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PubMed1975

Depression: Predisposing factors.

Factors predisposing to a depressive state had been investigated in a prospective study on a stratified population, accounted for in the preceding article (Nyström & Lindegård (1975a) ). Of the 114 persons seeking psychiatric care during the period of observation, 37 had a depression as the main diagnosis. As compared to their 370 matched controls, these patients showed a significant overrepresentation of psychasthenic traits (subvalidity according to Sjöbring), a tendency to ruminate, shyness in company and lack of endurance, certain asthenic subclinical symptoms such as habitual fatigue and irritability, certain depressive subclinical phenomena, various expressions of anxiousness, all kinds of insomnia, and certain forms of medical care and examinations. The findings can be used for mental hygienic purposes. It can be recommended that the environmental pressure within occupational as well as within private life, should be kept as low as possible, expecially for persons with characteristics shown to indicate mental vulnerability.

Anxiety↗
PubMed1995

Writer's cramp--analysis of 15 cases.

This study includes 15 patients of Writer's cramp. All were male and their age ranged from 21 to 57 years. They were from urban areas and of different occupation. They had obsessional pre-morbid personality. The study showed the prognosis of Writer's cramp after 12 weeks of treatment. This study showed that younger age group with early onset and less obsessional feature improved significantly by drug, psychotherapy and behaviour therapy.

Adult↗
PubMed1991

Spontaneous alternation behavior: an animal model for obsessive-compulsive disorder?

This study entailed the adoption of a well-established behavioral paradigm, spontaneous alternation, as a possible animal model for some of the symptoms observed in obsessive-compulsive disorder (OCD) in humans. Food-deprived rats were run in a T-maze in which both a black and a white goal box were equally baited with a small amount of chocolate milk. Each rat was given 7 trials every other day during which it was placed in the start box and allowed to make a choice. The mean number of choices until an alternation occurred was recorded. After a stable baseline of spontaneous alternation was achieved the effects of manipulating the serotonergic system were tested. Both the nonselective 5-HT agonist 5-MeODMT (1.25 mg/kg) and the more selective 5-HT1A agonist 8-OH-DPAT (2 mg/kg) disrupted spontaneous alternation. A course of chronic treatment (2 x 5 mg/kg for 21 days) with the selective 5-HT uptake blocking agent fluoxetine had a protective effect on the 5-MeODMT-induced disruption of spontaneous alternation behavior. Serotonergic manipulations of spontaneous alternation may be a simple animal model for the perseverative symptoms or indecisiveness seen in people diagnosed with OCD.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMedDate not supplied

Development of behavioral and emotional problems in Tourette syndrome.

Tourette syndrome is a movement disorder with multiple neuropsychiatric features. Using the parent form of the Child Behavior Checklist by Achenbach and Edelbrock, we identified behavioral and emotional difficulties in 78 males, 6-16 years of age, with Tourette syndrome. Symptoms most often identified included obsessive-compulsive behavior, aggressiveness, hyperactivity, immaturity, withdrawal, and somatic complaints. Abnormal checklist scores were most prevalent in adolescents with Tourette syndrome. Tic severity was not a statistically significant predictor of behavioral disturbance, although a suggestive relationship between tic severity and behavioral disturbance was observed in the 12- to 16-year-old group. Dividing Tourette syndrome patients into those with or without hyperactivity failed to identify whether hyperactivity had a major impact on abnormal behaviors. Our results illustrate the relative frequency of psychopathology in Tourette syndrome and emphasize the need for a comprehensive approach to this syndrome.

Adolescent↗
PubMed1999

Cognitive bias in eating disorders: implications for theory and treatment.

Research testing the predictions of cognitive-behavioral theory related to the psychopathology of eating disorders has lagged behind treatment outcome research. Central to cognitive theories of eating disorders is the hypothesis that beliefs and expectancies pertaining to body size and to eating are biased in favor of selectively processing information related to fatness/thinness, dieting, and control of food intake or body weight. In recent years, controlled investigations of the predictions of cognitive theories of eating disorders have yielded empirical support for these theories. This paper reviews research which has tested the predictions of cognitive-behavioral theory and discusses the implications of these findings for the treatment of eating disorders. Understanding of information processing biases may assist the clinician in understanding a range of psychopathological features of anorexia and bulimia nervosa, including denial, resistance to treatment, and misinterpretation of therapeutic interventions.

