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PubMed1997

Probabilistic reasoning in obsessive-compulsive and delusional disorders.

BACKGROUND: Delusional disorder (DD) and obsessive-compulsive disorder (OCD) have been investigated in previous studies using probabilistic reasoning paradigms and abnormalities in each group have been reported. No study to date has compared results between these groups. This study compares patients with these disorders with those who have both phenomena. METHODS: Thirty subjects with DD, 29 with OCD and 16 with obsessive and delusional features were compared with 30 normal controls in a study of probabilistic reasoning using two different computer-based tasks involving a Bayesian paradigm. RESULTS: Deluded subjects showed a 'jump to conclusions' reasoning style, but on a test that added a consequence to their choices did not differ from normals. OCD subjects deviated from Bayesian and control norms to a greater degree than did DD subjects. In subjects with mixed psychopathology, the presence of both phenomena appeared to 'normalize' these probability estimates. CONCLUSIONS: Our findings extend those of others but require cautious interpretation as to the role of probabilistic reasoning in the genesis of delusions or obsessions. Obsessionals in both the OCD and Mixed groups, showed substantial deviation from Bayesian norms, suggesting that obsessionality leads to a reasoning style that is less 'normal' than that of delusionals. Further work is required to investigate clinical correlates of these findings which provide modest support for the proposal that the combination of obsessions and delusions confers greater functional advantages than simply having delusions or obsessions.

Adult↗
PubMed1999

Clinical characteristics in patients with anorexia nervosa and obsessive-compulsive disorder.

BACKGROUND: The purpose of this study was to assess clinical characteristics, including co-morbid personality disorders in patients with both anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) in comparison with age- and sex-matched patients with OCD. METHODS: Fifty-three female patients with AN were divided into two groups based on the presence or absence of a current diagnosis of OCD, as assessed by the Structured Clinical Interview for DSM-III-R Patient version (SCID-P). Twenty-one women (40 %) who met the DSM-III-R criteria for both AN and OCD were compared with 23 female patients with OCD, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the SCID Axis II disorders. RESULTS: There were no significant differences on the mean Y-BOCS severity scores between these groups. However, AN patients with OCD were significantly more likely than OCD patients to have obsessions with need for symmetry or exactness and ordering/arranging compulsions, whereas both aggressive obsessions and checking compulsions tended to be more frequently identified in OCD patients compared with AN patients with OCD. AN patients with OCD were significantly more likely than OCD patients to meet the criteria for obsessive-compulsive personality disorder (OCPD). CONCLUSIONS: These results suggest that there are some differential characteristics of the OCD symptomatology between these disorders, although many patients with AN manifest significant impairment from primary OCD symptoms with similar magnitude in severity to that found in OCD patients.

Adult↗
PubMed2007

[Phenomenology and co-morbidity of childhood onset obsessive compulsive disorder].

OBJECTIVES: The goal of the study was to investigate the contents and comorbidity features of obsessive-compulsive disorder in children and adolescents. METHOD: 55 patients (29 males, 26 females), mainly inpatients selected from university clinics for child and adolescent psychiatry (95%), were investigated. Structured diagnostic interviews were used to interview patients and their parents. RESULTS: The mean age of onset for obsessive-compulsive disorders was 11.3 years. In males the onset was slightly earlier than among females, but this difference was not significantly significant. Compulsions mostly referred to washing and cleaning, checking, repeating, ordering, and counting. Most frequently, obsessions included thought about contamination, catastrophes, sexuality, and aggression. According to parental reports, the rate of comorbidity was high (lifetime diagnosis: 69%, current diagnosis: 53%), with anxiety, depressive, hyperkinetic, conduct, and eating disorders being the most frequent co-morbid conditions. Obsessive-compulsive symptoms were more intense in those patients who had a greater number of lifetime diagnoses of other psychiatric disorders. Comparing the rates found when structured interviews were carried out according to the study protocol to those for clinicians, clinicians were found to have diagnosed mixed obsessional thoughts and acts (presenting obsessional thoughts, as well as compulsive acts) less frequently. CONCLUSIONS: The results of this investigation are well in line with those of international studies on obsessive-compulsive disorders. The rates of disorders found were dependent on the diagnostic methods used. A potentially promising approach for further investigation is the sub-typing of patients according to symptom dimensions.

