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PubMed1992

Mental play in Gilles de la Tourette's syndrome and obsessive-compulsive disorder.

A new phenomenon, found only in Gilles de la Tourette (GTS) patients, and which we have called 'mental play', is described. It was compared with the phenomenon of counting, which occurred in both GTS and obsessive-compulsive patients. In the GTS patients both mental play and counting were best characterised as playful impulsions. In contrast to the GTS patients, the counting of the obsessive-compulsive patients was in line with their obsessive-compulsive behaviour. These findings suggest that repetitive symptoms in GTS patients, even when they share superficial similarities with obsessive-compulsive symptoms, should not be diagnosed automatically as obsessive-compulsive.

Adolescent↗
PubMed1999

'Obsessions' in children with autism or Asperger syndrome. Content analysis in terms of core domains of cognition.

BACKGROUND: We report a survey of the content of obsessions in children with autism spectrum conditions. We use the term 'obsessions' narrowly, to indicate strong, repetitive interests. We predicted that obsessions would not cluster randomly, but rather would occur significantly more often in the domain of 'folk physics' (an interest in how things work), and significantly less often in the domain of 'folk psychology' (an interest in how people work). These predictions were tested relative to a control group of 33 children with Tourette syndrome. AIMS: To examine the content of autistic obsessions, and to test the theory that these reflect an evolved cognitive style of good folk physics alongside impaired folk psychology. METHOD: Ninety-two parents returned a questionnaire designed to determine the subject of their child's obsessional interests. The results were analysed in terms of core domains of cognition. RESULTS: Both predictions were confirmed. CONCLUSIONS: These results suggest that impaired folk psychology and superior folk physics are part of the cognitive phenotype of autism. A content-free theory of obsessions is inadequate.

Asperger Syndrome↗
PubMed2005

Relationship between two aspects of perfectionism and obsessive-compulsive symptoms.

In this study was investigated the relationship between two aspects of perfectionism (Concern over Mistakes and Personal Standards) and obsessive-compulsive symptoms. College students (57 men and 193 women: M age = 19.5 yr., SD = 1.9) majoring in psychology were from introductory psychology classes and a psychological assessment practice class. They completed the Padua Inventory, which assesses obsessive-compulsive symptoms, and the subscales of Concern over Mistakes and Personal Standards of the Frost Multidimensional Perfectionism Scale, which assess the tendency to be concerned about making mistakes and the tendency to set excessively high standards, respectively. Multiple regression analysis indicated that only the Concern over Mistakes scores predicted significantly all Padua Inventory subscale scores. Perhaps only being concerned over making mistakes may be associated with obsessive-compulsive symptoms. The tendency to set high standards was not strongly correlated with obsessive-compulsive symptoms. Further, the relationship between setting high standards and having obsessive-compulsive symptoms reported in previous studies may be spurious. Further work is required to untangle these associations.

Adult↗
PubMed2006

Processes of inference, schizotypal thinking, and obsessive-compulsive behaviour in a normal sample.

Previous research has shown inferential confusion as measured by the Inferential Confusion Questionnaire to be related to obsessive-compulsive symptoms. A total of 108 participants (41 men and 66 women) from a normal population in The Netherlands (M age = 46 yr., SD = 15.5) completed a package of questionnaires measuring inferential confusion, schizotypal symptoms, and obsessive-compulsive behaviour. As expected, scores for both inferential confusion and schizotypal symptoms were significantly related to those for obsessive-compulsive behaviour. In addition, analysis showed that inferential confusion and schizotypal symptoms shared common variance, but both predicted an independent portion of the variance in obsessive-compulsive behaviour while controlling for neuroticism. The present results call for further inquiry into the role of inferential confusion and schizotypal thinking in obsessive-compulsive behaviour.

Adult↗
PubMed1999

Hoarding in obsessive-compulsive disorder: a report of 20 cases.

