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PubMed2001

Obsessive-compulsive symptoms in Parkinson's disease.

To systematically investigate obsessive-compulsive traits in Parkinson's disease, patients were administered the Maudsley obsessional-compulsive inventory (MOCI) and a modification of the Leyton obsessional inventory (LOI) to a sample of non-demented and non-depressed patients with Parkinson's disease. Patients with severe Parkinson's disease showed more obsessive traits than normal controls in MOCI and LOI total scores, and in the "checking", "doubting", and "cleaning" subscales of the MOCI. By contrast, patients with mild disease did not differ from controls. A significant correlation was found between severity and duration of illness and MOCI total score. These results support the involvement of basal ganglia in obsessive-compulsive symptomatology. As patients with mild Parkinson's disease did not differ from controls, obsessive-compulsive disorder does not seem to be directly related to the initial nigrostriatal dopaminergic deficiency which causes clinical Parkinson's disease symptomatology. The appearance of obsessive symptoms could be related to the subset of neurochemical changes taking place at the level of the basal ganglia circuitry as disease progresses.

Female↗
PubMed2004

Symptom dimensions in obsessive-compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure.

Although obsessive-compulsive disorder (OCD) is regarded as a unitary nosological entity, it encompasses a rich variety of heterogeneous mental and behavioural phenomena. The identification of clinical subtypes within this broad concept has been a focus of attention in recent years. In the present study, we administered a clinician-rated scale, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) with the Y-BOCS Symptom Checklist (Y-BOCS CL), as well as a self-report questionnaire, the Padua Inventory revised (PI-R), to 150 outpatients with OCD. A principal component analysis on the Y-BOCS CL, along with the PI-R, identified 6 consistent symptom clusters: (1) contamination obsessions and cleaning compulsions, (2) sexual/religious/somatic obsessions and checking, (3) high risk assessment and checking, (4) impulses and fear of loss of control, (5) need for symmetry and exactness, and ordering and counting compulsions, and finally (6) rumination. The Y-BOCS CL and PI-R showed great overlap and consistency regarding content and severity of the OCD symptoms. On inspection of items with identical content, only half of the items showed significant agreement. Both inventories have unique factors: rumination is represented solely in the PI-R, somatic obsessions and checking solely in the Y-BOCS CL. This means that the use of both clinician-administered and self-report measures is recommended, so that the entire spectrum of symptoms is represented.

Adult↗
PubMed1996

Obsessive-compulsive phenomenon in a so-called 'symptomarme schizophrenie': from the viewpoint of structural dynamics in defense mechanisms.

(1)'Antieidos' is a formlessness that results from the reverse intentionality of the life formation and is considered to be a principle of obsessive psychosis. 'Internal emptiness' is supposed to exist in the nucleus of schizophrenia. 'Antieidos' and 'internal emptiness' are in close proximity, partly overlapping each other. Obsessive psychosis and some types of simple schizophrenia are considered to have a common intentionality for the obsessive-compulsive phenomenon from the viewpoint of defensive structural dynamics. (2) The obsessive-compulsive phenomenon and the hypochondriacal phenomenon that coexist in simple schizophrenia are considered to be a 'noema' (something in which a meaning is given to the intended experience) that results from 'noesis' (action of consciousness seen in the intended experience) which has a defensive intentionality and as a result masks the basic disturbance in schizophrenia. Complementarity between the obsessive-compulsive phenomenon and the hypochondriacal phenomenon structured in this way can form one type of disease in the nonself-introspective category of simple schizophrenia.

Adult↗
PubMed1987

Fluvoxamine treatment of obsessive-compulsive disorder.

Sixteen outpatients who met DSM-III criteria for obsessive-compulsive disorder completed a 20-week double-blind, crossover trial with fluvoxamine and placebo. Thirteen (81%) improved with fluvoxamine, while three (19%) improved with placebo. Fluvoxamine treatment was associated with significant improvement on measures of obsessive-compulsive symptoms, anxiety, and depression. Depressed subjects' improvement on obsessive-compulsive measures correlated with improvement in symptoms of depression. Nondepressed subjects also showed improvement on measures of obsessive-compulsive symptoms. In this trial, fluvoxamine was an effective and safe treatment for obsessive-compulsive disorder.