Adolescent↗
PubMed2004

Linkage analysis for autism in a subset families with obsessive-compulsive behaviors: evidence for an autism susceptibility gene on chromosome 1 and further support for susceptibility genes on chromosome 6 and 19.

Although there is considerable evidence for a strong genetic component to idiopathic autism, several genome-wide screens for susceptibility genes have been carried out with limited concordance of linked loci, reflecting numerous genes of weak effect and/or sample heterogeneity. In the current study, linkage analysis was carried out in a sample of 62 autism-affected relative pairs with more severe obsessive-compulsive behaviors, selected from a larger (n=115) set of autism-affected relative pairs as a means of reducing sample heterogeneity. Obsessive-compulsive behaviors were assessed using the Autism Diagnostic Interview-Revised (ADI-R). In the sample with more severe obsessive-compulsive behaviors, multipoint NPL scores above 2 were observed on chromosomes 1, 4, 5, 6, 10, 11 and 19, with the strongest evidence for linkage on chromosome 1 at the marker D1S1656, where the multipoint NPL score was 3.06, and the two-point NPL score was 3.21. In follow-up analyses, analyzing the subset of families (n=35) where the patients had the most severe obsessive-compulsive behaviors generated a multipoint NPL score of 2.76, and a two-point NPL score of 2.79, indicating that the bulk of evidence for linkage was derived from the families most severely affected with obsessive-compulsive behaviors. The data suggest that there is an autism susceptibility gene on chromosome 1 and provide further support for the presence of autism susceptibility genes on chromosomes 6 and 19.

Autistic Disorder↗
PubMed1999

Prevalence and symptomatology of comorbid obsessive-compulsive disorder among bulimic patients.

This study sought to assess the prevalence and symptomatology of comorbid obsessive-compulsive disorder (OCD) among Japanese subjects who met the DSM-III-R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM-III-R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive-compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale-Brown Obsessive-Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive-compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.

Adult↗
PubMed2004

Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.

INTRODUCTION: Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others. METHODS: The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology. RESULTS: Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses. DISCUSSION: Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors

Adult↗
PubMed2003

Risperidone-induced obsessive-compulsive symptoms in two children.

OBJECTIVE: To present two cases of rapid-onset obsessive-compulsive symptoms in children treated with risperidone. CASES: "A" was an 8-year-old boy with attention deficit and chronic tic disorder who developed obsessive-compulsive symptoms within 2 weeks of starting risperidone. When the dose of 0.5 mg tid was discontinued, the obsessive-compulsive symptoms resolved with no return over 8 months of follow-up. "B" was an 11-year-old girl with mild mental retardation and aggression who was treated with risperidone 1 mg per day. Obsessive-compulsive symptoms suddenly emerged 10 days after starting risperidone and resolved within 3 days of discontinuation. In both cases, streptococcal pharyngitis was ruled out. CONCLUSION: Although the mechanism is not clear, these cases add to several other reports concerning the sudden emergence of obsessive-compulsive symptoms and anxiety symptoms in children treated with atypical antipsychotics. Clinicians should be alert to the possibility of these adverse effects in children treated with these drugs.

Adult↗
PubMed1996

Differential response of psychotic and obsessive symptoms to risperidone in an adolescent.

A 13-year-old boy with psychotic, depressive, and obsessive-compulsive symptoms initially presented with auditory and visual hallucinations and a lifetime of excessive worries about contamination. Family history was significant for schizophrenia and compulsive behavior. When treated with clomipramine 100 mg daily (plasma level 85 ng/mL), obsessive-compulsive symptoms but not the hallucinations improved significantly, and racing thoughts and grandiosity developed later. Haloperidol 0.5 mg daily reduced the psychotic symptoms but was poorly tolerated, and then trifluoperazine 3 mg daily was ineffective, so clomipramine was discontinued (without worsening of OCD symptoms). Trifluoperazine in combination with lithium 1500 mg daily (0.9 meq/L), and then with the addition of carbamazepine 250 mg daily (3.7 micrograms/mL), was only partially helpful. Dose reductions in any medication led to increased psychotic symptoms within days. Trifluoperazine was then replaced by risperidone 3 mg twice daily. Within 2 weeks of starting risperidone, psychotic symptoms ceased but the patient experienced an incapacitating exacerbation of obsessive-compulsive symptoms, experiencing the most severe symptoms in his illness. Sertraline 50 mg reduced the OCD symptoms only briefly. After 5 months on risperidone, risperidone and sertraline were discontinued, and the obsessive-compulsive symptoms significantly decreased within 2 weeks. These clinical observations suggest that even when risperidone has a therapeutic antipsychotic effect, it may exacerbate obsessive-compulsive symptoms in predisposed adolescents.