BACKGROUND: We describe the demographic characteristics, hoarding phenomenology, comorbid disorders, family histories, and treatment response of 20 adult obsessive-compulsive disorder (OCD) patients exhibiting hoarding behavior. METHOD: We utilized the Structured Clinical Interview for DSM-III-R, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview to gather data. RESULTS: We studied 9 women and 11 men. Their hoarding began from age 5 years to age 46 years (mean +/- SD age at onset = 20 +/- 11 years); hoarding was evident before the onset of other OCD symptoms in 9 patients. The most commonly hoarded items were newspapers and magazines, junk mail, old clothes, notes or lists, and old receipts. Hoarded material occupied from one room plus most or all closets to more than one room plus all closets, the garage, and yard. Seven patients rented additional storage space for hoarded items. Eighty-four percent of patients reported a family history of hoarding, and 80% grew up in a household where someone else hoarded. The most frequent primary motives for hoarding were fears of discarding something useful and discarding something that would be needed in the future. Lifetime prevalence of major depression and of impulse-control disorders, especially compulsive shopping, were high; only 3 patients met DSM-IV criteria for obsessive-compulsive personality disorder. Response of hoarding to selective serotonin reuptake inhibitors was less robust than is expected for obsessive-compulsive disorder. CONCLUSION: Whether hoarding behaviors mark a subset of obsessive-compulsive disorder patients with a different pathophysiology or functional anatomy deserves investigation.

Adolescent↗
PubMed2001

Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy.

BACKGROUND: The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictors of clinical outcome. METHOD: Sixty outpatients meeting DSM-II-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prolonged pharmacologic therapy with an SRI. RESULTS: Thirty-seven patients (61.7%) completed an adequate behavioral treatment. At long-term assessment, 22 patients (36.7%) exhibited a global Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a final reduction in Y-BOCS global score of less than 35% and were considered nonresponders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no significant differences in either Y-BOCS global or obsessions subscale scores between those who did and those who did not undergo behavioral therapy were detected. Obsessions of sexual/religious content were the unique factor related to a poorer long-term outcome. CONCLUSION: A substantial number of OCD patients showed persistent disabling symptoms at the long-term follow-up in spite of combined pharmacologic and behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions predicted poorer long-term outcome, whereas short-term response to SRI treatment failed to achieve predictive value in the long-term course of OCD.

Adolescent↗
PubMed2001

Patterns of temperament and character in subjects with obsessive-compulsive disorder.

BACKGROUND: The purpose of this study was to assess the temperament and character patterns of obsessive-compulsive disorder (OCD) patients and to investigate the relationship between patterns of temperament and character and the severity of obsessive-compulsive symptoms. METHOD: The subjects were 40 patients who met DSM-IV criteria for OCD and 40 age-, sex-, and IQ-matched healthy controls. All subjects completed Cloninger's Temperament and Character Inventory. Other instruments included the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS: OCD patients showed significantly higher scores of harm avoidance and lower scores of novelty seeking and self-directedness compared with healthy comparison subjects. In addition, the high harm avoidance and low self-directedness scores are correlated with a greater severity of obsessive-compulsive symptoms in OCD subjects (multiple regression analysis, beta = 0.39, t = 2.54, df = 34, p = .016; beta = -0.41, t = 2.46, df = 34, p = .019, respectively). CONCLUSION: OCD patients had distinct patterns of temperament and character compared with healthy comparison subjects. In addition, these patterns are specifically related to the severity of obsessive-compulsive symptoms.

Adult↗
PubMed2002

Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect.

BACKGROUND: The goal of this study was to investigate the co-occurrence of depressive disorders in obsessive-compulsive disorder (OCD) and the effect of these disorders on combined pharmacologic and behavioral treatment for OCD. METHOD: A retrospective chart analysis was performed on baseline ratings of 120 OCD patients and posttreatment ratings of 72 of these patients. For depressive symptoms, the Montgomery-Asberg Depression Rating Scale and the Self-Rating Depression Scale were applied; for obsessive-compulsive symptoms, the Yale-Brown Obsessive Compulsive Scale and the Maudsley Obsessive Compulsive Inventory were used; and for general anxiety symptoms, the Self-Rating Anxiety Scale, the Clinical Anxiety Scale, and the State-Trait Anxiety Inventory were given. RESULTS: One third of the OCD patients in our sample were found to be depressed. Symptom severity on OCD symptoms at baseline did not differ between depressed and nondepressed OCD patients; on general anxiety symptoms, the comorbid group was more severely affected. Both depressed and nondepressed OCD patients responded well to treatment, as reflected in assessments for depressive, obsessive-compulsive, and general anxiety symptoms. However, comorbid depression had a negative effect on treatment: depressed OCD patients showed less improvement than nondepressed OCD patients on most scales. CONCLUSION: Depression frequently accompanies OCD and appears to affect treatment outcome negatively. While both groups of patients improved with combination treatment, the OCD-alone group had more improvement than the group that had comorbid depression.

Adult↗
PubMed2003

Acute and long-term treatment and prevention of relapse of obsessive-compulsive disorder with paroxetine.