Adolescent↗
PubMed1987

Clinical comparison of Tourette's disorder and obsessive-compulsive disorder.

The authors report on 16 outpatients with Tourette's disorder, 16 outpatients with obsessive-compulsive disorder, and 16 normal control subjects who underwent structured interviews and psychological testing. Previous findings of a high incidence of obsessive-compulsive disorder in patients with Tourette's disorder were confirmed. There was a significantly greater incidence of tics in the patients with obsessive-compulsive disorder and their relatives. Both patient groups had high rates of unipolar depressive and generalized anxiety disorders. Panic and phobic disorders were frequent in the patients with obsessive-compulsive disorder but not in the patients with Tourette's disorder. The patients with obsessive-compulsive disorder showed less coprolalia, echo phenomena, self-destructive behavior, and childhood attention deficit.

Adult↗
PubMed1988

Return of symptoms after discontinuation of clomipramine in patients with obsessive-compulsive disorder.

To evaluate the need for maintenance drug therapy in patients with obsessive-compulsive disorder, the authors assessed 21 patients with obsessive-compulsive disorder who manifested sustained improvement during 5 to 27 months of clomipramine treatment and who agreed to participate in a double-blind discontinuation study. Of 18 patients who completed the study, 16 had substantial recurrence of obsessive-compulsive symptoms by the end of the 7-week placebo period. In addition, 11 had a significant increase in depressive symptoms. Treatment duration before discontinuation of clomipramine was not related to the frequency or severity of obsessive-compulsive or depressive symptom appearance. These findings suggest that prolonged drug treatment may be warranted for obsessive-compulsive disorder.

Adult↗
PubMed1989

Growth rate in adolescents with obsessive-compulsive disorder.

In an epidemiological study of 5,596 high school students, the authors identified 20 adolescents with obsessive-compulsive disorder and compared their physical size to that of adolescents of the same sex with no obsessive-compulsive symptoms. The obsessive-compulsive boys (N = 11) were shorter and weighed less than the other boys (N = 2,479) and were shorter than a subsample of normal boys (N = 33) and boys with other psychiatric diagnoses (N = 16). Regression analysis showed a flatter growth pattern through adolescence for the obsessive-compulsive boys (although within the 95% confidence limits for the other boys), suggesting a subtle neuroendocrine dysfunction in obsessive-compulsive disorder.

Adolescent↗
PubMed1993

CSF somatostatin in obsessive-compulsive disorder.

OBJECTIVE: Because the central administration of somatostatin to experimental animals produces behaviors with some similarities to the compulsions of patients with obsessive-compulsive disorder and because serotonin reuptake inhibitors have been reported to reduce brain content of somatostatin, the authors examined central somatostatin activity in patients with obsessive-compulsive disorder. METHOD: CSF for measurement of somatostatin was obtained from 15 drug-free outpatients with obsessive-compulsive disorder and 27 normal volunteers. RESULTS: The mean CSF somatostatin level was significantly higher in the patients with obsessive-compulsive disorder than in the normal subjects. CONCLUSIONS: Although the functional significance of this finding is unknown, these data are consistent with a role for somatostatin in the clinical symptomatology of obsessive-compulsive disorder and its response to neuropharmacological agents. The high levels of CSF somatostatin reported here in a patient subgroup whose predominant symptoms consisted of overly focused, perseverative thought processes are in contrast to the consistently low levels of CSF somatostatin seen in patients with a spectrum of disorders characterized by substantial cognitive deficits.

Adolescent↗
PubMed1993

Personality disorder in obsessive-compulsive volunteers, well comparison subjects, and their first-degree relatives.

OBJECTIVE: The authors sought to determine the frequency of DSM-III personality disorders in subjects with obsessive-compulsive disorder, well comparison subjects, and their first-degree relatives. METHOD: Thirty-two subjects with obsessive-compulsive disorder and 33 age-(within 5 years) and gender-matched well comparison subjects were assessed with the Structured Interview for DSM-III Personality Disorder and several self-report instruments. Their first-degree relatives were assessed in a blind manner with the same instruments. RESULTS: Subjects with obsessive-compulsive disorder were more likely than well comparison subjects to have a personality disorder, but compulsive personality was not the most frequent. No significant differences were found in the prevalence of personality disorders among first-degree relatives, including compulsive personality, or in obsessional, hysterical, or oral character traits. CONCLUSIONS: Personality disorders are highly prevalent among patients with obsessive-compulsive disorder, but the data do not support a relationship between obsessive-compulsive disorder and compulsive personality.

