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PubMed2002

Open trial of cognitive behavior therapy for childhood obsessive-compulsive disorder.

Examined the utility of CBT for childhood obsessive-compulsive disorder (OCD) including a preliminary exploration of predictors of response to this form of treatment. A total of 42 youngsters (mean age 11.8 years, 60% female, 52% on medication at baseline) with DSM-IV OCD were treated openly using a developmentally sensitive treatment protocol based on exposure plus response prevention (ERP). The treatment response rate (CGI < 2) was 79% with a mean decrease from baseline in NIMH global scores of 45%. Response was not related to age, gender, baseline medication status, comorbid symptomatology, or therapist experience. Poorer outcome was associated with more severe obsessions and greater OCD-related academic impairment at baseline. When presented in a developmentally appropriate manner, CBT is a useful treatment for childhood OCD. Controlled trials are needed to provide a more rigorous test of this treatment approach and provide better information regarding potential mediators and moderators of outcome.

Adolescent↗
PubMed1995

The biology of deception: emotion and morphine.

The biology of deception suggests that denial-like processes are at the core of the cognitive coping. In this regard, with cognitive ability, one associates or assumes that this process occurs by way of a 'rational' mind. Such a detailed cognitive process as being rational would also lead, counter intuitively, to inactivity and or major delays in conclusion reaching. Thus, our perceived rationality may also be a deceptive behavioral response. Of equal noteworthyness, man is also 'emotional'. We surmise that emotion represents the pre-cognitive short-cut to overcome this potential for excessive rationality. In this light, we may explain certain psychiatric disorders such as obsessive-compulsive behavior as emotional extremes dealing with cognitive habits used to bind anxiety operating most probably at the pre-cognitive level. Given recent discoveries in neuroimmunology and an understanding of naturally occurring morphine as both an immune and neurological down-regulatory substance we hypothesize that abnormalities associated with emotional extremes may be due, in part, to morphinergic imbalances.

Adaptation, Psychological↗
PubMed2003

Tourette's syndrome following temporal lobectomy for seizure control.

Gilles de la Tourette's syndrome (TS) is a neurobehavioral disorder characterized by multiple motor and vocal tics, occurring longer than a year and causing marked distress along with social and occupational impairments in level of functioning. It can be accompanied by obsessive-compulsive behavior and attention deficit disorder. This report discusses the case of a young woman with a simple motor tic disorder and intractable seizures who, after right temporal lobectomy for medically intractable epilepsy, developed TS with complex motor and vocal tics, severe obsessive-compulsive disorder, and paranoia. This neurobehavioral complication has not to our knowledge been previously reported after epilepsy surgery.

Anxiety↗
PubMed2005

The stalking of public figures: management and intervention.

Public figures are at relatively high risk of unusual contact initiated by fixated individuals. Prior research on managing the threat presented by public figure stalkers concludes that although direct threats rarely precede attacks, there is usually evidence of pre-planning. Furthermore, some public figure attackers do attempt to communicate with their future intended victim prior to attack. Thus, early warning signs from unusual contact behavior can be a powerful tool in threat assessment and risk management. The current paper offers a systematic concept for managing public figure stalking and constitutes five stages: (i) screening, (ii) first analysis, (iii) passive research, (iv) active research and finally (v) considered management strategy. It is concluded that assessment and management of risk are dynamic procedures, requiring ongoing monitoring and flexibility. Furthermore, although different stalkers will engage in ostensibly similar behavior, their motives and underlying psychopathologies may vary considerably. As such, all interventions require individual construction.

Delusions↗
PubMed1999

Influence of family history on clinical expression of Tourette's syndrome.