BACKGROUND: Limited information is available regarding optimal dosing or long-term pharmacotherapy with serotonin reuptake inhibitors in obsessive-compulsive disorder. This study evaluated the acute safety and efficacy and long-term efficacy, safety, and impact on relapse prevention of paroxetine in obsessive-compulsive disorder. METHOD: We enrolled 348 outpatients with DSM-III-R obsessive-compulsive disorder in phase 1, a 12-week randomized, double-blind, parallel study of fixed doses of paroxetine (20 mg/day, 40 mg/day, or 60 mg/day) and placebo. In phase 2, 263 phase 1 completers were enrolled in 6 months of flexibly dosed open-label paroxetine treatment. In phase 3, 105 responders to open-label paroxetine were randomized to 6-month double-blind, fixed-dose, parallel paroxetine/placebo treatment to evaluate long-term efficacy, safety, and impact on relapse prevention. The study was conducted from July 1991 to February 1994. RESULTS: Patients in phase 1 acute treatment receiving 40 mg/day or 60 mg/day of paroxetine improved significantly (p < .05) more than those receiving placebo; the mean reduction in Yale-Brown Obsessive-Compulsive Scale score was 25% on 40 mg/day of paroxetine and 29% on 60 mg/day compared with 13% on placebo. During phase 3, long-term treatment, a greater proportion of placebo- (59%) than paroxetine-treated (38%) patients relapsed. Paroxetine was well tolerated at all doses, with no significant increase in frequency of adverse events during long-term compared with short-term therapy. Greater adverse events in the placebo than in the paroxetine group in phase 3 probably represent a discontinuation effect. CONCLUSION: Paroxetine doses of 40 mg/day and 60 mg/day (but not 20 mg/day) are effective in treating acute obsessive-compulsive disorder. Long-term treatment with paroxetine is effective and safe, decreases the rate of relapse, and lengthens the time to relapse.

Acute Disease↗
PubMed2003

Comparison of clinical characteristics and comorbidity in schizophrenia patients with and without obsessive-compulsive disorder: schizophrenic and OC symptoms in schizophrenia.

BACKGROUND: Since a substantial proportion of schizophrenia patients has symptoms of obsessive-compulsive disorder (OCD), we sought to provide a phenomenological characterization of a schizophrenia subgroup with OCD. METHOD: A consecutive sample of patients who met DSM-IV criteria for both schizophrenia and OCD (N = 55) was compared with 55 schizophrenia patients without OCD matched for age and number of hospitalizations. Structured Clinical Interview for DSM-IV Axis I psychiatric disorders (SCID-I), including a specific module for tic disorders based on DSM-IV criteria, Scales for the Assessment of Positive and Negative Symptoms, Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impressions scale, and Hamilton Rating Scale for Depression were used. RESULTS: Schizophrenia patients with OCD (N = 55) had lower positive dimension scores than schizophrenia patients without OCD (N = 55) (p =.01). Two subgroups of schizo-obsessive patients were identified: OCD independent of schizophrenia symptoms and OCD partially overlapping positive schizophrenia symptoms. Schizophrenia patients with OCD had more SCID-detectable OCD-spectrum disorder, primarily body dysmorphic disorder and chronic tic disorders. More schizophrenia patients with OCD were treated with either add-on serotonin reuptake inhibitors or clozapine. CONCLUSION: Schizophrenia patients with OCD differ from their non-OCD-schizophrenia counterparts in severity of schizophrenia symptoms, co-occurrence of OCD-spectrum disorders, and pharmacotherapy. These findings and the identification of 2 subgroups of schizo-obsessive patients support the validity of this unique clinical entity and may facilitate the establishment of diagnostic criteria for a schizo-obsessive subtype of schizophrenia.

Adult↗
PubMed2006

The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake.

OBJECTIVE: This article describes the method and intake findings of the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the naturalistic course of obsessive-compulsive disorder (OCD) in a large clinical sample using longitudinal research methodology. METHOD: Intake data, collected between June 2001 and October 2004, are presented for 293 adult participants in a prospective, naturalistic study of OCD. Participants had a primary diagnosis of DSM-IV OCD and had sought treatment for the disorder. RESULTS: Our findings indicate that OCD typically has a gradual onset and a continuous course regardless of age at onset. There is a substantial lag between the onset of the disorder and initiation of treatment. OCD, which almost always coexists with other psychiatric symptoms, leads to serious social and occupational impairment. Compared with participants with late-onset OCD, early-onset participants had higher rates of lifetime panic disorder, eating disorders, and obsessive-compulsive personality disorder. The groups also differed on the types of obsessive-compulsive symptoms that were first noticed, as well as on rates of current obsessions and compulsions. CONCLUSION: The demographics, clinical characteristics, comorbidity rates, and symptom presentation of the sample are consistent with those reported for cross-sectional studies of OCD, including the DSM-IV Field Trial. The current sample has a number of advantages over previously collected prospective samples of OCD in that it is large, diagnostically well characterized, recruited from multiple settings, and treatment seeking. This unique data set will contribute to the identification of meaningful phenotypes in OCD based on stability of symptom dimensions, prospective course patterns, and treatment response.

