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PubMed1998

Hoarding and treatment response in 38 nondepressed subjects with obsessive-compulsive disorder.

OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.

Age Factors↗
PubMed2005

Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder: a crossover study.

BACKGROUND: Although serotonin reuptake inhibitors (SRIs) are the first-line treatment for obsessive-compulsive disorder (OCD), approximately half of patients with OCD do not respond adequately to SRI monotherapy. Patients with predominant obsessions are common in OCD and are often difficult to treat, necessitating adjunctive treatment. METHOD: This was a 9-week, double-blind, placebo-controlled, crossover study comparing the benefits of 2-week adjunctive treatments with risperidone, haloperidol, and placebo in patients with OCD (DSM-IV criteria) who continued to have severe symptoms despite taking a stable dose of an SRI. Eligible patients must have been receiving a therapeutic dose of an SRI for at least 12 weeks and at the screening visit had a score > or = 10 on items 1-5 (obsession) and a total score > or = 16 on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Data were collected from January 1999 through April 2002. RESULTS: Sixteen patients were enrolled and 12 completed the study. On the YBOCS, both risperidone and haloperidol significantly reduced obsession (p < .05) when compared with placebo. There was a tendency that haloperidol, and to a lesser degree risperidone, also reduced the compulsion and the total YBOCS scores. These results were accompanied by a reduction in the Hopkins Symptom Checklist 90-revised (SCL-90R) anxiety scale score. According to the 17-item Hamilton Rating Scale for Depression, the SCL-90R depression scale, and the Profile of Mood States, risperidone, but not halo-peridol, also improved depressed mood. Neither risperidone nor haloperidol changed neurocogni-tive function during the 2-week treatment. All 12 patients completed the 2-week risperidone treatment, but 5 of the 12 terminated haloperidol treatment early owing to intolerable side effects. CONCLUSION: Adjunctive risperidone improved obsessions and depressed mood and was well tolerated in patients with SRI-refractory OCD.

Adult↗
PubMed1999

Evaluation of the Yale-Brown Obsessive Compulsive Scale (YBOCS-hd) for heavy drinking with mild to moderately dependent alcohol abusers.

BACKGROUND: Many similarities have been noted between urges and desires to drink heavily and obsessive-compulsive disorders (OCD). Based on such similarities, Modell et al. (1992) developed the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), a modified version of YBOCS, to assess obsessions and compulsions related to heavy drinking. Evaluation of the YBOCS-hd has been limited to more severely dependent alcohol abusers. METHODS: The present study used a self-administered version of the YBOCS-hd to evaluate (1) the severity of drinking-related obsessive compulsive symptoms with mild to moderately dependent alcohol abusers (problem drinkers), and (2) whether end-of-treatment changes in YBOCS-hd scores would be related to within-treatment functioning. RESULTS: Results indicated that problem drinkers have lower alcohol-related Obsessive and Compulsive subscale scores than did more severely dependent drinkers, but higher scores than did non-problem drinkers, supporting the construct validity of the YBOCS-hd. In addition, at the end of treatment, the YBOCS-hd scores of alcohol abusers who drank at low-risk levels during treatment were significantly lower than the scores of those who drank at high-risk levels. Lastly, exploratory factor analysis did not provide support for the two purported YBOCS-hd subscales (Obsessive, Compulsive). Instead, the analysis yielded a single general factor and a second factor that contained two questions measuring heavy drinking. CONCLUSIONS: Despite the fact that total YBOCS-hd scores covaried with drinking, neither the total YBOCS-hd pretreatment score nor the two subscale scores predicted functioning at the end of treatment. The present results call into question the utility of the YBOCS-hd, because a single item measuring the heaviness of drinking was as useful as the total YBOCS-hd and its two subscales in relating changes during treatment to end-of-treatment functioning for problem drinkers. However, although the YBOCS-hd does not predict changes in drinking, it may have value as an indirect measure of drinking in situations where direct measurement of alcohol consumption is undesirable (i.e., direct measurement might be reactive). Because the present findings are derived from problem drinkers, further research is needed to confirm the factor structure of the YBOCS-hd with clients who represent a broader range of alcohol problem severity.

Adult↗
PubMedDate not supplied

Prevalence of obsessive compulsive symptoms (OCS) in a sample of Egyptian adolescents.