OBJECTIVE: To determine the influence of family history on clinical expression of Tourette's syndrome (TS). BACKGROUND: Recent studies have suggested that clinical expression of TS is similar among sporadic (SP) and familial patients but may be influenced by bilineal (BIL) transmission of tics or obsessive-compulsive behavior (OCB) in high-density pedigrees. METHODS: The authors used family history methodology, supported by direct examination of affected relatives in 73% of familial patients, to determine the frequency of SP TS, and of unilineal (UNL) and BIL transmission of tics or OCB in 111 consecutively ascertained juvenile TS patients. For individuals in each group, severity of tics, attention deficit hyperactivity disorder (ADHD), and OCB were assessed at presentation and after a mean follow-up interval of 2.6 years, using the Tourette's Syndrome Global Scale and the Clinical Global Impression scales. The phenomenology of OCB was evaluated using the symptom checklist of the Children's Yale-Brown Obsessive Compulsive Scale. RESULTS: The authors documented BIL transmission of tics in seven patients (6%). Patient age and sex were similar for the SP (n = 21; 19%), UNL (n = 66; 59%), and BIL (n = 24; 22%) groups, as was ADHD and tic severity at presentation and follow-up. Severity of OCB differed significantly between groups, with moderate to severe OCB affecting 5% of SP, 12% of UNL, and 37% of BIL patients at presentation (p = 0.007), and 5% of SP, 17% of UNL, and 54% of BIL patients at follow-up (p = 0.0001). Relative to UNL or SP patients, BIL patients were more likely to exhibit self-injurious behaviors (p = 0.0005). CONCLUSIONS: OCB is less prominent in SP than in familial TS, perhaps reflecting a more restricted pathophysiology in this subgroup. Although BIL transmission of tics is relatively infrequent in consecutive TS pedigrees, cotransmission of OCB from an otherwise unaffected parent is common and significantly influences development of OCB and self-injurious behaviors, but not tics, in offspring. Genetic heterogeneity, epigenetic factors, and gene-environment interactions may play a more important role than genetic dosage effects in determining tic severity in TS.

Adolescent↗
PubMed1987

Motor, behavioral and pharmacologic findings in Tourette's syndrome.

We studied 112 patients with Tourette's syndrome (TS); the male-to-female ratio was 3.8, the mean age of onset was 7.3 years, and the average duration of symptoms prior to the initial evaluation was 15.2 years. Seventy-nine percent of the patients had at least one family member with motor or vocal tics, and an additional 10 percent had a family member with marked obsessive-compulsive behavior. Simple motor tics occurred as the presenting symptom in about one-third of patients; one-third had multiple motor tics at the onset, and another third started with vocal tics. During the course of the illness all patients developed multifocal motor tics and 86 percent had vocal tics. Verbal and mental coprolalia was present in 44 percent of the patients. Copropraxia was seen in 19 percent of patients, and both coprolalia and copropraxia were more frequent among the males than expected. Attentional deficit disorder was diagnosed in 36 percent of the patients and 32 percent had obsessive-compulsive personality. Sleep disturbances were reported by 62 percent of the patients and polysomnographs in 34 patients showed motor and vocal tics during all stage of sleep, sleep apnea, abnormal arousal pattern, and other sleep disturbances. Patients with mild symptoms improved with clonidine or clonazepam, but those with more advanced disorder required fluphenazine, pimozide, haloperidol or tetrabenazine.

Adolescent↗
PubMed2005

The problem behavior model: the development of a stalkers clinic and a threateners clinic.

Traditionally, forensic mental health services have focused on the assessment and treatment of offenders with serious mental disorders. In recent years, there has been growing recognition that forensic clinicians have an important role to play for those offenders who engage in criminal acts driven by psychological or/and social problems, which may, or may not, occur in conjunction with a major mental disorder. This is especially true for specific offenses such as stalking and threatening. This article describes the innovation of the problem behavior model. This model uses a reductionist approach and the nexus between psychiatry and psychology to address the complex phenomena associated with specific problem behaviors that often culminate in offenses. The model is illustrated by describing the development of specialist clinics for the problem behaviors of stalking and threatening.

Aggression↗
PubMed2007

The prevalence effect in a laboratory environment: Changing the confidence ratings.

RATIONALE AND OBJECTIVES: We sought to assess whether or not prevalence levels affected the confidence ratings of readers during the interpretation of cases in a laboratory receiver operating characteristic-type observer performance study. MATERIALS AND METHODS: We reanalyzed a previously conducted observer performance study that included 14 readers and 5 different levels of prevalence. The previous study yielded the observation that in the laboratory we could not detect a "prevalence effect" in terms of differences in areas under the receiver operating characteristic curves. The detection ratings (for presence or absence) of lung nodules, interstitial disease, and pneumothorax for the five prevalence levels were compared, and a test for trend in averaged ratings as a function of abnormality prevalence was performed within a mixed-model setting that accounts for different sources of variability and correlations induced by the study design. RESULTS: The ratings of the cases in terms of confidence that the specific abnormality in question is present tend, on average, to be larger when actual disease prevalence is lower. The rate of the increase of the average confidence ratings with the decreasing prevalence of a specific abnormality is very similar for actually positive and actually negative cases for every considered abnormality. The observed trend in the changes of the average confidence ratings as a function of prevalence levels was statistically significant (p < 0.01). CONCLUSION: Expectations of disease prevalence in the case mix during a laboratory observer performance study may systematically affect the behavior of observers in terms of their actual confidence ratings.