Attitude↗
PubMed2026

Sequential rTMS for MDD and OCD in a patient with left parietal perinatal ischemic infarct: a case report.

Major depressive disorder (MDD) commonly co-occurs with obsessive-compulsive disorder (OCD), resulting in greater symptom severity, functional impairment, and suboptimal response to standard pharmacologic and psychotherapeutic interventions. These challenges underscore the need for neuromodulation strategies to target distinct neural networks implicated in mood regulation and compulsivity. This report describes outcomes of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC), and low-frequency (LF) rTMS of the right orbitofrontal cortex (OFC), in a patient with comorbid MDD, OCD, and a left parietal perinatal ischemic infarct. Over the course of treatment, serial psychometric assessments demonstrated progressive reductions in frequency and intensity of depressive symptoms, anxiety, and obsessive-compulsive behaviors, measured via Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This case adds to the growing body of literature demonstrating efficacy of DLPFC and OFC stimulation for depression and OCD. Further large-scale, blinded, and randomized trials are warranted to examine the efficacy of sequential DLPFC and OFC stimulation for comorbid MDD and OCD compared with single-site DLPFC stimulation.

dorsolateral prefrontal cortex (DLPFC)↗
PubMed1992

Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies.

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.

Attitude to Health↗
PubMed2005

A randomized controlled trial of Japanese patients with obsessive-compulsive disorder--effectiveness of behavior therapy and fluvoxamine.

BACKGROUND: The aim of this study was to confirm and compare the efficacy of fluvoxamine (the only licensed SSRI for treatment for OCD in Japan) and behavior therapy in treating Japanese patients with OCD. In addition, we investigated predictors of these treatments. METHODS: Thirty-one outpatients meeting the DSM-III-R criteria for OCD without any axis I disorder were randomly assigned to one of three treatment conditions: BT (behavior therapy +/- pill placebo), FLV [autogenic training (a psychological placebo for OCD) +/- fluvoxamine] and control group [autogenic training (psychological placebo) +/- pill placebo] for 12 weeks of treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression-Improvement Scale (CGI-I) were administered blindly at baseline and week 4, 8 and 12. RESULTS: Twenty-eight patients completed this study. Patients in the BT and FLV groups showed significantly more improvement than those in the control group in the mean score of total Y-BOCS; moreover, the BT group showed significantly more reduction in total Y-BOCS score at the end of treatment than the FLV group (BT > FLV, p < 0.01). Patients with lower baseline total Y-BOCS, past history of a major depressive episode and absence of cleaning compulsion improved more with fluvoxamine. CONCLUSIONS: We confirmed the effectiveness of behavior therapy and fluvoxamine for Japanese patients with OCD. Behavior therapy improved the condition of OCD patients more than fluvoxamine.

Adolescent↗
PubMedDate not supplied

The effects of prenatal cocaine exposure on reversal learning using a simple visual discrimination task in rhesus monkeys.

The purpose of this research was to determine if adult animals that were exposed to cocaine prenatally would be able to adapt to changes in the rules of reinforcement for a simple discrimination task. Treatment groups included 0.0, 1.0, and 3.0 mg cocaine/kg/day and an escalating-dose group that began treatment at 3.0 mg cocaine/kg/day, after which the dose was increased by 0.5 mg cocaine/kg/day every 2 weeks throughout the pregnancy. All animals performed a color and position discrimination task for food reinforcers for approximately 6 years before the present study. For this task, subjects were presented with colored stimuli that determined the correctness of subsequent position choices: left for red or yellow and right for blue or green. At 7 years of age, the rules for obtaining reinforcement were reversed. Animals exposed to all doses of cocaine showed impaired reversal performance. Further, animals exposed to the escalating doses of cocaine continued to show this impairment for over 285 sessions (about 21/2 years). The number of sessions required by subjects to master these contingency changes indicated that, using a task with which they have an extensive history, cocaine-exposed animals have greater difficulty in adapting to important changes in their environment.

Age Factors↗
PubMed1981

Current therapeutic options in the management of typical anxiety.