1-Naphthylamine↗
PubMedDate not supplied

Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: an open trial of a new protocol-driven treatment package.

OBJECTIVE: The authors present an open trial of cognitive-behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder. METHOD: The authors developed a treatment manual explicitly designed to facilitate (1) patient and parental compliance, (2) exportability, and (3) empirical evaluation. Successive versions of the manual were used to treat 15 consecutive child and adolescent patients with obsessive-compulsive disorder, most of whom were also treated with medications. RESULTS: Statistical analyses showed a significant benefit for treatment immediately posttreatment and at follow-up. Nine patients experienced at least a 50% reduction in symptoms on the Yale-Brown Obsessive-Compulsive Scale at posttreatment; 6 were asymptomatic on the National Institute of Mental Health Global Obsessive-Compulsive Scale. No patients relapsed at follow-up intervals as long as 18 months. Booster behavioral treatment allowed medication discontinuation in 6 patients. No patient refused treatment; 2 discontinued prematurely. CONCLUSIONS: Cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, appears to be a safe, acceptable, and effective treatment for obsessive-compulsive disorder in children and adolescents.

Adolescent↗
PubMed1995

A 1 year double-blind placebo-controlled fixed dose study of sertraline in the treatment of obsessive-compulsive disorder.

The objective of this study was to evaluate the safety and efficacy, over a 1 year treatment period, of three dose levels of sertraline and placebo in the treatment of non-depressed adult out-patients with obsessive-compulsive disorder (OCD). Following 1 week of single-blind placebo washout, patients (n = 325) from 11 sites following identical protocols were randomly assigned to 12 weeks of double-blind treatment with one of three fixed doses of sertraline (50, 100 or 200 mg) or placebo. At the end of 12 weeks, treatment responders (including placebo patients) were offered an additional 40 weeks of double-blind treatment at their assigned doses. Efficacy measures were the Yale-Brown Obsessive Compulsive Scale, the NIMH Global Obsessive Compulsive Scale, Clinical Global Impressions of Severity of Illness and Global Improvement and the Maudsley Obsessive Compulsive Inventory. Patients in the pooled sertraline group showed greater improvement than placebo-treated patients on all efficacy measures, based on the endpoint analyses. Moreover, pairwise comparisons at endpoint revealed a significant effect on all three investigator-rated scales in patients receiving 50 or 200 mg of sertraline; in the 100 mg group, there was a significant effect on the NIMH Global Obsessive Compulsive Scale only. Patients completing 3 months of sertraline treatment exhibited excellent toleration and sustained improvement during an additional 40 weeks of therapy. Results support the safety, efficacy and tolerability of daily doses of 50-200 mg of sertraline in the long-term treatment of patients with OCD.

1-Naphthylamine↗
PubMed2003

Lack of efficacy of low doses of quetiapine addition in refractory obsessive-compulsive disorder.

BACKGROUND: Some studies have shown that low dose of neuroleptic addition to ongoing antiobsessive treatment might be effective in treatment resistant obsessive-compulsive disorder (OCD). The primary purpose of this study was to evaluate the efficacy of low-dose quetiapine in clomipramine and serotonin reuptake inhibitor-refractory obsessive-compulsive disorder patients. METHOD: Eight obsessive-compulsive disorder patients who were resistant to treatment after 2 or more inadequate trials with clomipramine or serotonin reuptake inhibitor were admitted to the study. The patients were administrated on open trial of quetiapine at daily dose of 150 mg. Treatment response was assessed using the Yale-Brown Compulsive Scale and the Clinical Global Impressions Scale. RESULTS: Only 2 patients were partial responders, with Yale-Brown Compulsive Scale score decreases of 28% and 29%. CONCLUSION: The results of this preliminary open trial suggest that low dose of quetiapine may not be effective in treatment-resistant obsessive-compulsive disorder patients. Larger placebo-controlled trials are needed to investigate the clinical efficacy of quetiapine addition at low doses to antiobsessive treatment in treatment-refractory obsessive-compulsive disorder.

