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Influence of age and tic disorders on obsessive-compulsive disorder in a pediatric sample.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with emerging data suggesting that age of onset and/or the presence of tics may define clinically important subgroups. OBJECTIVE: This study set out to evaluate the impact of age and tic disorders on the symptom profile in a pediatric sample of patients with OCD ascertained from a specialty clinic. METHODS: Eighty children with OCD (50 boys, 30 girls) were assessed for symptom type, severity, age of onset, presence of a tic disorder, and functional status. Each child's most impairing obsessions and compulsions were identified and compared by age category (above and below the age of 11 years) and according to the presence or absence of a tic disorder. RESULTS: The mean age of the sample was 11.1 +/- 3.19 years (range 4-18 years). The most common obsessions reported were contamination and worries about harm. Common compulsions included washing and rituals to prevent harm. The only significant differences across age groups were the percentage of religious worries and slightly higher severity of obsessions in the adolescent age group (p < 0.05). The presence of tics was associated with increased frequency of repetitive behavior unrelated to harm avoidance (p < 0.05). Children without a history of tics were more likely to describe incidents of contamination, washing, and repetitive request for reassurance (p < 0.05 for each). CONCLUSION: In this convenient sample of clinically ascertained children, there were few phenotypic differences in children above or below the age of 11 years. Differences in the distribution of OCD symptoms according to the presence or absence of tics, which has been documented in adult samples, were evident in this sample.

Adolescent↗

Obsessions and compulsions in women with postpartum depression.

OBJECTIVE: The quantity, content, and intensity of the obsessions and compulsions of women with postpartum onset major depressive disorder were compared with those of women with major depressive disorder with non-postpartum onset. METHOD: Sequential cases of women with postpartum onset major depression (N = 37) and major depression (N = 28) who presented to our Women's Mood Disorders program were included. Psychiatric examination using DSM-IV criteria and the Inventory to Diagnose Depression established the diagnosis of major depression. Obsessive thoughts and compulsions were reported on the Yale-Brown Obsessive Compulsive Scale and reviewed during the psychiatric examination. Comparisons between groups were performed with chi-square statistics, Fisher exact test and its extensions, and Mann-Whitney U test. RESULTS: Although more women with postpartum onset major depression (N = 21, 57%) than major depression (N = 10, 36%) reported obsessional thoughts, the difference between the groups was not significant (p = .13). However, for women who endorsed obsessions, those with postpartum onset had a higher median number (median = 7) than women without postpartum onset (median = 2, p = .00). Most of the difference in frequency of thoughts was owing to more women with postpartum onset major depression having aggressive thoughts (N = 20, 95%) than women with major depression (N = 6, 60%, Fisher exact p = .03). The most frequent content of the aggressive thoughts for women with postpartum onset major depression was causing harm to their newborns or infants. The presence or number of obsessional thoughts or compulsions was not related to severity of the depressive episode. CONCLUSION: Childbearing-aged women commonly experience obsessional thoughts or compulsions in the context of major depressive episodes. Women with postpartum onset major depression experience disturbing aggressive obsessional thoughts more frequently than women with non-postpartum major depression.

Adolescent↗

Exposure and response prevention in patients with obsessions.

The outpatient treatment of patients with obsessions alone is often said to be less successful compared to the outpatient treatment of patients with both obsessions and compulsive symptoms. This article presents the outcome of the treatment of 26 obsessive patients. The success rate, measured after 10 treatment sessions, was 73%. At follow-up after 12-36 months, improvement appeared to have been maintained or to have increased in 61.5% of the patients, figures comparable to the outcome of patients with both obsessions and compulsions.

Adolescent↗

Fluoxetine treatment of obsessive-compulsive disorder.

Fluoxetine hydrochloride, a new antidepressant, was administered to 10 obsessive-compulsive patients, and the effects of treatment were examined in a single-blind placebo design. The effects of fluoxetine were examined with respect to depressive symptomatology and obsessions and compulsions per se. The results suggest that fluoxetine affected depressive symptoms but also had an effect on self-reported measures of obsessions and ritualistic behavior. Results are discussed in terms of improvement in obsessive-compulsive disorder, the relation of improvement to initial levels of depression, and patients' ability to tolerate the drug.

Adult↗

Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study.

