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PubMed2004

Manipulation of responsibility in non-clinical subjects: does expectation of failure exacerbate obsessive-compulsive behaviors?

An exaggerated sense of responsibility is currently considered as the ground for the obsessive-compulsive disorder. Obsessive-like behaviors, such as hesitations and checks, may be induced in non-clinical subjects by increasing perceived responsibility (i.e., perceived personal influence on negative outcomes). In line with Salkovskis' proposal [The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions, in: P.M. Salkovskis (Ed.), Frontiers of Cognitive Therapy, Guilford, New York], we tested the hypothesis that reduced coping abilities (i.e., an exaggerated expectation of failure) are another effectual factor contributing to obsessive-like behaviors. We examined 47 normal volunteers in a visuo-spatial memory task, and manipulated their perceived personal influence and expectation of failure by giving differential instructions and feedback about their performance. Increase of perceived personal influence induced slowness, hesitations and checks without enhancing performance. Expectation of failure exacerbated obsessive-like behaviors, again without affecting performance. These results confirm the role of responsibility in obsessive-like behavior and indicate that reduced coping abilities may contribute to worsen dysfunctional strategies.

Achievement↗
PubMed2000

Thalamic volume in pediatric obsessive-compulsive disorder patients before and after cognitive behavioral therapy.

BACKGROUND: Neurobiologic abnormalities in the thalamus have been implicated in the pathophysiology of obsessive-compulsive disorder. We recently reported increased thalamic volume in treatment-naive pediatric obsessive-compulsive disorder patients versus case-matched healthy comparison subjects that decreased to levels comparable to control subjects after effective paroxetine therapy. To our knowledge, no prior study has measured neuroanatomic changes in the thalamus of obsessive-compulsive disorder patients near illness onset before and after cognitive behavioral therapy. METHODS: Volumetric magnetic resonance imaging studies were conducted in 11 psychotropic drug-naive 8-17-year-old children with obsessive-compulsive disorder before and after 12 weeks of effective cognitive behavioral therapy monotherapy (> or =30% reduction in obsessive-compulsive disorder symptom severity). RESULTS: No significant change in thalamic volume was observed in obsessive-compulsive disorder patients before and after cognitive behavioral therapy. CONCLUSIONS: Our findings suggest that reduction in thalamic volume after paroxetine therapy may be specific to paroxetine treatment and not the result of a general treatment response or spontaneous improvement. These results are preliminary in view of the small sample studied.

Adolescent↗
PubMedDate not supplied

Rates for tic disorders and obsessive compulsive symptomatology in families of children and adolescents with Gilles de la Tourette syndrome.

The aim of this study was to assess rates for tic disorders and obsessive compulsive psychopathology in families of children and adolescents with Gilles de la Tourette syndrome (TS). Diagnoses were based on the DSM III-R criteria. Obsessive compulsive psychopathology, that did not fulfill the criteria for obsessive compulsive disorder (OCD) was additionally assessed and termed obsessive compulsive symptoms (OCS). The authors hypothesized that comorbid OCD or OCS in TS patients predicts a higher familial loading with obsessive compulsive symptomatology. The study cohort included 87 patients with TS who were evaluated clinically and with the use of a structured psychiatric interview. All available parents (152/174; 87%), several sibs (49/93; 53%) and some second degree relatives (27/659; 4.1%) were also interviewed. For other first and second degree relatives the family history method was used. Familial rates for TS were clearly elevated. Rates for chronic tic disorders (CT) were considerably lower than in previous studies. Additionally, tic disorders not otherwise specified (TDNOS) were diagnosed in a substantial number of first degree (15/267; 5.6%) and second degree relatives (36/659; 5.5%). OCD in parents (4/174; 2.3%) did not occur in an above baseline rate. However, both OCD (14/87; 16.1%) and OCS (15/87; 17.2%) were frequently associated with TS in index patients. Interestingly, 10 of 16 fathers with OCS also had a tic disorder. Obsessive compulsive psychopathology clustered in families. It is concluded that genetic studies in TS could profit from adhering to a conservative diagnostic approach to both tic disorders and OCD. The familial clustering of OCS/OCD in conjunction with the elevated paternal rate for the co-occurrence of tic disorders and OCS might indicate heterogeneity of TS.