Adult↗
PubMedDate not supplied

[Cognitive function in the obsessive-compulsive disorder associated with cerebral lesions].

INTRODUCTION: Although obsessive-compulsive symptoms are uncommon among patients with neurological diseases, structural neuroimaging (CAT or MRI) disclose focal brain lesions in some patients. However, little is know about the clinical phenomenology of obsessive-compulsive symptoms and the cognitive deficits that occur in neurological conditions. OBJECTIVE: To review the cognitive functioning of patients who develop an obsessive-compulsive disorder (OCD) in association with focal brain lesions. DEVELOPMENT: In the present study, the author review recent studies which suggest that OCD associated with brain lesions is relatively similar to idiopathic or 'functional' OCD (i.e., OCD unassociated with gross brain damage). Idiopathic and acquired forms of OCD are clinically heterogeneous. The content of obsessions and compulsions in acquired OCD depends, at least in part, of the causative lesion, whereas the pattern of cognitive deficits is more homogeneous affecting attention, general intelligence, verbal and visuospatial memory, and executive function. CONCLUSION: It is suggested that the study of different subgroups of patients with acquired OCD would detect differences in the phenomenology of obsessions and compulsions as well as in the pattern of cognitive deficits. Moreover, this approach can improve our understanding about the pathophysiological mechanisms underlying idiopathic OCD.

Brain Diseases↗
PubMed2001

[Obsessive-phobic disorders with the phenomena of mysophobia in slowly progressing schizophrenia].

54 patients, 24 men and 30 women, (mean age 27 years) were examined. Two types of obsessive-phobic disorders with the phenomena of mysophobia were distinguished: obsession of the external (extracorporal) threat and obsession of contamination. Disorders of the first type (25 cases) were observed in psychopathic-like schizophrenia. They were characterized by a fear of possible contacts with different pathogenic agents--toxic substances, sharp small subjects, bacteria. Obsessions presented with a system of actions preventing phobic situations (rituals). With progression of the disease there was a decrease of both the degree and affective saturation of phobic disorders together with preserving rituals. Negative disorders presented with rough psychopathic-like changes with features of the "verschroben" defect. The disorders of the second type (29 patients) were observed in neurosis-like schizophrenia. Mysophobia manifested with both the repeated control and the fear of contamination accomplished. Ritual behavior presented with repeated actions and repeated control of the "sterility" of the own body and the surrounding subjects. Dynamics of these disorders was characterized by a tendency to more severe rituals of the control and persisting anxiety. Deficit disorders manifested with mental infantilism with psychopathic-like disorders of schizo-anancastic sphere. The above types of the obsessive-phobic disorders have a differential-diagnostic significance in respect of clinical variations of schizophrenia and determination of the state acuity with possible reversibility of the disorders (in neurosis-like schizophrenia).

Adolescent↗
PubMedDate not supplied

[Clinical characteristics of 104 patients with obsessive compulsive disorder].

INTRODUCTION: Obsessive compulsive disorder is a common disorder, but research on its clinical features is scarce. The goal of this study is to describe the clinical characteristics and demographic features of a large sample of patients with Obsessive compulsive disorder. METHOD: The characteristics of 104 patients who sought psychiatric treatment and who were diagnosed as having Obsessive compulsive disorder were assessed by means of a structured questionnaire. RESULTS: The mean age of onset was 20 years and the mean time before soliciting treatment was 4 years. Most of the patients reported an insidious onset and related the onset to an stressful event. The most frequent obsessions were doubt, aggressiveness and contamination. Checking, need to ask and mental rituals were the most frequent compulsions. Cleaning and repetition compulsions were most frequent in women. DISCUSSION: Our results regarding age at onset of illness, way of onset or prevalence of certain obsessions and compulsions are similar to previous research. No agreement was obtained with previous research regarding the link between stress and illness onset, the course of the disorder or the time before treatment was sought. The differences with respect to previous studies could be accounted for the use of different instruments or criteria. The need for the development of instruments allowing to shed light on these discrepancies is stressed.

