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PubMed1990

Efficacy of long-term fluoxetine treatment of obsessive-compulsive disorder.

Ten outpatients meeting DSM-III-R criteria for obsessive-compulsive disorder completed a 32-week, open-label study with fluoxetine, a selective serotonin reuptake blocker. The patients were evaluated every four weeks for obsessive-compulsive symptomatology, anxiety, and depression. Significant improvement of obsessive-compulsive and anxiety measures were observed after four weeks, with maximal improvement at eight weeks. Depressed and nondepressed patients showed similar rates of improvement in obsessive-compulsive symptomatology. Overall, fluoxetine was tolerated well by all patients, and no serious side effects were observed. This study suggests that fluoxetine is an effective and safe treatment for obsessive-compulsive disorder, both for short-term alleviation and for long-term maintenance.

Body Weight↗
PubMedDate not supplied

[Obsessive-compulsive symptoms associated with panic disorder. Predictive factor of a good therapeutic response to fluvoxamine].

In a sample of 35 patients with a diagnosis of panic disorder or agoraphobia with panic attacks according DSM III criteria, the authors found 8 patients (23%) with obsessive compulsive symptoms. This subgroup and 7 patients without obsessive compulsive symptoms were treated with fluvoxamine, a selective serotonin uptake inhibitor in an 8 weeks open study (2 weeks wash out, 6 weeks treatment). At the end of the study, a dramatic reduction of anxiety was found in different rating scales. Ten patients improved and no panic attack was noted: 7 in the group with obsessive compulsive symptoms (N = 8) and 3 in the group without obsessive compulsive symptoms (N = 7). Interest of fluvoxamine in panic patients with obsessive compulsive symptoms who do not respond to common antipanic medication is suggested. Controlled studies are necessary to confirm these first results.

Adult↗
PubMed1990

Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive compulsive disorder?

It seems unlikely that a solitary disturbance in serotonin function can fully account for the pathophysiology of obsessive compulsive disorder. The authors propose that some forms of obsessive compulsive disorder, e.g., obsessive compulsive disorder with a history of Tourette's syndrome, may involve a relative or absolute derangement in both brain serotoninergic and dopaminergic systems. A role for dopamine in the pathophysiology of obsessive compulsive disorder is supported by a review of the preclinical and clinical evidence. Additional studies are needed to more directly evaluate dopamine function in patients with obsessive compulsive disorder.

Dopamine↗
PubMedDate not supplied

[Obsessive-compulsive disorders in adolescents].

The research recently conducted and ongoing in adolescent obsessive-compulsive disorder indicates that the clinical signs and symptoms are indistinguishable from those seen in adults. Comorbidity appears to follow the same trends in adolescents and adults, with anxiety and affective symptomatology predominating. Contrary to expectation, Gilles de la Tourette disorder does not appear either as a concurrent syndrome, or as an eventual outcome in obsessive-compulsive adolescents. Males are greatly over-represented among adolescents with an early childhood onset. The neurological and neuropsychological findings are the only ones that appear to distinguish the adolescent and adult obsessive-compulsive patients. The findings point to frequent neurological abnormalities in adolescents with obsessive-compulsive disorder. The natural history over the short-term seems to be negatively affected by severity. The clinical efficacy of clomipramine and the failure of another tricyclic antidepressant parallels the therapeutic experience reported in adult patients. The presence of depression is unrelated to the efficacy of clomipramine. The neuropsychological and neurological abnormalities, together with the data from the longitudinal and treatment studies, strongly suggest that obsessive-compulsive disorder in adolescents is not a variant of the overall group of anxiety disorders.

Adolescent↗
PubMedDate not supplied

[Obsessive-compulsive behavior caused by bilateral lesions of the lenticular nuclei. A new case].