Adolescent↗
PubMed2003

Obsessive-compulsive behaviors in parents of multiplex autism families.

Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive-compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive-compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive-compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive-compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies.

Adult↗
PubMed1997

Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment.

Previous reports have stressed the implication of Personality Disorders as predictors of a poorer treatment outcome in Obsessive-Compulsive Disorder (OCD). The aim of this study was to see whether or not Obsessive-Compulsive Personality Disorder in Obsessive-Compulsive Disorder may be predictive for a poorer outcome to antiobsessive pro-serotonergic pharmacological treatment. For this purpose, 30 OCD patients were divided into two groups according to the presence or absence of Obsessive-Compulsive Personality Disorder. Ten-week standardized treatments with oral SRI drugs were given to look for different outcomes between the two groups in Obsessive-Compulsive symptom severity. At the end of the study we found that the presence of Obsessive-Compulsive Personality Disorder, along with the total number of Personality Disorders, did predict poorer response to pharmacological treatment in OCD.

Adult↗
PubMed1997

Cognitive-behavioral treatment of obsessive thoughts: a controlled study.

Twenty-nine patients with obsessive-compulsive disorder as diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) who did not have overt compulsive rituals were randomly assigned to treatment and waiting-list conditions. Patients in the treatment condition received cognitive-behavioral therapy consisting of a detailed explanation of the occurrence and maintenance of obsessive thoughts, exposure to obsessive thoughts, response prevention of all neutralizing strategies, cognitive restructuring, and relapse prevention. Compared with waiting-list patients, treated patients improved significantly on measures of severity of obsessions, current functioning, self-report obsessive-compulsive symptoms, and anxiety. When waiting-list patients were subsequently treated, the combined group improved on all outcome measures. Treatment gains were maintained at 6-month follow-up. Results indicate that cognitive-behavioral therapy is effective in the treatment of patients with obsessive thoughts, a group that has often been considered resistant to treatment.

Adult↗
PubMed2000

[The question of the connection between obsessive-compulsive disorder and narcissism].

Freud's psychodynamic concept of the anal-sadistic regression in obsessive-compulsive neurosis is completed with the clinical observation of the structural ego deficit in connection with obsessive-compulsive disorder. Not being able to rely on one's own behaviour, described by Quint, for example, explains that the self-assessing function is lacking in the obsessive-compulsive patient. Such patients need the other person to acknowledge and confirm their behaviour as a self-object, i.e. as a part of his self. The aspect of the narcissistic bond of the obsessive-compulsive patient is emphasised here as a differentiation to the more superficial criteria of narcissism in the DSM-IV. The obsessive-compulsive symptomatology has the function to hold on to his self-object as no autonomy is available and loss of bond is experienced as loss of self. The relation of obsessive-compulsive disorder and narcissism is described on the basis of three case histories and supported by biographic and psychotherapeutic data. Furthermore attention is drawn to the consequences of this opinion for a modified psychodynamic therapeutical approach.

Humans↗
PubMed2005

Are there interactions among dysfunctional beliefs in obsessive compulsive disorder?

Contemporary cognitive models of obsessive-compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive-compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive-compulsive symptoms. To investigate this issue, data from 248 obsessive-compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2- and 3-way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive-compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.

Adult↗
PubMed1995

Demographic and clinical features of obsessive-compulsive disorder in children and adolescents.

OBJECTIVE: To describe the demography, symptomatology, and comorbidity of 31 clinically referred children and adolescents with obsessive-compulsive disorder. METHOD: The patients were assessed in an outpatient clinic for lifetime psychopathology with the Diagnostic Interview for Children and Adolescents. The child and adolescent version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used to group obsessive-compulsive symptoms and rate symptom severity. Demographic, medical, developmental, academic, and behavioral information was recorded by the parents in the Yale Children's Inventory and the Child Behavior Checklist. RESULTS: The male-female ratio was approximately 3:2. Most patients had had multiple obsessions and compulsions that had changed over time. The CY-BOCS correlated highly with another measure of obsessive-compulsive behavior, but not with any of the Child Behavior Checklist scales. Symptom severity was influenced by an interaction between gender and age at onset of the illness. More than 80% of the subjects had other lifetime psychiatric diagnoses. CONCLUSIONS: The results provide further evidence that obsessive-compulsive disorder is a chronic, severe illness in children and adolescents that is often associated with other forms of psychopathology. The data support the concurrent and discriminant validity of the CY-BOCS.