Nineteen children (mean [+/- SD] age, 14.5 +/- 2.3 years) with severe, primary obsessive-compulsive disorder completed a ten-week, double-blind, controlled trial of clomipramine hydrochloride (mean dosage, 141 mg/day) or placebo, each of which was administered for five weeks. Half of the subjects had not responded to previous treatment with other tricyclic antidepressants. There was a significant improvement in observed and self-reported obsessions and compulsions that was independent of the presence of depressive symptoms at baseline. Improvement in obsessive-compulsive symptoms did not correlate significantly with plasma concentrations of the drug or its metabolites. Clomipramine appears to be effective in the treatment of children with obsessive-compulsive disorder and the treatment seems to be independent of an antidepressant effect.

Adolescent↗

Cingulotomy for refractory obsessive-compulsive disorder. A long-term follow-up of 33 patients.

To evaluate the feasibility of cingulotomy as a treatment for patients with intractable obsessive-compulsive disorder, we evaluated the records of all 35 patients with this diagnosis who had undergone one or more such procedures at Massachusetts General Hospital, Boston, during the last 25 years. Retrospectively, all but two of these patients met DSM-III-R criteria for obsessive-compulsive disorder. Six patients were deceased; four by suicide. Questionnaires were sent to the remaining 27 patients with obsessive-compulsive disorder; 17 patients returned the questionnaire and another agreed to an interview without completing the forms. Sixteen of these 18 patients participated in a telephone interview, and patient reports were corroborated by an informant in 10 cases. Despite the presence of some side effects, such as easily controlled seizures (9%) and transient mania (6%), the results of this investigation support the use of cingulotomy as a potentially effective treatment for patients with severe and disabling obsessive-compulsive disorder. With the use of very conservative criteria, we estimated that at least 25% to 30% of the patients benefited substantially from this procedure. Similar results were found in a preliminary prospective study of four patients who recently underwent cingulotomy after state-of-the-art preoperative treatments had failed.

Adult↗

Abnormalities in the regulation of vasopressin and corticotropin releasing factor secretion in obsessive-compulsive disorder.

In light of prior data that the central administration of vasopressin in animals is associated with abnormal persistence of behaviors acquired under aversive conditioning, we studied the secretion of arginine vasopressin into the cerebrospinal fluid and plasma in patients with obsessive-compulsive disorder and controls. Patients with obsessive-compulsive disorder had significantly elevated basal levels of arginine vasopressin in the cerebrospinal fluid and significantly increased secretion of arginine vasopressin into the plasma in response to hypertonic saline administration. Moreover, seven of 12 patients with obsessive-compulsive disorder showed a loss of the normal linear relationship between plasma arginine vasopressin level and osmolality. In addition, cerebrospinal fluid corticotropin releasing hormone, which has synergistic effects with arginine vasopressin centrally and at the pituitary gland, was also significantly elevated in patients with obsessive-compulsive disorder compared with controls.

Adolescent↗

Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder.

BACKGROUND: The new technique of functional magnetic resonance imaging was used to investigate the mediating neuroanatomy of obsessive-compulsive disorder symptoms. METHODS: Ten patients with obsessive-compulsive disorder and 5 normal subjects were studied via functional magnetic resonance imaging during control and provoked conditions. Data analysis entailed parametric and nonparametric statistical mapping. RESULTS: Statistical maps (nonparametric; P < 10(-3)) showed activation for 70% or more of patients with obsessive-compulsive disorder in medial orbitofrontal, lateral frontal, anterior temporal, anterior cingulate, and insular cortex, as well as caudate, lenticulate, and amygdala. No normal subjects exhibited activation in any brain region. CONCLUSIONS: Results of functional magnetic resonance imaging were consistent with past studies of obsessive-compulsive disorder that used other functional neuroimaging modalities. However, paralimbic and limbic activations were more prominent in the present study.

Adult↗

An obsessive-compulsive view of obesity and its treatment.

It was hypothesized that some obese individuals who are obsessed with food and who eat compulsively may not respond to the stimulus control techniques widely used in treating obesity. Sixty-eight participants were administered a measure of obsessive tendencies and randomly assigned to three treatment modalities: (a) Exposure and response prevention; (b) Stimulus control; (c) Control. Results indicated that participants who scored high on the Eating Obsessive Compulsive questionnaire (EOC) maintained weight loss significantly better with exposure and response prevention (ERP) training than did either the stimulus control or the control group. It was concluded that for the obsessive-compulsive eater, ERP training is the treatment of choice.