The aim of this work was to determine the prevalence of OCS among a community sample of Egyptian students. The sample was selected using a multistage stratified random sample of students from El Abasseya educational area in Cairo. The tools used in this study included the General Health Questionnaire for screening of psychiatric morbidity and the Arabic Obsessive Scale for obsessive traits. The Yale Brown Obsessive Compulsive Scale was used to determine the profile of OCS and the ICD-10 research criteria for diagnosis of OCD among OCS positive subjects. The prevalence of psychiatric morbidity among the total sample was 51.7%, whilst that of obsessive traits was 26.2% and that of obsessive compulsive symptoms was 43.1%. OCS were more prevalent among the younger students, among female students and first born subjects. Aggressive, contamination and religious obsessions and cleaning compulsions were the commonest among the sample; 19.6% of subjects with OCS fulfilled ICD-10 criteria for OCD.

Adolescent↗
PubMed2002

[Obsessive-phobic disorder typology in schizophrenia].

The study aims at clinical characteristics of obsessive-phobic disorders (OPD) in schizophrenia with regard to their modification in main disease development and interaction with basic schizophrenia symptoms (positive and negative). Eighteen patients, mean age 28.2 years, were examined. An affinity degree of schizophrenia to OPD was found to be associated with endogenous progressive process. In slowly progressive schizophrenia, an affinity is selective, concerning to one of the obsessive phobic syndrome component (phobic component proper or avoidance behavior) and realizing in either positive, or negative manifestation of schizophrenia. Two obsessive-phobic syndrome types were determined: OPD of the 1st type--panic and generalized anxiety disorder (52 patients) are modified because of overlapping by chronic endogenous anxiety, obsessive-phobic symptoms being not represented in structure of negative changes (asthenia defect); in OPD of the 2nd type (agora and social phobias, 80 patients) an overlapping of psychopathological symptoms related to avoidance behavior and negative changes (psychopathic-like defect "verschroben" type) was found. Phobic syndrome component does not tend to psychopathological transformation and undergoes reverse changes. In typical cases of progressive schizophrenia has no affinity. But exclusion is--the OPD of the 3rd type (obsessive-compulsive disorders with a fear of external threat and massive defense rituals, 49 patients). In this case, total affinity to schizophrenia is realized in overlapping of both obsessive syndrome components with positive and negative manifestation of schizophrenia.

Adult↗
PubMedDate not supplied

[A standardized cognitive-behavioural group treatment program for obsessive compulsive disorder: preliminary outcomes].

This study provides preliminary outcome data about the efficacy of a cognitive behavioural group therapy program for obsessive compulsive disorder (OCD). Twenty patients were studied, 19 completed the group and one dropped out (5%), Twelve patients were evaluated at 6 month follow-up (40% of drop-outs). All were outpatients who received a primary DSM IV diagnosis of OCD. All evaluations were performed before and after the beginning of the group. Evaluations involved: 1) one or more face-to-face interviews, 2) scales or questionnaires which are designed to provide information relevant to anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), OCD symptoms (YBOCS, four target rituals and four target obsessions) and OCD cognitive measures (Obsessive Beliefs Questionnaire: OBQ). The patients completed a 12-week closed-ended treatment program. The group meets once a week for 3 hours. The first 6 sessions included cognitive therapy and the 6 other sessions focused on behaviour therapy. During the first session of each technique, workbooks are provided and discussed with the patients. During the cognitive treatment of the weekly group, patients apply the cognitive therapy of Salkovskis during the sessions and at home. The therapy focused on challenging OCD appraisals and beliefs through various cognitive techniques. During the 6 last sessions explanations of behavioural therapy techniques are done then the patients practiced in vivo and imaginal exposures and response prevention. Morever, each patient received an exposure homework practice. Then six monthly meeting dates are scheduled and patients are encouraged to carry on homeworks. The sample included 12 women and 8 men and the mean age at intake was 37 (SD=9.33) years. Eighteen of the patients were taking medication for their OCD symptoms before and concurrent with group participation. The sample had a mean education of 15 (SD=3) years. Average symptom duration was 14 (SD=9) years. Significant reduction in YBOCS and obsessive beliefs (OBQ) were observed for subjects following treatment. A repeated measure analysis of variance failed to find a significant difference at post-test in Beck Depression and Anxiety Inventories. On main targets (four target rituals and four target obsessions) of the therapy, there was a change after the introduction of the cognitive therapy. There was no change between the cognitive therapy and the behaviour therapy. The difference was only maintained after the complete program. Extending the duration of the group to behaviour therapy did not enhance eventual outcomes. Clinical impressions suggested that behaviour therapy helped to maintain the results in the long term. The present study also demonstrated that most patients maintained gains made during the group at 6-month follow-up. Maintenance of gains was apparent for both the YBOCS and target symptoms (rituals and obsessions). However, there was no change in depression. At pre-test, the OCD patients had a mean score of 18, which is a mild level. Interestingly, there was a significant difference at 6 months in the Beck Anxiety Inventory. The anxiety level needed more time to decrease than OCD symptoms. Cognitive and behaviour therapy delivered in group was effective in decreasing OCD symptom severity and produced a decrease in all but one of the cognitive measures, the estimation of the threat. The result obtained at the end of the therapy was not sufficient at the follow up. This belief was common in all the anxiety disorders and was not specific of OCD. This clinical study is the first report of a cognitive and behavioural group program for OCD. Despite the limitations of this study, it demonstrates the utility of cognitive behaviour group therapy as an effective and efficient treatment of OCD.