Adult↗
PubMed1995

Obsessive-compulsive disorder among patients with anorexia nervosa and bulimia nervosa.

OBJECTIVE: The present study sought to determine the prevalence of obsessive-compulsive disorder among patients with eating disorders. METHOD: Ninety-three women who met DSM-III-R criteria for anorexia nervosa or bulimia nervosa were investigated by using a semistructured diagnostic interview, the Yale-Brown Obsessive Compulsive Scale, and the Eating Disorder Inventory. RESULTS: Thirty-four patients (37%) met the DSM-III-R criteria for obsessive-compulsive disorder and also had a clinically significant score of 16 or higher on the Yale-Brown scale. These patients also had significantly higher, and hence pathological, mean scores on five of eight Eating Disorder Inventory scales than patients with eating disorders without concomitant obsessive-compulsive disorder. CONCLUSIONS: These results suggest that there is a high prevalence of obsessive-compulsive disorder among patients with anorexia and bulimia nervosa and that this prevalence may be correlated with the severity of the eating disorder.

Adolescent↗
PubMed1995

Lack of efficacy of clozapine monotherapy in refractory obsessive-compulsive disorder.

OBJECTIVE: The authors assessed the efficacy of clozapine monotherapy for adults with treatment-resistant obsessive-compulsive disorder. METHOD: Twelve adults with refractory obsessive-compulsive disorder participated in a 10-week, open-label, systematic trial of clozapine. They were assessed with the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, and the global improvement item of the Clinical Global Impression (CGI) scale. RESULTS: None of the 10 patients who completed the trial was a responder. No significant change was observed in obsessive-compulsive or depressive symptoms or in scores on the CGI global improvement item. CONCLUSIONS: These findings suggest that clozapine monotherapy is not effective for most adult patients with treatment-resistant obsessive-compulsive disorder.

Adult↗
PubMed1997

B lymphocyte antigen D8/17: a peripheral marker for childhood-onset obsessive-compulsive disorder and Tourette's syndrome?

OBJECTIVE: It has been hypothesized that Sydenham's chorea, a major manifestation of rheumatic fever, may provide a medical model for obsessive-compulsive disorder and associated conditions, such as Tourette's syndrome. Monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in nearly all patients with rheumatic fever and is thought to be a trait marker for susceptibility to this complication of group A streptococcal infection. The authors investigated whether D8/17 expression is greater than normal in some forms of obsessive-compulsive disorder and Tourette's syndrome. METHOD: By immunofluorescence techniques, 31 patients with childhood-onset obsessive-compulsive disorder and/or Tourette's syndrome or chronic tic disorder and 21 healthy comparison subjects were evaluated for percentage of D8/17-positive B cells. None had rheumatic fever or Sydenham's chorea. Levels of antineuronal antibodies and streptococcal antibodies were also determined. RESULTS: The average percentage of B cells expressing the D8/17 antigen was significantly higher in the patients (mean = 22%, SD = 5%) than in the comparison subjects (mean = 9%, SD = 2%). When classified categorically, all patients but only one comparison subject were D8/17 positive. No difference between groups in the presence of antineuronal antibodies or high streptococcal titers was found. CONCLUSIONS: Patients with childhood-onset obsessive-compulsive disorder or Tourette's syndrome had significantly greater B cell D8/17 expression than comparison subjects despite the absence of documented Sydenham's chorea or rheumatic fever. These findings suggest that D8/17 may serve as a marker for susceptibility among some forms of childhood-onset obsessive-compulsive disorder and Tourette's syndrome, as well as rheumatic fever or Sydenham's chorea.

Adolescent↗
PubMed2002

Obsessive-compulsive and panic symptoms in patients with first-admission psychosis.

