather than differences in symptom distribution. CONCLUSION: Obsessions are more time consuming, distressing, and interfering than compulsions and impulsions. Furthermore, the symptomatic repetitive behaviors were distributed differently among patients with both Tourette's disorder and OCD and patients with OCD (no tics). Patients with Tourette's and OCD are phenomenologically more similar to Tourette's than to OCD. These differences possibly represent differences in underlying pathophysiology between Tourette's and tic-free OCD.

Adult↗
PubMed1992

Cerebrospinal fluid neurochemistry in children and adolescents with obsessive-compulsive disorder.

Cerebrospinal fluid hormones, monoaminergic metabolites, and dynorphin A (1-8 sequence) were examined in 43 children with severe, primary obsessive-compulsive disorder. Cerebrospinal fluid levels of 5-hydroxyindoleacetic acid were positively correlated with one of eight obsessive-compulsive disorder severity ratings and three of seven measures of improvement following 5 weeks of treatment with clomipramine hydrochloride. Arginine vasopressin concentration was significantly and negatively correlated with several ratings of obsessive-compulsive disorder symptom severity, while oxytocin concentration was positively correlated with depressive symptoms. The ratio of arginine vasopressin to oxytocin was also negatively correlated with obsessive-compulsive disorder and depressive symptoms. Comorbid affective disorder was associated with decreased arginine vasopressin concentrations, while concomitant anxiety disorder was associated with increased oxytocin. Dynorphin A (1-8 sequence), homovanillic acid, corticotropin, 3-methoxy-4-hydroxyphenylglycol, and corticotropin releasing hormone were not significantly related to obsessive-compulsive disorder symptoms. These results seem to indicate that arginine vasopressin may be related to obsessive-compulsive disorder symptom severity, while 5-hydroxyindoleacetic acid might be associated with drug response.

Adolescent↗
PubMed1996

Cerebral structural abnormalities in obsessive-compulsive disorder. A quantitative morphometric magnetic resonance imaging study.

BACKGROUND: A previous pilot study of only posterior brain regions found lower white-matter volume in patients with obsessive-compulsive disorder than in normal control subjects. We used new cohorts of patients and matched normal control subjects to study whole-brain volume differences between these groups with magnetic resonance imaging-based morphometry. METHODS: Ten female patients with obsessive-compulsive disorder and 10 female control subjects, matched for handedness, age, weight, education, and verbal IQ, underwent magnetic resonance imaging with a 3-dimensional volumetric protocol. Scans were blindly normalized and segmented by means of well-characterized semiautomated intensity contour mapping and differential intensity contour algorithms. Brain structures investigated included the cerebral hemispheres, cerebral cortex, diencephalon, caudate, putamen, globus pallidus, hippocampus amygdala, third and fourth ventricles, corpus callosum, operculum, cerebellum, and brain stem. Anterior to posterior neocortical regions, including precallosum, anterior pericallosum, posterior pericallosum, and retrocallosum, with adjacent white matter were also measured. Volumes found different between groups were correlated with Yale-Brown Obsessive Compulsive Scale score and Rey-Osterieth Complex Figure Test measures. RESULTS: Confirming results of our earlier pilot study and expanding the findings to the whole brain, patients with obsessive-compulsive disorder had significantly less total white matter but, in addition, significantly greater total cortex and opercular volumes. Severity of obsessive-compulsive disorder and nonverbal immediate memory correlated with opercular volume. CONCLUSIONS: Replication of volumetric white-matter differences suggests a widely distributed structural brain abnormality in obsessive-compulsive disorder. Whereas determining the etiogenesis may require research at a microscopic level, understanding its functional significance can be further explored via functional neuroimaging and neuropsychological studies.

Adult↗
PubMed2000

Obsessive and compulsive symptoms in a general population sample of female twins.

Obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) exhibit a familial pattern of transmission. The different components of these conditions and the extent to which these components are inherited have not been studied well. A sample of 1,054 female twins, including both members of 527 pairs, from the Virginia Twin Registry returned questionnaires that included 20 items from the Padua Inventory of obsessive-compulsiveness. Their responses were used to estimate the heritability of the different factors of OCS in this population. Principal components analysis suggested two meaningful factors corresponding roughly to obsessions and compulsions. The best-fit model suggested heritabilities of 33 and 26%, respectively. The correlation between additive genetic effects on compulsiveness and obsessiveness was found to be +0.53. Self-report symptoms of obsessions and compulsions in women from the general population are moderately heritable and due, in part, to the same genetic risk factors. An understanding of the etiology of these symptoms is relevant to the study of OCD. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:791-796, 2000.

Adult↗
PubMed1994

Procrastination tendencies among obsessive-compulsives and their relatives.