Adolescent↗
PubMed2001

Adolescent Obsessive-Compulsive Drinking Scale: an assessment tool for problem drinking.

Alcoholism has been studied in adults and found to share obsessive-compulsive characteristics. The Yale-Brown Obsessive Compulsive Scale (YBOC) was used to quantify the measurements of this disorder. This study adapted the YBOC for use with adolescents/young adults in an attempt to measure the "craving" expressed as obsessive and compulsive phenomenon. The primary findings show that the obsessive compulsive dimensions of alcohol cravings, as described in adult populations, also exist in adolescent/young adults. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed utilizing idioms and language typical for the 17-20 age group. Various quantitative evaluations proved that the Interference and Irresistibility sub-scales were the primary dimensions causing the obsessive behavior. This study begins to address this aspect of adolescent substance abuse utilizing a tool that is easy to administer. Because of the ease of use, although not a diagnostic instrument, the A-OCDS may be useful for identifying problem drinking in adolescents as well as detecting impairment in function related to drinking.

Adolescent↗
PubMedDate not supplied

[Cognitive therapy in patients with obsessive ruminations].

The article stands out the elevate amount of patients with obsessive-compulsive disorder who only or mainly present obsessive ruminations. Firstly, the basic concepts of behavioral model of obsessive-compulsive disorder are enunciated. In the second place, the limitations of behavioural treatment for patient with obsessive ruminations are discussed. Then, the general characteristics of cognitive model of compulsive-obsessive dysfunction are formulated. Finally, steps of cognitive treatment for patient with obsessive ruminations are outlined.

Cognitive Behavioral Therapy↗
PubMed2005

[Obsessive-compulsive symptoms in schizophrenia].

Schizophrenia and obsesive compulsive disorder (OCD) are among the oldest described psychiatric disorders. Although they appear to be two distinct psychiatric disorders, early literature about the existence of obsessive-compulsive symptoms in schizophrenia dates back to the 1920's. The findings that atypical antipsychotics exacerbate obsessive-compulsive symptoms among schizophrenic patients and the emergence of a possible biological relation between the two diseases increased interest in this subject. Until the 1990's information about the aetiology of obsessive-compulsive symptoms which are observed in about 60% of schizophrenic patients, was insufficient. Recently there has been progress in explaining the structural and functional abnormalities in both OCD and schizophrenia. Knowledge of the cortico-subcortical circuits might explain the co-incidence of symptomatology in the two disorders. It is shown that there is prefrontal cortex dysfunction in both disorders but the bases of dysfunctions are distinct from each other. These dyfunctions derive from two different neuro-anatomical systems partially connected with each other and with different neuro-anatomical connections. It is suggested that dorsolateral prefrontal cortex (DLPC) dysfunction occurs in schizophrenia and ventro-medial prefrontal cortex dysfunction (VMPC) in OCD. In this review, the incidence of obsessive-compulsive symptoms in schizophrenia, their effect on the disorder, the features of the schizo-obsessive patient group and the mechanism of how atypical antipsychotics exacerbate obsessive compulsive symptoms are discussed. Thus, we aimed to highlight the neurobiologic heterogeneity and phenomenology of schizophrenic disorder.

Humans↗
PubMed1987

A controlled study of Tourette syndrome. IV. Obsessions, compulsions, and schizoid behaviors.