Another case of obsessive behaviour as the consequence of lentiform nuclei lesions is reported. All the aspects of an obsessive neurosis were present: irresistible compulsiveness, acute anxiety in case of non accomplishment, magic-like clues. The symptoms appeared after a carbon monoxide poisoning, in a 31-years-old woman who had previously a pathological personality, of the psychopathic type, but without obsessive features. The onset of compulsions was paralleled by frontal-like psychological changes, but there was no reduction of intellectual or mnesic functions. A previous depressive state continued after the poisoning, so that the patient did not show an empty mind as did the other patients; the loss of "self-psychic activation" was only partial. All these case-reports emphasize the fact that the neuropsychological testing must not be limited to the behaviour and must investigate the "mental content" as well. They also lead us to emphasize similitudes between psychic disorders related to lenticular lesions and those related to frontal lobe lesions, including obsessive-like activities. Such case-reports provide a model in which some components of the obsessive neurosis, hebephrenia and depression are the consequence of an identified brain damage. It can be suggested that the neural circuits involving frontal lobes and parts of the neostriatum and of the pallidum are implicated in the mechanisms of these three types of psychoses.

Adult↗
PubMed1993

[Differential diagnosis and therapeutic problems in tics and obsessive-compulsive disorders during the developmental age].

In order to point to the differential-diagnostic issue of tics and obsessive-compulsive disorders because of similar clinical manifestations of some forms of tics with compulsive behavior, and ebcause of frequent obsessive features found in children with tics, we have examined 121 patients with tic and 9 patients with obsessive-compulsive disorder. In the tic group we found a significant occurrence of differently manifested obsessive line, while in the compulsive disorders group we found a great percentage of tics. Attempts made in order to differentiate these two clinical pictures in practice were based on the recognition that in both cases we deal with a unique etiopathogenetic factor in the form of frustration which in some children cause a feeling of tension which in some cases further manifests itself in the deterioration of voluntary movements initiating tics, sometimes provoke defensive mechanisms leading to the obsessive-compulsive syndrome and sometimes both issues are present. Such recognition implicates a more complex approach to the child's personality by neglecting the differences between the two disorders and includes a therapeutic program consisting of psychomotor reduction and relaxation, medication, parent assistance and school cooperation.

Adolescent↗
PubMed1994

Obsessive-compulsive disorder: a concealed diagnosis.

Epidemiologic data suggest that obsessive-compulsive disorder is the fourth most common mental disorder, after phobias, substance abuse and depression, and is nearly as common as asthma and diabetes mellitus. The understanding of obsessive-compulsive disorder and its treatment have significantly improved over the past decade. Positron emission tomographic scanning has demonstrated characteristic changes in the cerebral metabolism of patients with obsessive-compulsive disorder. Selective serotonin reuptake inhibitors have been shown to alleviate the symptoms of this disorder. Treatment of obsessive-compulsive disorder includes drug therapy, behavior therapy and family therapy. The family physician can play a key role in recognizing the clinical markers of obsessive-compulsive disorder and negotiating a treatment plan that significantly lessens the psychosocial morbidity associated with it.

Algorithms↗
PubMedDate not supplied

[Self-evaluation of obsessive-compulsive disorder. Adaptation and validation of two psychometric scales to the French version].

Reliable and valid measures of obsessive-compulsive behaviors are essential to investigation of obsessive-compulsive disorder (OCD). With observer-rated scales, accurate self-assessment is also required in the evaluation of OCD. In a collaborative study, two psychometric instruments for self assessment of OCD were translated and adapted into a french version: The Maudsley Obsessive-Compulsive Inventory (MOCI). and the Lynfield Obsessional-Compulsive Questionnaire (LOCQ) with 2 scores generated for "resistance" (LOCQ-R) and "interference" (LOCQ-I). The validity and the reliability of these two instruments were studied within different selected psychiatric groups, OCD, Panic disorder with or without Agoraphobia, Major Depression, and in a control group. Between-groups comparison showed that MOCI and LOCQ global scores (respectively 17 +/- 3.9 for MOCI global score, p < 0.01; and 40.3 +/- 11.0 for LOCQ-R, 43.1 +/- 12.0 for LOCQ-I global scores, p < 0.0001) can differentiate between the obsessional patients and the other groups. An overlap between OCD and Major Depression groups was observed on MOCI "doubting" and "slowness" sub-scores. By comparing MOCI and LOCQ global scores with observer-rated scales of obsessive-compulsive behaviour, we found adequate correlations: CPRS-OC (subscale of Comprehensive Psychiatric Rating Scale for Obsessions and Compulsions) (r > 0.5; p < 0.01), CAC (Compulsive Activities Check-list) (r > 0.6; p < 0.01), and global time spent on rituals (r > 0.5; p < 0.01). The total MOCI and LOCQ scores were significantly, but weakly correlated with depression and anxiety measures (r = 0.30-0.49).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Postpartum obsessive compulsive disorder: a case series.