Participants diagnosed with obsessive-compulsive disorder (OCD; 39 women, 26 men; M age = 40) and their family relatives (11 women, 7 men; M age = 45) completed standardized measures of obsessions, compulsions, decisional procrastination (indecision), and avoidant procrastination. Among the OCDs, obsessions were related significantly to decisional procrastination, and compulsions were related significantly to decisional and avoidant procrastination. In comparison to family members of obsessive compulsives, the OCDs reported significantly greater obsessions, compulsions, and indecisions, but not procrastination motivated by avoidance. Results suggest that individuals with clinical obsessive-compulsive tendencies do, in fact, report states of indecision, as claimed by DSM-III-R. However, these clinical individuals may not differ significantly from nonclinical samples (e.g., family members) in avoidant procrastination.

Adult↗
PubMed1994

A Self-Rated Scale for Obsessive-Compulsive Disorder.

The Self-Rated Scale for Obsessive-Compulsive Disorder is an objective 35-item questionnaire that measures the severity of obsessive-compulsive disorder (OCD). Scale construction employed both rational and empirical item-selection procedures and utilized the responses of 127 diagnosed obsessive-compulsive subjects. A cross-validation study that used 40 obsessive-compulsive subjects found high internal consistency and significant correlations between the new scale and two clinician-rated measures of OCD. Principal components analysis of the combined subject sample (167 obsessive-compulsive subjects) identified four orthogonal components: distressing thoughts, rituals, perfection, and fear of contamination. In conclusion, the Self-Rated Scale for Obsessive-Compulsive Disorder appears to be a comprehensive, easy-to-use, and psychometrically sound instrument for measuring severity of OCD.

Adult↗
PubMed2003

Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder.

BACKGROUND: Transcranial magnetic stimulation (TMS) was introduced as a neurophysiological technique in 1985 when Anthony Barker and his team developed a compact machine that permitted non-invasive stimulation of the cerebral cortex (Barker 1985). Since its introduction, TMS has been used to evaluate the motor system, to study the function of several cerebral regions, and for the pathophysiology of several neuropsychiatric illnesses. In addition, it has been suggested that TMS might have therapeutic potential. Some controlled studies have evaluated the effects of repetitive TMS (rTMS) in patients with obsessive-compulsive disorder (OCD). Greenberg (Greenberg 1997) observed that a single session of right prefrontal cortex stimulation produced a significant decrease in compulsive urges in OCD patients lasting over eight hours. Other studies have reported transitory improvements in mood but there are no observations for changes in anxiety or obsessions. OBJECTIVES: To develop a systematic review on the clinical efficacy and safety of transcranial magnetic stimulation from randomised controlled trials in the treatment of obsessive-compulsive disorder. SEARCH STRATEGY: An electronic search was performed including the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (last searched June, 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966-2002), EMBASE (1974-2002), PsycLIT (1980-2002), and bibliographies from reviewed articles. SELECTION CRITERIA: Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for obsessive-compulsive disorder. DATA COLLECTION AND ANALYSIS: All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion. MAIN RESULTS: Three trials were included in the review and only two contained data in a suitable form for quantitative analysis. It was not possible to pool any results for a meta-analysis. No difference was seen between rTMS and sham TMS using the Yale-Brown Obsessive-Compulsive Scale or the Hamilton Depression Rating Scale for all time periods analysed. REVIEWER'S CONCLUSIONS: There are currently insufficient data from randomised controlled trials to draw any conclusions about the efficacy of transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder.

Humans↗
PubMedDate not supplied

Patterns of obsessive compulsive symptoms in Tourette subjects are independent of severity.

Studies have examined the expression of obsessive compulsive (OC) symptoms in obsessive compulsive disorder (OCD), OCD with co-occurring Tourette's Syndrome (TS) or chronic motor tic disorder (CMT) and TS alone. In adult samples, there appears to be a relatively consistent OC symptom thematic content that characterizes OCD alone and OCD in conjunction with tics or TS. Previous studies have controlled for the severity of OC symptoms in OCD and TS groups. In the current study, it was our objective to determine whether patterns of OC symptoms in TS are independent of OC symptom severity. The current exploratory study examined OC symptom expression in a nonclinically based TS sample with a broad range of OC symptoms and severity and a selected clinical OCD sample without TS/tics. Univariate and multivariate statistical analysis explored patterns of OC symptom expression between the two groups. Similar to previous reports examining OC symptoms in OCD and OCD with TS/tics, subjects with OCD alone were characterized by contamination obsessions and cleaning compulsions. In contrast, TS subjects had more somatic, sexual and symmetry obsessions and more checking, counting and touching/blinking compulsions, independent of OC symptom and tic severity. A discriminant function using obsessive items alone correctly grouped 91.4% of cases. The current study replicates patterns of OC symptom expression unique to OCD alone. Patterns of OC symptoms, in particular obsessive symptoms, can robustly predict membership in OCD or TS groups, even with a substantial variation in OC symptom severity as measured by the Y-BOCS score.

Adult↗
PubMed1999

Obsessive-compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders: measuring the effects of depression.