To determine the frequency of obsessive, compulsive, and schizoid behaviors in Tourette syndrome (TS), we prospectively questioned 246 patients with TS, 17 with attention-deficit disorder (ADD), 15 with ADD due to a TS gene, and 47 random controls. The comparative frequency of obsessive, compulsive, and repetitive behaviors--such as obsessive unpleasant thoughts, obsessive silly thoughts, echolalia, palilalia, touching things excessively, touching things a specific number of times, touching others excessively, sexual touching, biting or hurting oneself, head banging, rocking, mimicking others, counting things, and occasional or frequent public exhibitionism--were significantly more common in TS patients than in controls. The frequency of each of these was much higher for grade 3 (severe) TS. Most of these behaviors also occurred significantly more often in individuals with ADD or in individuals with ADD secondary to TS (ADD 2(0) TS). When these features were combined into an obsessive-compulsive score, 45.4% of TS patients had a score of 4-15, whereas 8.5% of controls had a score of 4 or 5. These results indicate that obsessive-compulsive behaviors are an integral part of the expression of the TS gene and can be inherited as an autosomal dominant trait. Schizoid symptoms, such as thinking that people were watching them or plotting against them, were significantly more common in TS patients than in controls. Auditory hallucinations of hearing voices were present in 14.6% of TS patients, compared with 2.1% of controls (P = .02). These symptoms were absent in ADD patients but present in ADD 2(0) TS patients. These voices were often blamed for telling them to do bad things and were frequently identified with the devil. None of the controls had a total schizoid behavior score greater than 3, whereas 10.9% of the TS patients had scores of 4-10 (P = .02). This frequency increased to 20.6% in the grade 3 TS patients. These quantitative results confirm our clinical impression that some TS patients have paranoid ideations, often feel that people are out to get them, and hear voices.

Adolescent↗
PubMed1981

[Differential diagnosis between obsessive neurosis and schizophrenia in children].

Under study there were 116 patients with obsessive neurosis who had fallen sick in childhood and adolescence, as well as 28 schizophrenics with obsessive syndrome who had fallen sick at the same age, and were at first observed by pedopsychiatrists as patients with the obsessive neurosis. Dynamic clinical and catamnestic studies of the two groups of the patients have enabled the authors to specify a number of signs supplementing the criteria of differentiating those diseases described in literature. Characteristic of the obsessive neurosis are signs of perseverance of the "through" syndrome, i. e. the type of the obsessive syndrome (compulsive, phobic, or mixed compulsive-phobic one) determining this or that clinical variant of the neurosis throughout the whole disease. Patients with schizophrenia show a tendency to a "regressive" time course of the syndrome, i. e. to addition of obsessions corresponding to earlier levels of the psychic response.

Adolescent↗
PubMed1993

Clomipramine treatment of obsessive compulsive symptomatology in schizophrenic patients.

BACKGROUND: Schizophrenic patients with obsessive compulsive symptoms have poor prognoses. Clomipramine is an effective antiobsessional agent, but its possible antiobsessional effect in schizophrenic patients with obsessive compulsive symptoms who are taking neuroleptics has not been studied. METHOD: We conducted an open pilot study in which we added clomipramine to ongoing neuroleptic regimens of five chronic DSM-III-R schizophrenic (N = 3) or schizoaffective (N = 2) patients who were consecutively admitted for treatment during an active phase. Clomipramine treatment was subsequently discontinued in two patients (off-on-off design), whereas it was discontinued and then reinstituted in three patients (off-on-off-on design). RESULTS: All five patients had substantial reductions in previously persistent obsessive compulsive symptoms, and all experienced relapse of their obsessive compulsive symptoms after clomipramine treatment cessation. In the three patients for whom the authors were able to reinstitute clomipramine, an improvement in obsessive compulsive symptoms was noticed once again. Only one patient had an exacerbation of her psychosis with the combined treatment. CONCLUSION: The addition of clomipramine, a serotonin reuptake blocker, to ongoing neuroleptic treatment in schizophrenic patients with obsessive compulsive symptoms was associated with specific reductions of those symptoms. Further studies of antiobsessional agents in selected schizophrenic patients appear warranted.

Adolescent↗
PubMed1993

Biological approaches to treatment-resistant obsessive compulsive disorder.

Biological approaches to the patient with treatment-resistant obsessive compulsive disorder are briefly reviewed. The most commonly employed strategy involves combining a potent serotonin reuptake inhibitor (SRI) (e.g., clomipramine or fluvoxamine) with another medication that may exert effects on the brain serotonin system. Open-label reports regarding the addition of tryptophan, fenfluramine, lithium, or buspirone to ongoing SRI therapy of obsessive compulsive disorder are encouraging. However, the anti-obsessive compulsive efficacy of SRI-lithium and SRI-buspirone combination therapy has not been confirmed in recent controlled trials. Preliminary evidence suggests that addition of neuroleptic may benefit SRI-refractory obsessive compulsive disorder patients who have a comorbid chronic tic disorder. Other biological approaches (e.g., electroconvulsive therapy and psychosurgery) are considered in terms of their narrowly defined roles in the treatment of patients with SRI-resistant obsessive compulsive disorder. Finally, an algorithm is proposed for those patients with obsessive compulsive disorder who fail to respond to an adequate trial with a potent SRI.