BACKGROUND: The puerperium has typically been a period of risk for the development of psychiatric illness. Although postpartum depressive illness has been discussed extensively in the literature, obsessive compulsive disorder during pregnancy and puerperium has received little attention. METHOD: Fifteen women with new-onset obsessive compulsive symptoms during the puerperium were retrospectively evaluated by chart review; all met DSM-III-R criteria for obsessive compulsive disorder. Distinctive features of their clinical presentation, pharmacotherapy received, and status at 1-year follow-up were recorded. RESULTS: Patients were noted to have a characteristic constellation of symptoms comprised of disabling intrusive obsessional thoughts to harm their babies. Obsessive rituals were not observed in any of the patients described. Patients frequently developed secondary depression and appeared to be exquisitely responsive to serotonin selective reuptake inhibitors. CONCLUSION: The puerperium may be a period of risk for development of new-onset obsessive compulsive disorder. Clinicians caring for puerperal women need to be aware of the impact of these symptoms on maternal and fetal well-being.

Adult↗
PubMed1996

[Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients].

OBJECTIVES: The most common strategy to search for homogenous subgroups of Obsessive-Compulsive Disorder (OCD) patients has been based on the OCD symptoms themselves as a classifying variables. The purpose of this study was to: expand recognition of major clinical OCD subtypes in a large cohort of patients recruited from the national french survey: "Screening-Understanding-Treating OCD"; reproduce preliminary data coming from a US collaborative study on OCD sub-types [Baer L, J Clin Psychiatry, 1994; 55 (3):18-23]. METHOD: From 731 OCD/OCS (OC disorder or syndromes) patients recruited in the phase 1 of the national french survey, complete collected data on the Y-BOCS Symptom Checklist (YBOCS-CL) were obtained in 615 patients and on the OCD spectrum inventory in 646 patients. Principal components analysis (PCA) was firstly applied on major symptom categories of the YBOCS-CL, and next on each individual symptom. Gender effect on clinical aspects of OCD was also explored by comparative descriptive analysis. RESULTS: The first PCA on major symptoms categories confirmed the grouping of all categories in three major factors, named as following: Facteur 1 = "Predominantly Compulsive" (loaded with items of symmetry, order, hoarding, repeting, counting, checking); Facteur 2 = "Predominantly Obsessive" (loaded with aggression, violent, religious, sexual obsessions) and Facteur 3 = "Mixed" (with contamination and somatic obsessions and washing compulsions). Our data seemed to be very close to US collaborative study that had found in a sample of 107 OCD patients, the presence of the same three major clinical factors. The second PCA applied on all YBOCS-CL individual items had provided interesting items groupings, suggesting a reorganization and re-labelling of YBOCS-CL symptoms categories. Therefore, a new presentation of the YBOCS-CL can be proposed with a more clinical relevance than the original version. Results from OC spectrum inventory showed high comorbidity rate with many of OCD related disorders. Finally, a gender influence on OC clinical manifestations was observed, especially more severity and higher rate of difficult OC-subtypes in male patients. The french national survey data on OC symptoms sub-typing and clustering showed a "natural" groupings of OC symptom categories which add more validity to the subtypes proposed by ICD-10 (based on syndromal predominance : obsessions, compulsions or mixed). These sub-categories are not part of the DSM III-R, neither of the new version of DSM IV!

Adult↗
PubMed1997

[Obsessive-phobic disorders in anorexia and bulimia nervosa].

The data on 1500 patients with syndrome of anorexia and bulimia nervosa were summarised in terms of clinical-psychopathological, catamnestic and experimental-psychological investigation. This syndrome was considered as one disease which presented the variation of borderline mental pathology or the manifestation of schizophrenic process. Obsessive-phobic disorders were observed in majority of patients (95%). Such disorders were characterized by prevalence of obsessive phenomena with food content. It was noted that diagnosis and prognostic significance had either obsessive-phobic disturbances or obsessions with other content which occurred on the initial stage of disease, before development of syndrome of anorexia and bulimia and in period of pronounced cachexia. The therapeutic resistance of obsessive disturbances in patients with anorexia and bulimia were emphasized as well as the necessity of prolonged ambulatory treatment of such patients.