Adolescent↗
PubMed2007

Anti-androgenic treatment of obsessive-compulsive disorder: an open-label clinical trial of the long-acting gonadotropin-releasing hormone analogue triptorelin.

Some case reports have shown that patients suffering from obsessive-compulsive disorder can be effectively treated with anti-androgenic pharmacological agents with various modes of action. The most effective group of such agents is the long-acting analogues of the gonadotropin-releasing hormone. This investigation was undertaken in order to further elucidate the possibility of using such powerful anti-androgenic agents in the treatment of obsessive-compulsive disorder. Six male patients, all suffering from therapy-resistant obsessive-compulsive disorder, were included in a 48 weeks open-label trial of the long-acting GnRH-analogue triptorelin. Every other week, the patients rated the severity of obsessive-compulsive disorder symptoms by means of a visual analogue scale. During the course of the trial, five out of six patients experienced a considerable improvement. The finding gives further support to the contention that anti-androgenic agents are effective in the treatment of obsessive-compulsive disorder.

Adult↗
PubMed2006

Association analysis of the NrCAM gene in autism and in subsets of families with severe obsessive-compulsive or self-stimulatory behaviors.

OBJECTIVES: An autism susceptibility locus (AUTS1, MIM#608636) has been identified in chromosome 7q31. NrCAM is a candidate gene for AUTS1 because it is expressed in the brain and encodes a receptor involved in nervous system development. Polymorphisms in NrCAM have been reported to be associated with autism susceptibility and with substance abuse, implicating NrCAM in reward circuitry. Self-stimulatory, perseverative behavior in autism might be due to defects in reward circuitry. In addition, models of drug addiction have also borrowed from models of obsessive-compulsive behavior designed to reduce anxiety. Thus, our goals were to replicate previous associations of NrCAM with autism, making use of a large cohort, and to clarify whether NrCAM was associated with a specific endophenotype of autism in the repetitive behaviors and stereotyped interests domains. METHODS: We genotyped six NrCAM single nucleotide polymorphisms in 352 families and we tested for association between these polymorphisms and autism in the entire cohort and in two subsets, one with severe obsessive-compulsive behaviors and one with pronounced self-stimulatory behaviors. RESULTS: We found no association between single nucleotide polymorphisms of NrCAM and autism in our large cohort, or in the severe obsessive-compulsive behavior and self-stimulatory behavior subsets. However, we observed a significant overtransmission (21 transmitted vs 6 nontransmitted, chi2=12.054, P=0.0005) of the haplotype G-G-A-G-C-A of rs722519-rs1269622-rs405945-rs6958498-rs401433-rs439587 in the severe obsessive-compulsive behavior subset, likely driven by the G-C haplotype of rs6958498-rs401433, which itself showed significant overtransmission (31 transmitted vs 13 nontransmitted, chi2=8.844, P=0.003). CONCLUSIONS: Overtransmission of particular haplotypes of NrCAM, that may relate to the expression level of NrCAM in the brain, appeared to be associated with autism in the severe obsessive-compulsive behavior subset.

Autistic Disorder↗
PubMed2001

Obsessive-compulsive symptoms, white noise and intrusions of self-relevant negative thoughts in a thought suppression paradigm.

Forty female students participated in an experiment where they were asked to suppress a negative self-relevant thought. Half the group suppressed in a loud white noise condition (90 decibels) whereas the other half suppressed in a noise condition of much lower intensity (50 decibels). The subjects were divided up into two groups on the basis of their scores on the Obsessive Compulsive Thoughts Checklist (Bouvard, Cottraux, Mollard, Arthus, Lachance, Guerin, Sauteraud & Yao, 1997). It was predicted that 1) Subjects scoring high on obsessive-compulsive symptoms would show more intrusive thoughts 2) Loud noise would increase intrusive thoughts, especially for subjects scoring high on obsessive-compulsive symptoms. As expected subjects who scored high on obsessive-compulsive symptoms showed more intrusive thoughts, but contrary to expectations loud noise did not increase intrusive thoughts. In fact obsessive-compulsive symptoms were related to more intrusions in the condition of noise of less intensity but not in the condition of loud noise. Implications are discussed.