Behavior Therapy↗
PubMed1996

Obsessive-compulsive symptoms in schizophrenia: a comparison of olanzapine and placebo.

The antipsychotic drug olanzapine is similar to clozapine and risperidone in potent serotonergic antagonism. We assessed obsessive-compulsive symptoms during olanzapine treatment because these symptoms have been reported during risperidone and clozapine treatment. Obsessions and compulsions were measured in 25 subjects with schizophrenia before and after a 6-week double-blind trial comparing two olanzapine doses to placebo. At baseline, 8 subjects had mild or moderate obsessions, and 6 had mild compulsions. There was no significant difference in the course of obsessive-compulsive symptoms among the three treatment groups. We found that olanzapine did not appear to cause obsessive-compulsive symptoms in patients with schizophrenia. Our sample size, the dose and duration of olanzapine treatment, and assessment methods limit the extent to which this finding can be generalized. Though emerging obsessive-compulsive symptoms have been reported for 13 clozapine-treated and 2 risperidone-treated patients with schizophrenia, this phenomenon has not yet been demonstrated in a controlled study.

Adult↗
PubMedDate not supplied

[Comparative study of normal subjects and obsessive compulsive subjects on intrusive thoughts and memory].

Four surveys have shown that more than 80% of normal subjects have obsessive thoughts with content similar to those found in obsessive compulsive patients. "Abnormal" and "normal" intrusive thoughts do not differ in content but in duration, frequency and rejectability. Thirteen DSM III-R non-depressed obsessive compulsive patients with checking rituals were compared with 13 sex-, age-, and education matched control subjects. Our study compared the content of abnormal and normal obsessions. No between-group difference was found suggesting that a sub-group of obsessive compulsive patients with checking rituals did not change the general result. The memory processes were also compared. Several investigators have shown an impairment in visual spatial memory tasks but none in verbal tasks with obsessive compulsive patients. In three studies non clinical checkers were found to show some deficits in memory compared to non checkers. In our study we used the Wechsler memory scale. Clinical checkers appear to have difficulties recalling details of meaningfully linked verbal sequence and immediate visual reproduction.

Adult↗
PubMed2003

Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder.

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder--particularly those living in rural areas--do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.

Journal Article↗
PubMed2006

Impulsivity and compulsivity in patients with trichotillomania or skin picking compared with patients with obsessive-compulsive disorder.

To compare impulsivity and compulsivity, we performed a case control study comparing a group of 20 patients with obsessive-compulsive disorder with a group of 20 patients with skin picking and/or trichotillomania (SP/T). The instruments used were Structured Clinical Interview for DSM-IV Axis I Diagnosis, Yale-Brown Obsessive-Compulsive Scale, Schalling Impulsivity Scale, and Hamilton Anxiety and Depression Inventories. A Multidimensional Impulsive-Compulsive Spectrum Assessment Instrument was designed for this particular study. The Yale-Brown Obsessive-Compulsive Scale scores were significantly higher in patients with obsessive-compulsive disorder, compared with patients with SP/T (F = 90.29; P < .001). The Hamilton Inventories and Schalling Impulsivity Scale revealed no significant intergroup differences. The Multidimensional Impulsive-Compulsive Spectrum Assessment Instrument allowed us to find 6 statistically significant differences between groups: the ability or inability to delay an impulse, quick response or action planning, feelings of pleasure or guilt during or after an act, ritualization, and whether the patient believes he/she has losses or benefits if prevented from acting. In conclusion, SP/T should deserve further attention about their classification in future versions of diagnostic manuals because, as in International Classification of Diseases, Tenth Revision, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition includes these disorders in the same chapter as pathological gambling, kleptomania, pyromania and others. Despite their resemblance to compulsions, their classification under the Obsessive-Compulsive Spectrum needs particular phenomenological and neurobiologic investigation.

Adolescent↗
PubMed2001

The concealment of obsessions.

Patients' deliberate concealment from others of the content and frequency of their obsessions is a common and important aspect of obsessive-compulsive disorder (OCD). It is an overlooked manifestation of the safety behaviour that is believed to sustain OCD (e.g., neutralizing, thought suppression, avoidance behaviour, concealment). The phenomenon of concealment is understandable in terms of the cognitive theory of obsessions which states that obsessions are caused when the person attaches catastrophic personal significance to their unwanted intrusive thoughts. It is suggested that the selected, planned, suitable disclosure of obsessions can be therapeutic--presumably because it exposes the patient to alternative interpretations of the significance of the unwanted thoughts.

Deception↗