Adult↗

Factor analysis of obsessive-compulsive disorder YBOCS-SC symptoms and association with 5-HTTLPR SERT polymorphism.

Symptoms defining obsessive-compulsive disorder (OCD) are diverse. Factor analyses of OCD symptoms have been used to evaluate obsessive-compulsive phenotypes that are thought to be more homogenous than the macro phenotype. There is evidence that three factors (symmetry/ordering, obsessions/checking, and hoarding) are familial and preliminary evidence that repetitive rituals are associated with a functional polymorphism in the promotor region of the serotonin transporter gene (5-HTTLPR). The goal of this study was to examine relationships between OCD symptom dimensions and 5-HTTLPR. We genotyped 153 subjects who met DSM-IV criteria for OCD. We used the Yale-Brown obsessive-compulsive scale symptom checklist (YBOCS-SC) to assess OCD symptoms. Using principle components analysis, we derived four factors from the 13 symptom categories of the YBOCS-SC in this patient sample, which replicated previous factor analyses of this scale. The frequencies of the S allele and the SS genotype were associated with the second factor including obsessions regarding symmetry and compulsions involving repeating, counting, and ordering/arranging. This study may contribute to understanding of molecular genetic features underlying the appearance of symptom clusters in OCD.

Adult↗

Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents.

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms.

Adolescent↗

Influence of age of onset on clinical features in obsessive-compulsive disorder.

We compared early-onset and late-onset obsessive-compulsive disorder (OCD) patients in terms of demographic and clinical features. One hundred sixteen outpatients whose primary diagnosis was OCD according to DSM-IV diagnostic criteria were recruited. Early-onset (n=50) and late-onset (n=66) OCD groups were compared with respect to demographic variables and scores obtained on various scales. A male gender predominance was found in early-onset OCD group. Symmetry/exactness obsessions, religious obsessions, hoarding/saving obsessions, and hoarding/collecting compulsions also were significantly more frequent in the early-onset group than in the late-onset group. The results may suggest a phenotypic difference between the two groups. Further studies are needed to investigate the differences between early-onset and late-onset OCD groups to examine the hypothesis that early-onset OCD is a distinct subtype of the disorder.

Adult↗

Yale-Brown Obsessive Compulsive Scale: the dimensional structure revisited.

The factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) has been examined in a number of prior investigations; however, findings have not consistently yielded a stable factor solution. The present study therefore tested the fit of each previously reported factor structure. One hundred thirty-one adults with obsessive-compulsive disorder (OCD) were administered the Y-BOCS; a portion of these participants completed self-report measures of depression and obsessive-compulsive symptoms and were rated on a global impairment index. Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of obsession and compulsion factors. Reliability and convergent validity of these factors were generally satisfactory, although divergent validity was not entirely supported. Implications of these findings on scoring the Y-BOCS are discussed.

Adolescent↗

Reduced short-term obsessive-compulsive symptoms in schizophrenic patients treated with risperidone: a single-blind prospective study.

BACKGROUND: Risperidone is a widely used agent as first-line treatment in schizophrenia with a favorable side-effect profile. However, a number of case reports have suggested an increase in obsessive-compulsive symptoms in patients treated with risperidone. OBJECTIVE: The aim of this study was to investigate the effect of risperidone on obsessive-compulsive symptoms in the treatment of schizophrenia. METHOD: Forty patients with DSM-IV diagnosis of schizophrenia were included in the study. The Yale-Brown obsessive compulsive scale was administered before, at the end of first and second months of treatment. Paired-samples t-test was used to compare the three assessments. RESULTS: There was not an increase, but a significant decrease, in YBOCS scores over time during risperidone treatment (p<0.05). CONCLUSION: In the present study risperidone caused a significant decrease in obsessive-compulsive symptoms in the treatment of schizophrenia.

Adult↗

Using obsessions as reinforcers with and without mild reductive procedures to decrease inappropriate behaviors of children with autism.