Adult↗
PubMed2005

Short-term verbal memory deficits in patients with obsessive-compulsive disorder.

Recent neuropsychological studies have found deficits in the verbal memory of patients with obsessive-compulsive disorder. Difficulties in using organizational strategies were presumed to be the cause. Preceding studies did not look closely at their ability of feature detection of stimuli. Efficiency in feature detection is crucial to use the attributes or feature of stimuli as a clue in memory tasks. We examined verbal memory deficit and the ability of feature detection in Japanese patients with obsessive-compulsive disorder. We administered Iddon et al.'s verbal strategy task to 16 patients with obsessive-compulsive disorder and 16 healthy controls. The feature of Iddon et al.'s task was to include a phase that showed subjects the semantic structure of the task and timed each subject's analysis of the organization. Patients with obsessive-compulsive disorder were slower to classify stimuli words into semantic categories than were healthy controls. They recalled and recognized significantly fewer words than did healthy controls. In recall tasks, they used less organizational strategy than did healthy controls. Patients with obsessive-compulsive disorder were slower to analyze features of stimuli words than were healthy controls. This slowness possibly contributes to impaired memory performances that patients showed during the encoding process, since the efficient use of organizational strategies in limited time is difficult for them.

Age Factors↗
PubMed1992

Obsessive and compulsive characteristics of craving for alcohol in alcohol abuse and dependence.

The purpose of this study was to quantify the extent to which subjective ratings of craving for alcohol in the alcohol-abusing or dependent person (herein, alcoholic) correlate with measurable and specific characteristics of obsessions and compulsions. The Yale-Brown Obsessive Compulsive Scale modified to reflect obsessionality and compulsivity specifically related to heavy drinking (Y-BOCS-hd) was used for this purpose. Highly significant correlations were found in the alcoholic population (n = 62) between subjectively rated craving for alcoholic beverages and several of the Y-BOCS-hd questions regarding alcohol-related thoughts and drinking behavior. Additionally, mean craving scores were considerably greater in the alcoholic population than in the matched control population (n = 62). The data suggest that craving shares specific features in common with the obsessions of obsessive-compulsive disorder and that the existence of craving is dependent on the presence of obsessive thoughts about drinking. Positive correlations between craving and measures of compulsive drinking behavior also were found; compulsive drinking behavior, however, may reflect the consequences of craving rather than a fundamental characteristic of craving itself. The data show that despite difficulties in defining the term craving, it is clearly a phenomenon that is experienced or endorsed by most alcoholic subjects and is not by most persons who do not abuse alcohol.

Adult↗
PubMed1996

Hypochondriacal fears and beliefs in obsessive-compulsive disorder.

The relationship of obsessions and compulsions with hypochondriasis is receiving increasing attention, but has not been substantiated by adequate research. The Illness Attitude Scales (IAS), which identify hypochondriacal patients, were administered to 30 patients with DSM-IV obsessive-compulsive disorder and 30 healthy control subjects matched for sociodemographic variables. All IAS scales were significantly higher in patients with obsessions and compulsions. However, there were no significant differences between patients and controls in the number of subjects whose symptom intensity exceeded a clinical threshold for hypochondriasis and disease phobia. Furthermore, hypochondriacal fears and beliefs were poorly correlated with obsessions and compulsions. The results suggest the presence of mild abnormal illness behaviour in patients with obsessive-compulsive disorder, unlike the situation in patients with panic disorder and depression.

Adolescent↗
PubMed2006

Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome.

OBJECTIVE: A significant number of patients with obsessive-compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. METHOD: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. RESULTS: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. CONCLUSION: Our results strongly indicate that in-patients with obsessive-compulsive hoarding respond poorly to CBT.

Adult↗