Anxiety is a frequent symptom seen in a variety of clinical settings. Recognizing that therapeutic interventions (including drugs) can be costly and may involve potential risks, treatment of anxiety should proceed with some care. As outlined in Table 3, the first step is to establish a diagnosis, determining whether the anxiety is secondary to primary medical or psychiatric disorders. The remaining significant anxiety states fall into acute situational disturbances (best treated with benzodiazepines on a short-term basis) and the primary anxiety disorders. In each case, counseling or psychotherapy may be appropriate. Treatment of primary anxiety disorders is probably best accomplished by a combination of behavior interventions and, when necessary, temporary use of psychotropic drugs. The specific behavior intervention varies with the disorder (Table 6) and ranges from systematic desensitization or immersion techniques (for phobias) to thought stopping or aversion relief (for obsessive-compulsive behavior) to paradoxical intention (for panic disorders). Temporary use of tricyclic antidepressants or MAO inhibitors (probably equally effective) should be considered in the major anxiety disorders when panic attacks become frequent or subjective anxiety levels become intolerably high. Treatment of situational anxiety usually rests with counseling. When functioning is impaired, benzodiazepines can be most helpful as antianxiety agents or as hypnotics (e.g., flurazepam) for periods not to exceed 2-3 weeks.

Adrenergic beta-Antagonists↗
PubMed2006

The normalcy of neurosis: evolutionary origins of obsessive-compulsive disorder and related behaviors.

One of the most curious questions plaguing subscribers of evolutionary theory is how natural selection's fine-tuned editing function could allow disease to persist. For evolutionary psychiatrists, the existence of psychopathology is thus perplexing. To illustrate a potential answer to one instance of this broad question, we examine the correlates of obsessive-compulsive disorder (OCD) within our normal repertoire of thought and action. The evidence presents a picture of OCD as a dysregulation of normal behaviors and mental states throughout the course of human development. We speculate that such correspondence may be more than a coincidence and that OCD is a consequence of a dysregulation of the neural circuits that are crucially involved in threat detection and harm avoidance. These neural systems are also likely to underlie aspects of religious experience and ritual as well as the wonders of romantic and early parental love.

Animals↗
PubMed2005

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: long-term follow-up and predictors of outcome.

OBJECTIVE: The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome. METHOD: Undertaken at a university-based clinic, this study involved 48 participants (8-19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome. RESULTS: Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome. CONCLUSIONS: The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis.

Adolescent↗
PubMed2006

What can we learn from the first community-based epidemiological study on stalking in Germany?

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in continental European countries. The authors published the first community-based epidemiological study on stalking in Germany. The purpose of this paper is to discuss possible implications of these epidemiological data for the mental health system, forensic psychiatry and legal regulations in Germany. For these reasons some data of our epidemiological study are outlined and reanalyzed. To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims and the impact of stalking on current psychological well-being in a German community sample, a postal survey was conducted with 2000 inhabitants randomly selected from Mannheim (response rate 34.2%, n=679). The survey included a stalking questionnaire and the WHO-5 well-being scale. Almost 12% of the respondents reported having been stalked. This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health were significant and there was a high rate of physical (31%) and sexual (19%) violence in the context of stalking. Our data suggest that the phenomenon deserves more attention in future forensic psychiatric research and practice. Implications for forensic psychiatric assessment and treatment of stalkers as well as for management of stalking victims are discussed.

Adolescent↗
PubMed1998

FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder.

In subjects with obsessive-compulsive disorder (OCD), lower pre-treatment metabolism in the right orbitofrontal cortex (OFC) and anterior cingulate gyrus (AC) has been associated with a better response to clomipramine. We sought to determine pre-treatment metabolic predictors of response to behavioral therapy (BT) vs. pharmacotherapy in subjects with OCD. To do this, [18F]fluorodeoxyglucose positron emission tomography scans of the brain were obtained in subjects with OCD before treatment with either BT or fluoxetine. A Step-Wise Variable Selection was applied to normalized pre-treatment glucose metabolic rates in the OFC, AC, and caudate by treatment response (change in Yale-Brown Obsessive-Compulsive Scale) in the larger BT group. Left OFC metabolism (normalized to the ipsilateral hemisphere) alone was selected as predicting treatment response in the BT-treated group (F = 6.07, d.f. = 1,17, P = 0.025). Correlations between normalized left OFC metabolism and treatment response revealed that higher normalized metabolism in this region was associated with greater improvement in the BT-treated group (tau = 0.35, P = 0.04), but worse outcome (tau = -0.57, P = 0.03) in the fluoxetine-treated group. These results suggest that subjects with differing patterns of metabolism preferentially respond to BT vs. medication.

Adult↗