Adolescent↗
PubMed1997

Fenfluramine challenge test in obsessive-compulsive disorder--first results.

Obsessive-compulsive disorder is a chronic psychiatric illness, affecting up to 3% of the general population, to the middle of 60-th it was supposed to be untreatable. Antidepressant pharmacotherapy is one of the treatment alternatives today. We compared efficacy and safety of citalopram versus clomipramine (serotoninergic antidepressants) in 6 weeks in double blind therapy of obsessive-compulsive disorder. The second objective was to compare prolactin response to a fenfluramine challenge test before the treatment of patients and after 6 weeks of the treatment. In a sample of 14 patients we confirmed significant therapeutic response after 3 weeks of pharmacotherapy, better in obsession than in compulsion. We found low level of adverse effects in the first week of therapy--dry mouth, anxiety, nausea, somnolence, tremor, and sexual adverse events. There were no changes in the laboratory, test EEG, and ECG examinations. Fenfluramine challenge test showed statistically significant decrease of prolactin levels 1 hour after administration of fenfluramine. It was not observed after six weeks of the therapy. Statistically significant negative correlation between prolactin plasma levels at the 6th hour after administration of fenfluramine and obsession item of YBOC Scale was showed after the 3rd and 6th week of the therapy. The correlation was not observed for compulsion item YBOC Scale. Side effects observed during and after the challenge test were anxiety and nervousness and gastrointestinal problems, lasted from 1 hour to 10 hours. These preliminary result could support the idea, that obsessions and compulsions have not necessary the same biological background. The challenge paradigm appears to be a possible way to clarify the pathogenesis of OCD. Our study will continue.

Adult↗
PubMedDate not supplied

[Self-assessment questionnaire of alcoholic craving (ECCA Questionnaire: Behavior and Cognition in Relation to Alcohol: French translation and validation of the Obsessive-Compulsive Drinking Scale].

Clinical, neurobiological and neuropsychological hypotheses suggest that the dimension of alcohol craving includes the concept of both obsessive thoughts about alcohol use and compulsive behaviors toward drinking. Anton et al. (1995) developed a 14 items self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS) which includes items for assessing three dimensions: global, and the obsessive and the compulsive subdimensions. In this study, we included 156 patients, 105 men and 51 women, who met DSM IV diagnostic criteria for alcohol dependence. The mean age of our population was 39.1 +/- 11.2 years without difference between sexes. We did not found any correlation between the CAGE score and the OCDS total score or the obsessive and compulsive subscores (respectively, r = .15, r = .10 et r = .18). Moreover, we did not found any correlation between OCDS scores and mean daily alcohol consumption (r = .18, r = .16, r = .19). This could indicate that the dimension measured by the scale was somewhat independent of actual drinking. As such, it might act as an independent measure of the "state of illness" for alcohol-dependent patients. The test-retest correlation for the OCDS total score was .95 and the obsessive and compulsive subscales test-retest correlations were .93 and .89 respectively. The internal consistency of the items of the OCDS was high (alpha = .89). Principal component analysis had identified in the french version of the OCDS, three factors accounting for 63.5% of the total variance. These results indicate that the french version of the OCDS seems to validly measure a dimension of alcohol dependence. The ease of administration, reliability, and concurrent validity of the OCDS makes it particularly useful as an outcome measurement tool for various clinical therapeutic protocols in alcoholism.

Adult↗
PubMed2005

Pregnancy-induced obsessive compulsive disorder: a case report.

Pregnancy is a well-recognised risk factor in precipitating obsessive-compulsive disorder. We present and discuss a case with the onset of obsessive-compulsive disorder in the fourth month of gestation, which fully recovered two weeks after delivery. The phenomenology of the observed disorder was similar to earlier reports of obsessive-compulsive disorder in pregnancy, i.e. the obsessions and compulsions were predominantly related to the concern of contaminating the foetus resulting in washing compulsions. Despite the initial success with anti-obsessional drugs, the patient stopped the medication in the last month of gestation. Nevertheless, she fully recovered two weeks after the delivery without any psychiatric intervention. There were no obsessive-compulsive symptoms at one-year follow up. The possible mechanisms involved in the aetiology of this case, and future research directions in understanding the role of pregnancy in OCD are discussed.