Obsessive-compulsive symptoms have been related to severity in the clinical presentation of eating disorders, whereas the impact of depression on the correlations between their severity and the severity of eating disorders has not been investigated. This paper assesses the effects of depression in 42 adolescent patients who met DSM-IV criteria for anorexia nervosa or bulimia nervosa by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). The results indicate that patients who show elevated obsessionality and compulsivity on the Y-BOCS display a significantly higher degree of disturbed attitudes and behaviours concerning eating than patients with limited obsessionality and compulsivity. However, when the effects of depression are considered, all the differences found disappear. Our study suggests that depression is more directly associated with the severity of eating disorders than obsessive-compulsive symptoms and that the intensity of obsessive-compulsive symptoms in eating disorders is influenced by the intensity of depression. The relations between obsessive-compulsive symptoms, depression and eating disorders are not known. Even so this study highlights the importance of assessing depression when using obsessive and compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders.

Adolescent↗
PubMed2003

Attitudes toward obsessive-compulsive disorders--an experimental investigation.

BACKGROUND: Fear, embarrassment and stigma are salient factors contributing to reluctance to seek help for psychological distress. Although vignette studies have often been employed to assess attitudes towards psychological disorders, no study has specifically assessed attitudes towards Obsessive-Compulsive Disorder (OCD). METHODS: An experimental study assessing attitudes toward obsessive-compulsive problems is presented. One hundred and thirteen undergraduate students were given vignettes describing three subtypes of obsessive-compulsive problem (harming, washing and checking). They were asked to make judgements about fear, shame and social acceptance, and to evaluate how they themselves might feel if they experienced the problems described in the vignettes. RESULTS: The obsessive-compulsive problems described in the vignettes were evaluated differently in terms of shame, fear and social acceptance. The harming problems were rated as being the most unacceptable, followed by the washing behaviour, and then the checking behaviour. CONCLUSION: The findings suggest that attitudes to obsessive-compulsive problems are likely to be complex and that help-seeking influences may vary across the different subtypes of this disorder. The implications for people seeking help for obsessive-compulsive problems are pointed out.

Adolescent↗
PubMed2005

Obsessive-compulsive symptoms among patients with Sydenham chorea.

BACKGROUND: Among patients with tic disorders, a distinctive clinical profile of obsessive-compulsive symptomatology has been described. The present investigation was designed to document the phenomenology of obsessive-compulsive symptoms (OCS) among patients with Sydenham chorea (SC), the neurologic variant of rheumatic fever. We hypothesized that OCS occurring in association with SC would be similar to those among patients with tic disorders. METHODS: The authors studied the presence of OCS in 73 patients with SC by using the Yale-Brown Obsessive-Compulsive Scale at the Pediatric Clinics of the University of Sao Paulo Medical Center in Sao Paulo, Brazil (n = 45) and at the National Institute of Mental Health in Bethesda, Maryland (n = 28). RESULTS: The most frequent symptoms observed among subjects with comorbid SC and OCS were aggressive, contamination, and somatic obsessions and checking, cleaning, and repeating compulsions. A principal component factor analysis yielded a five-factor solution (accounting for 64.5% of the total variance), with contamination and symmetry obsessions and cleaning compulsions loading highly. CONCLUSIONS: The symptoms observed among the SC patients were different from those reported by patients with tic disorders but were similar to those previously noted among samples of pediatric patients with primary obsessive-compulsive disorder.

Adolescent↗
PubMed2001

Predictive validity of the overvalued ideas scale: outcome in obsessive-compulsive and body dysmorphic disorders.

Overvalued ideas have been theoretically implicated in treatment failure for obsessive-compulsive disorder (OCD). Until recently, there have not been valid assessments for determining severity of overvalued ideas. One recent scale, the Overvalued Ideas Scale (OVIS; Neziroglu, McKay, Yaryura-Tobias, Stevens & Todaro, 1999, Behaviour Research and Therapy, 37, 881-902) has been found to validly measure overvalued ideas. However, its predictive utility has not been determined. Two studies were conducted to examine the extent to which the OVIS predicts treatment response. Study 1 examined the response to behavioral therapy in a group of participants diagnosed with OCD. Residual gain scores showed a significant correlation between treatment outcome for compulsions and pretreatment OVIS scores (28.1% variance accounted). Pretreatment OVIS scores were not significantly correlated with residual gains in obsessions (1.7% variance accounted). The predictive utility of the OVIS was superior to a single item assessment of overvalued ideas available on the Yale-Brown Obsessive Scale in predicting outcome for compulsions. For this item, the variance accounted for compulsions was 6.3% and for obsessions was 3.9%. Study 2 examined the response to behavioral therapy in a group of participants diagnosed with body dysmorphic disorder (BDD), a condition ostensibly linked to OCD and presumed to present with higher levels of overvalued ideas. Residual gains scores showed a significant relationship between obsessions and OVIS (accounting for 34.8% of the variance), but not for compulsions (10.2% variance accounted). As in Study 1, the predictive utility of the OVIS was superior to the single item assessment (with 0.2% variance accounted for compulsions, 2.4% variance accounted for obsessions). Taken together, the studies reported here show that this OVIS is predictive of treatment outcome, and the predictive value depends on which symptoms are used to assess outcome. Further, the scale is more effective in predicting outcome than a widely used single item assessment.

Adolescent↗