OBJECTIVE: The occurrence, persistence and specificity of the association between comorbid obsessive-compulsive and panic symptoms and three psychotic disorders--schizophrenia/schizoaffective disorder, bipolar disorder with psychosis, and major depression with psychosis--were examined in a first-admission, epidemiologically defined group of patients with psychotic symptoms. METHOD: The Structured Clinical Interview for DSM-III-R obsessive-compulsive and panic modules were administered at baseline and 24-month follow-up to patients with schizophrenia/schizoaffective disorder (N=225), bipolar disorder with psychosis (N=138), and major depression with psychosis (N=87) participating in the Suffolk County (N.Y.) Mental Health Project. The rates of subsyndromal symptoms and disorder criteria met were compared across the three psychosis groups. Recognition and treatment of anxiety symptoms at initial discharge and impact of the baseline presence of anxiety symptoms on 24-month clinical status were also examined. RESULTS: Obsessive-compulsive and panic symptoms were present at baseline in 10%-20% of all three groups. There was no specific association between obsessive-compulsive symptoms and any specific psychosis diagnosis; however, women with major depression with psychosis had a significantly higher rate of panic symptoms than the other two groups, and schizophrenia/schizoaffective disorder patients with baseline panic symptoms were significantly more likely to exhibit positive symptoms of psychosis after 24 months. CONCLUSIONS: The authors found no specific association between obsessive-compulsive symptoms and diagnosis early in the illness course, but the finding of an association between panic symptoms and psychotic depression among female patients and between baseline panic and positive psychotic symptoms in schizophrenia/schizoaffective disorder patients at 24 months suggests the need for further study.

Adult↗
PubMed2001

The narcissistic function in obsessive-compulsive neurosis.

Freud's intrapersonal concept of anal-sadistic regression is set against the interpretation of obsessive-compulsive neurosis as a structural ego deficit. The interpersonal dimension that comes to the fore as a result of this, becomes clear if we focus on obsessive-compulsive behavioral disorder: Persons suffering from obsessive-compulsive neurosis lack the self-assessment factor. It needs another person as part of their own ego who accepts and supports them in their behavior. A clinical example illustrates this narcissistic function of compulsion together with the changes in the psychodynamic approach and resulting therapy. Against DSM-classification with the concept of obsessive-compulsive disorder, which contains an unspecific symptomatology that occurs both in neurosis, schizophrenia, melancholia, and organic psychosis, this article advocates the specific and differentiated concept of obsessive-compulsive neurosis.

Ego↗
PubMed2002

Association of obsessions and compulsions in schizophrenia with neurocognition and negative symptoms.

It is unclear whether obsessions and compulsions in schizophrenia spectrum disorders are associated with a unique pattern of symptoms and deficits. Accordingly, the present study compared symptom levels and neurocognitive function of participants with schizophrenia or schizoaffective disorder with (n=11) and without (n=52) significant obsessive-compulsive symptoms. Analyses of variance revealed that the obsessive-compulsive group performed more poorly on measures of executive function and vigilance and had higher levels of negative and emotional discomfort symptoms. Unexpectedly, the obsessive-compulsive group also demonstrated superior performance on a measure of visual memory. The implications of these clinical correlates of obsessive-compulsive phenomena in schizophrenia spectrum disorders are discussed.

Adult↗
PubMed1996

A preliminary study of partial hospital management of severe obsessive-compulsive disorder.

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.

Adolescent↗
PubMed1996

Hoarding and obsessive-compulsive symptoms.

The present study attempts to extend recent research on the relation between hoarding and obsessive-compulsive experiences. In both college student and community samples, hoarding was associated with higher scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS). The relationship was stronger among the community sample, in which there was a greater range of compulsive symptoms and hoarding behavior. Hoarding was also associated with higher levels of general psychopathology as measured by the Brief Symptom Inventory but not by the Obsessive-Compulsive Personality Disorder subscale from the Millon Clinical Multiaxial Inventory-II or by a measure of ordinary risk taking. Among a sample of patients with obsessive-compulsive disorder (OCD), 31% reported hoarding obsessions and 26% reported hoarding compulsions on the YBOCS symptom checklist. These frequencies are similar to those found elsewhere and suggest that, although not as frequent as the classical symptoms of OCD, hoarding is a common symptom among OCD patients.

Adolescent↗
PubMed1976

The relationships between obsessional personality, obsessions in depression, and symptoms of depression.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets. Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions, in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.

Adult↗