Journal Article↗
PubMed2005

Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory--Part 2: Factor analyses and testing of a brief version.

The Obsessive Belief Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III) were designed to assess beliefs and appraisals considered critical to the pathogenesis of obsessions. In previous reports we have described the construction and psychometric properties of these measures. In this study a battery of questionnaires assessing anxiety, depression, and obsessive compulsive symptoms was completed by 410 outpatients diagnosed with obsessive compulsive disorder, 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Items from 6 theoretically derived subscales of the OBQ were submitted to factor analysis. Three factors emerged reflecting (1) Responsibility and threat estimation, (2) Perfectionism and intolerance for uncertainty, and (3) Importance and control of thoughts. A 44-item version (OBQ-44) composed of high-loading items from the 3 factors showed good internal consistency and criterion-related validity in clinical and non-clinical samples. Subscales showed less overlap than original scales. Factor analysis of the III yielded a single factor, suggesting the total score be used in lieu of the 3 rationally derived subscales. The scales performed well on tests of convergent validity. Discriminant validity was promising; hierarchical regression analyses indicated that the OBQ subscales and III generally predicted OC symptoms after controlling for general distress. A revision of the OBQ, the OBQ-44, is included in the appendix

Adult↗
PubMed2006

The structure of childhood obsessions and compulsions: dimensions in an outpatient sample.

While obsessive-compulsive disorder (OCD) is defined as a unitary condition, prior research has identified meaningful and distinct symptom dimensions in adult samples. In contrast, there have been no investigations of symptom dimensions in samples of children diagnosed with OCD. The present study sought to address this gap. Children diagnosed with OCD (n = 137) were administered the Children's Yale-Brown Obsessive-Compulsive Scale symptom checklist and severity index. Symptoms were analyzed using principal components analysis. As with adult samples, four factors were identified from the checklist. However, these four factors (compulsions, sexual/aggressive obsessions, superstitions, and hoarding/ordering/somatic concerns) were different in content from adult studies. Further, several symptoms significantly contributed to more than one dimension. Each dimension was significantly correlated with scores from the severity index, with the exception of the obsession score with the hoarding/ordering/somatic concerns factor. Results suggest that there are distinct dimensions of symptoms in childhood OCD, but that these dimensions do not correspond to those identified in adults. Instead, it appears that some factors share variance, and the dimensions themselves are separated based upon developmental trajectories. The dimensions examined may be useful in future treatment studies using pharmacological and/or behavioral interventions.

Adolescent↗
PubMed2005

The Yale-Brown Obsessive Compulsive Scale: factor analysis, construct validity, and suggestions for refinement.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. Despite its popularity, a number of questions remain regarding the Y-BOCS' psychometric properties including: (a) whether obsessional and compulsive symptoms contribute independently to global OCD severity and (b) whether the Y-BOCS subscales are valid with respect to other measures of OCD. We examined these issues in a sample of 100 patients with a diagnosis of OCD. While our confirmatory factor analyses failed to reproduce any previously reported models of the Y-BOCS factor structure, exploratory factor analysis indicated a two-factor solution that assessed symptom severity (i.e., time, distress, and interference from obsessions and compulsions) as separate from resistance and control of obsessions and compulsions. In contrast to the Resistance/Control Subscale, the Severity Subscale demonstrated good psychometric properties and construct validity. Based on our findings we recommend revisions to scoring the Y-BOCS.

Adult↗
PubMed1998

A cognitive theory of obsessions: elaborations.

The theory that obsessions are caused by catastrophic misinterpretations of one's intrusive thoughts/ images/impulses is elaborated in an attempt to explain the frequency of obsessions and why they persist. The internal and external provocations of obsessions are considered, and an explanatory framework for the varying contents of obsessions is set out. The role and functions of neutralization and inflated responsibility are assessed, and the treatment implications of the theory are described.

Cognition↗