Adolescent↗
PubMed1995

Treatment of obsessive-compulsive symptoms in schizophrenic patients with clomipramine.

Recent studies show that obsessive-compulsive symptoms may occur in many patients with schizophrenia and may predict a poor prognosis. Pilot studies have shown that some schizophrenic patients may improve if a serotonin reuptake blocker is added to their neuroleptic. We have performed a pilot, double-blind, crossover study of clomipramine (CMI) or placebo, added to maintenance psychotropic medication. Six schizophrenic patients with obsessive-compulsive symptoms were studied in a double-blind CMI versus placebo crossover protocol. The patients met DSM-III-R criteria for chronic schizophrenia, experienced obsessive-compulsive symptoms, and had been previously stabilized on their psychiatric medication. The patients were rated at baseline and longitudinally through the study with the Positive and Negative Symptom Scale for Schizophrenia (PANSS) and the Yale Brown Obsessive-Compulsive Scale (YBOCS). An analysis of covariance was used to compare the drug versus placebo effect at the final visit with the baseline rating as a covariate. Ratings on both the YBOCS and the PANSS showed that patients improved significantly more on CMI than on placebo. No patients experienced an exacerbation of psychotic symptoms. Preliminary findings from this double-blind, crossover, pilot study of CMI and placebo, designed to assess the effect of CMI in the treatment of schizophrenic patients with obsessive symptoms, suggest that CMI is superior to placebo in the treatment of obsessions and compulsions and improves overall schizophrenic symptoms. Further studies with larger samples and longer follow-up period are necessary to confirm these preliminary findings.

Adult↗
PubMed1997

Long-term pharmacotherapy of obsessive-compulsive disorder: a double-blind controlled study.

The aim of this study was to investigate whether obsessive-compulsive patients previously treated successfully with clomipramine or fluvoxamine could tolerate reduction of the daily dosage without worsening of the clinical condition. Thirty informed obsessive-compulsive patients, given a diagnosis according to DSM-III-R criteria, were recruited consecutively into the study. Patients were blindly assigned to one of the groups of treatment with different rates of reduction of the previously effective daily drug dosage: group 1 (control group, no reduction), group 2 (reduction of 33-40%), and group 3 (reduction of 60-66%). The entire study lasted 102 days. From baseline to the end of the study, the clinical condition was evaluated by the administration of standardized tests (Yale-Brown Obsessive-Compulsive Scale, Hamilton Rating Scale for Depression, Clinical Global Impression [CGI] scale), and blood samples were collected for plasma drug level determinations. The criterion for discontinuation of the study was the worsening of obsessive-compulsive symptoms, arbitrarily defined by an increase of > 5% from the baseline total Yale-Brown Obsessive-Compulsive Scale score, as measured in two successive assessments, and a worsening of global clinical condition as measured by the CGI scale. The main result of the study was borne out from the survival analysis. There were no significant differences in the cumulative proportion of patients from each group of treatment who did not worsen during the 102 days of observation. This preliminary result, which needs to be confirmed in larger samples, suggests that long-term maintenance therapy for obsessive-compulsive disorder might be provided with lower dosages of the antiobsessional drug, with clear advantages for tolerability and compliance.

Adult↗
PubMed1997

A double-blind study of fluvoxamine and clomipramine in the treatment of obsessive-compulsive disorder.