We assessed the effectiveness of using the obsessions of children with autism to reduce their inappropriate behaviors. Baseline consisted of a traditional differential reinforcement of other behaviors (DRO) in which food reinforcers were provided contingent upon a period of nonoccurrence of the inappropriate behaviors. Then, three treatment conditions were assessed using a multielement design. One condition provided objects of obsession as reinforcers for periods of nonoccurrence of the inappropriate behaviors. A second condition also provided the obsessions as reinforcers, but in conjunction with mild reductive procedures (verbal "no", time-out). A final condition used the food reinforcers of baseline, but with mild reductive procedures. Results indicated that all three treatment conditions were more effective than the traditional food DRO of baseline. The most effective condition was the obsessions plus mild reductive procedures. Results are discussed in terms of recommendations for effective treatment planning.

Autistic Disorder↗

Insight and alexithymia in adult outpatients with obsessive-compulsive disorder.

OBJECTIVE: To elucidate the relationships between insight and alexithymia in a sample of adult outpatients with obsessive-compulsive disorder (OCD). METHODS: 112 adult outpatients with OCD were tested. Severity of OCD was assessed with the first 10-items of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and score for item # 11 on the Y-BOCS was considered as a measure of insight. Alexithymia was measured with 20-item Toronto Alexithymia Scale (TAS-20). Additional measures were Maudsley Hospital Obsessive Compulsive Inventory (MOCI) and Montgomery Asberg Depression Rating Scale (MADRS). RESULTS: Of the patients, 29.5% showed poor or no insight. Patients with poor or no insight were more alexithymic than patients with excellent, good and moderate insight. TAS-20 total score and subfactors positively correlated with score for item # 11 on the Y-BOCS, severity of OCD and MADRS scores. In stepwise regression model, MADRS scores, factor 3 of TAS-20 (Externally Oriented Thinking), somatic and hoarding-saving obsessions were significantly associated with lower insight. CONCLUSIONS: Results show a relationship between poor or absent insight and high alexithymia levels in OCD patients.

Adult↗

Dissociation and symptom dimensions of obsessive-compulsive disorder. A replication study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a phenotypically very heterogeneous disease with high rates of comorbid psychiatric pathology. Previous studies have indicated that OCD is associated with higher levels of dissociation. The aims of the present study were to replicate and extend previous findings of a significant link between certain OCD symptom dimensions and dissociation. METHODS: The study sample comprised 50 patients with OCD, as confirmed by the Mini International Neuropsychiatric Interview,who had a score of at least 16 on the Yale-Brown Obsessive-Compulsive Scale. All patients were assessed with the short version of the Hamburg Obsessive-Compulsive Inventory and the Dissociative Experience Scale (DES). Correlation analyses and multiple regression analyses were performed to evaluate the relationship between OCD symptom dimensions and dissociation. RESULTS: The checking dimension was most strongly related to dissociation, followed by the symmetry/ordering and obsessive thoughts dimensions. In contrast, no significant relationship was found between dissociation and the washing/cleaning, counting/touching, and aggressive impulses/fantasies dimensions. Multiple regression analyses revealed that: (1) only the checking dimension showed an independent positive correlation with dissociation, and (2) only higher scores on the DES subscale "amnestic dissociation" were associated with higher scores for checking compulsions. CONCLUSIONS: Our results suggest that there might be a specific link between checking behavior and dissociation in OCD. Moreover, checking compulsions seem to be particularly associated with amnestic dissociation. Further studies focusing on amnestic dissociation as a potentially important determinant of checking compulsions are warranted.

Adult↗

Maudsley Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample.

Obsessive-compulsive disorder is increasingly being studied in nonclinical samples. The self-report instruments used to select these samples, however, have not been validated with a diagnostic interview. This study thus investigated the predictive validity of the Maudsley Obsessional-Compulsive Inventory (MOCI) using the Anxiety Disorders Interview Schedule (ADIS), a semi-structured interview created according to DSM-III guidelines. Four sections of the ADIS--generalized anxiety disorder, simple phobia, social phobia and obsessive-compulsive disorder--were administered to 11 individuals who scored in the top 2% and 11 individuals who scored in the normal range of the MOCI 6-7 months prior to the interview. High nonclinical MOCI scorers reported more frequent and severe obsessions and compulsions as well as greater disturbance by these symptoms. In addition, the high MOCI group experienced more general worry and interference from worry, and more frequent and severe physiological symptoms when they worry. However, the two groups did not differ in terms of simple and social phobia symptoms. High MOCI scorers thus did not report a broad range of anxiety symptoms or fears, but specific obsessions and compulsions. These results provide further support for the validity of the MOCI in nonclinical samples over a 6-7 month interval.

Adolescent↗