Adolescent↗
PubMed2001

Risperidone augmentation of specific serotonin reuptake inhibitors in the treatment of refractory obsessive-compulsive disorder: report of two cases.

The efficacy of specific serotonin reuptake inhibitors (SSRI) in the treatment of obsessive-compulsive disorder (OCD) has been established, but more than 40% of patients continue to have a poor response to SSRI. Low-dose antipsychotic augmentation of SSRI has contributed to the amelioration of symptoms in the treatment of refractory obsessive-compulsive disorder patients. Due to the risk of side effects from traditional antipsychotics, atypical novel antipsychotic augmentation of SSRI may be a good choice in the treatment of refractory obsessive-compulsive disorder. Herein we report our experience with two OCD patients, one with a poor response to fluoxetine 80 mg per day for 3 months, and the other with poor response to fluoxetine 60 mg per day for 3 months. Both OCD patients also proved to have a poor response to paroxetine 60 mg per day for 6 weeks. Neither patient had received any psychotherapy or behavioral therapy. Both patients showed significant improvement in their obsessive-compulsive symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), after risperidone 1 mg per day was added to their on-going use of paroxetine 60 mg per day. Within 4 weeks of adding risperidone, the two patients' Y-BOCS scores had decreased by 57% and 53%. This result suggests that risperidone augmentation of SSRI may be a good choice and an effective treatment strategy for refractory OCD.

Adult↗
PubMed1992

Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias.

BACKGROUND: Paraphilias and related disorders have recently been thought of as sexual addictions. However, it has also been argued that these disorders are sexual compulsions. The question arises as to whether these disorders and obsessive compulsive disorder respond in the same way to pharmacotherapy. METHOD: We retrospectively reviewed outcome in 13 patients who presented with sexual symptoms and were treated with serotonin reuptake blockers. Symptoms were divided into paraphilias, nonparaphilic sexual addictions, and sexual obsessions. RESULTS: Paraphilias had the least improvement, while sexual obsessions had the best response to medication. CONCLUSION: Paraphilias and related disorders may be less responsive than sexual obsessions or compulsions to serotonin reuptake blockers. Perhaps paraphilias and related disorders are on the impulsive rather than the compulsive end of the spectrum of obsessive compulsive disorders. Controlled trials are, however, necessary to replicate these preliminary findings.

Adolescent↗
PubMed1992

The serotonin hypothesis of obsessive compulsive disorder: implications of pharmacologic challenge studies.

Demonstration of the efficacy of serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors such as clomipramine in the treatment of obsessive compulsive disorder has fueled interest in the neurobiological basis of this illness. Results of treatment studies, investigations of biological markers, and pharmacologic challenges are reviewed and implications for a 5-HT theory of obsessive compulsive disorder discussed. While the nature of the dysregulation in serotonin transmission that may attend obsessive compulsive disorder has yet to be fully elucidated, evidence accumulates that 5-HT function in part modulates obsessive compulsive symptoms. Development of more specific probes and new brain imaging techniques will further enhance understanding of the pathophysiology of obsessive compulsive disorder.

Biomarkers↗
PubMed2005

[Quality of life in patients with obsessive-compulsive disorder: relations with cognitive functions and clinical symptoms].

OBJECTIVE: To compare quality of life in patients with obsessive-compulsive disorder with that in healthy subjects and to relate quality of life to cognitive functions and the severity of clinical symptoms. METHODS: Twenty-three patients who met DSM-IV criteria for obsessive compulsive disorder and 22 healthy subjects were included in the study. Quality of life (Turkish Quality of Life Scale-Brief Form) and cognitive functions were investigated in all subjects. In the patient group the relation of quality of life to the cognitive functions and to the severity of clinical symptoms and in the control group the relation of quality of life to the cognitive functions was investigated. RESULTS: The comparison of quality of life between the patient and control groups showed a significant difference (F= 2.60, p= 0.04). The significant differences between the two groups in psychological and social scores were responsible for the overall significant difference. The scores of quality of life were correlated with the scores of the cognitive tests (Trail Making Test, Auditory Consonant Trigram Test and Digit Span Test) and the severity of obsessive-compulsive symptoms. CONCLUSION: The present study revealed that quality of life is lower in patients with obsessive-compulsive disorder than in healthy subjects and is related to cognitive functions and the severity of obsessive-compulsive symptoms.

Adult↗