A double-blind trial was carried out to assess the efficacy and safety of fluvoxamine, a selective serotonin reuptake inhibitor, in comparison with clomipramine, a classical tricyclic antidepressant, in the treatment of obsessive-compulsive disorder. A total of 26 individuals with obsessive-compulsive disorder and with no comorbid disorders at baseline were included in the study. The obsessive-compulsive disorder symptom severity was rated using the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impression Scale. The primary efficacy measures indicated an equal improvement in the two groups (38% in the patients taking fluvoxamine and 40% in those taking clomipramine, as compared with baseline values), but onset was faster in the clomipramine group. Side effects, in particular anticholinergic side effects, were more prominent in the clomipramine group. The present double-blind trial confirms an equal efficacy of clomipramine and fluvoxamine in obsessive-compulsive patients. Although clomipramine had a faster onset, fluvoxamine was better tolerated, so that it seems more suitable for long-term treatment of obsessive-compulsive patients.

Adolescent↗
PubMed1999

Fluvoxamine treatment of obsessive-compulsive symptoms in schizophrenic patients: an add-on open study.

Obsessive-Compulsive (OC) symptoms are observed in a substantial proportion of schizophrenic patients and pose a significant therapeutic challenge. Based on findings of the benefit of the anti-obsessive agent clomipramine, we designed an open-label study to examine the effect of adding the serotonin-selective reuptake inhibitor (SSRI) fluvoxamine to the ongoing antipsychotic regimen of schizo-obsessive patients. The study population consisted of ten neuroleptic-stabilized chronic schizophrenic patients with OC symptoms. Fluvoxamine (up to 150 mg/day) was added to the ongoing antipsychotic treatment, which remained unchanged for the entire 12-week trial period. The patients were evaluated before the trial and at weeks 1, 2, 4, 6, 8 and 12 (end point) with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Schedule for Assessment of Positive Symptoms and the Schedule for Assessment of Negative Symptoms. The results showed a significant improvement in obsessions (P < 0.02) (but not compulsions) and both positive (P < 0.01) and negative (P < 0.05) schizophrenic symptoms. By the end of the trial, three patients showed a more than 50% reduction in the Y-BOCS score, with complete amelioration of the OC symptoms in one of them. Three patients were dropped from the study during the first 4 weeks, two because of aggressiveness and one because of psychotic exacerbation. No exacerbation or new onset of extrapyramidal side-effects (EPS), as measured by the Barnes Akathisia Scale (BARS) and the Simpson-Angus Scale (SAS), was noted during the course of the trial and there were no other significant clinical side-effects of fluvoxamine addition. We conclude that fluvoxamine may be an effective adjunctive agent in some schizo-obsessive patients.

Adult↗
PubMed1988

Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder.

Three patients with multiple personality disorder and three with obsessive-compulsive disorder were compared on a variety of self-report measures and on two structured interviews. Amytal Sodium interviews had been conducted on the obsessive patients; alter personality-like entities claiming responsibility for the obsessions and compulsions were contacted in two patients. The one obsessive patient with no alter personality differed markedly from the other five on the SCL-90, the Lynfield Inventory, and the Dissociative Experiences Scale. Structured interviews with the Anxiety Disorders Interview Schedule and the Dissociative Disorders Interview Schedule also clearly differentiated this patient from the other five. It appears that there is a phenomenological overlap between multiple personality disorder and some cases of obsessive-compulsive disorder. Obsessive patients with prominent dissociative features may be a psychologically and biologically distinct subgroup.

Adult↗
PubMed2006

Pulse-loaded intravenous clomipramine in treatment-resistant obsessive-compulsive disorder.

INTRODUCTION: Small studies have suggested that intravenous clomipramine (CMI) may be more effective and induce faster improvement in obsessive-compulsive disorder than do orally administered serotonin reuptake inhibitors. OBJECTIVE: To test these hypotheses, we conducted a randomized, double-blind, double-dummy study of pulse-loaded intravenous versus oral CMI, followed by open-label oral CMI for 12 weeks. METHODS: We enrolled a volunteer and referred group of 34 adults with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition obsessive-compulsive disorder of > or =1-year duration and Yale-Brown Obsessive Scale score of > or =20. Eligible subjects had failed > or =2 adequate serotonin reuptake inhibitor trials. Subjects received pulse loaded CMI 150 mg by vein or by mouth on day 1 and 200 mg on day 2. Oral CMI began on day 6 at 200 mg/d and was increased by 25 mg every 4 days to 250 mg/d, as tolerated, for 12 weeks. RESULTS: Adverse events led to one withdrawal during oral pulse loading and 5 during open-label oral treatment. Intravenous pulse loading did not induce a more rapid or greater Yale-Brown Obsessive Scale score decrease than oral pulse loading at day 6 or by week 12. Day 6 and week 12 improvement were unrelated to plasma drug or metabolite concentrations. Pulse loading itself seemed to induce more rapid and greater improvement than expected in treatment-resistant obsessive-compulsive disorder. CONCLUSIONS: Further investigation of oral pulse-loading regimens in treatment-resistant obsessive-compulsive disorder is warranted.

Administration, Oral↗
PubMed2004

Obsessive-compulsive disorder secondary to bilateral frontal damage due to a closed head injury.

OBJECTIVE: To describe a patient who exhibited obsessive-compulsive disorder and frontal lobe dysfunction signs after a closed head trauma. BACKGROUND: Recent evidence indicates that frontal-subcortical circuits are involved in the pathogenesis of primary obsessive-compulsive disorder. There are a number of case reports of secondary obsessive-compulsive disorder after lesions involving certain parts of these circuits. METHOD: Clinical examinations, cognitive and behavioral assessments, and-lesion analysis based on magnetic resonance imaging were conducted. RESULTS: The patient displayed marked obsessive-compulsive behavior along with hyperorality and apathy. Magnetic resonance imaging showed symmetrical frontal-polar abnormal signal intensity. Topographic lesion analysis revealed involvement of Brodmann areas 11, 10, 24, 25, and 32. CONCLUSIONS: The patient presented in this report had both frontal lobe dysfunction signs and obsessive-compulsive disorder secondary to bilateral frontal damage due to a closed head injury. The etiological significance of head injury and frontal lobe involvement in obsessive-compulsive disorder is discussed in the context of the clinical and neuroimaging findings and of previous series of brain injured patients.

Adult↗
PubMed1995

Obsessive-compulsive behaviour in children and adolescents: a cross-sectional Australian study.

OBJECTIVE: To examine the reliability of the survey form of the Leyton Obsessional Inventory-Child Version (LOI-CV), ascertain the prevalence of self-reported obsessive-compulsive behaviour together with age and sex differences and identify the most common obsessive-compulsive behaviours and their associated level of interference. METHODOLOGY: The survey form of the LOI-CV was administered to a large sample of children and adolescents attending regular schools. Participants were aged between 8 and 16 years (n = 1602). RESULTS: We found the survey instrument to have adequate internal consistency and test-retest reliability. There was an age-related decline in self-reported obsessive-compulsive behaviour and girls reported a higher level of obsessive-compulsive behaviour than boys. The most common obsessive-compulsive behaviours included: repeated thoughts or words, having trouble making decisions, having to do certain things and doing things in the exact manner and having a bad conscience. For the most part, these behaviours were associated with low levels of interference. However, for a significant minority of youth (5 to 14%), these behaviours did cause problems and significantly interfered with their lives. CONCLUSIONS: Although many obsessive-compulsive behaviours are part of normal development, they may still be problematic for some children and adolescents.

Adolescent↗
PubMed2004

Paroxetine in the treatment of obsessive-compulsive disorder: randomized, double-blind, placebo-controlled study in Japanese patients.

The efficacy of paroxetine in the treatment of obsessive-compulsive disorder in Western populations is well established. The present study compares the efficacy and safety of paroxetine with placebo in the treatment of obsessive-compulsive disorder in Japanese patients. Patients aged 16 years or older who met Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for obsessive-compulsive disorder and had a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of >/=16 were randomized to receive 12 weeks' therapy in a double-blind manner. Paroxetine 20-50 mg/day or placebo was administered following a 1 week, placebo run-in phase. One hundred and ninety-one patients were randomized to either paroxetine or placebo, 188 patients were assessed as the full analysis set (FAS) and 144 patients completed the 12 week study. After adjustment for the Y-BOCS total score at baseline, reductions in obsessive-compulsive total score at week 6 and at the end of therapy were significantly greater in the paroxetine group than the placebo group. Most of the adverse events that occurred during the study were of mild to moderate intensity. Paroxetine is effective and well tolerated in Japanese adult patients with obsessive-compulsive disorder.

Adolescent↗