Humans↗
PubMed1991

Clinically managing disruptive behavior on the ward.

1. The inability to manage disruptive yelling has lead to the overuse of physical restraints, inappropriate use of psychotropic medications, and provoked feelings of powerlessness, helplessness, and frustration among caregivers that could detract from the overall quality of care. 2. Behavioral analysis provides a framework for caregivers to identify, modify, and develop practical means to alleviate and to monitor a problem. 3. Noisy behavior can become more manageable by combining the effects of improved environment, continuous monitoring and simplification of medication, individualized nursing care, and a sense of creativity. 4. Caregivers need to examine their own feelings and behavior and to understand that they have a responsibility to create an environment in which their clients can respond positively.

Aged↗
PubMed1995

Obsessional harassment and erotomania in a criminal court population.

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.

Adult↗
PubMed2000

Negative family-of-origin experiences: are they associated with perpetrating unwanted pursuit behaviors?

Parental divorce, history of parental relationship separation, perceptions of interparental conflict, and witnessing parental violence were retrospectively assessed in a sample of 213 college students from several regions in the United States, all of whom had suffered an unwanted break-up of an important romantic relationship. This study investigated whether these family-of-origin experiences were associated with perpetrating unwanted pursuit behaviors after the relationship break-up. Results indicated that male participants who had experienced either parental divorce or separation perpetrated more severe unwanted pursuit behavior than males who had not experienced parental divorce or separation or females from either divorced, separated, or intact families. For females, severe unwanted pursuit behavior perpetration was correlated with threatening and intense parental arguments. These findings suggest that a variety of types of negative parental relationship behavior may be risk factors for perpetrating severe unwanted pursuit behaviors. The gender-specificity and implications of these findings are discussed.

Adult↗
PubMed2004

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial.

OBJECTIVE: To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD). METHOD: This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components. RESULTS: By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up. CONCLUSIONS: Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.

Adolescent↗
PubMed1999

Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder.

Obsessive-compulsive disorder (OCD) is one of the most common psychiatric disorders, occurring in 2% to 3% of the U.S. population. Borderline personality disorder is found in 2% of the U.S. population. These disorders denote the endpoints on a spectrum of compulsive and impulsive disorders. One endpoint marks compulsive or risk-aversive behaviors characterized by overestimation of the probability of future harm, highlighted by OCD. The other endpoint designates impulsive action characterized by the lack of complete consideration of the negative results of such behavior, such as borderline and antisocial personality disorders. This article examines studies testing the efficacy of different medications in treating compulsive and impulsive disorders. Mood stabilizers such as divalproex, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients.

Aggression↗
PubMed2003

A clinical interpretation of attitudes and behaviors associated with celebrity worship.

The phenomenon of celebrity worship is currently conceptualized as an abnormal type of parasocial relationship, driven by absorption and addictive elements and which potentially has significant clinical sequelae. The authors hypothesize that the three increasingly extreme sets of attitudes and behaviors associated with celebrity worship also partly reflect the three domains of personality discussed in Eysenckian theory. Specifically, celebrity worship for entertainment-social reasons may reflect extraversion personality traits; intense-personal attitudes and behaviors toward celebrities may reflect neuroticism traits; and celebrity worship of a borderline-pathological nature may reflect psychoticism traits. To test this idea, the authors administered the Celebrity Attitude Scale and the Abbreviated Form of the Revised Eysenck Personality Questionnaire to large convenience samples of students (N = 317) and community (N = 290) respondents. Results indicate that celebrity worship is not an uncommon phenomenon. Further, correlational analyses supported predictions and suggest that Eysenckian domains of personality may promote or hinder a person's progression along the continuum of behaviors associated with celebrity worship.

Adolescent↗
PubMedDate not supplied

Pachydermodactyly in two young girls.

Pachydermodactyly is a benign, superficial fibromatosis frequently observed in young males. We describe the condition in two young girls affected by Ehlers-Danlos syndrome (EDS) and tuberous sclerosis, respectively. We hypothesized that in the patient with tuberous sclerosis, pachydermodactyly is a clinical manifestation of the associated systemic disease, whereas obsessive-compulsive behavior is probably the main cause in the girl with EDS.

Biopsy↗
PubMed2006

Relationship between ghrelin levels, alcohol craving, and nutritional status in current alcoholic patients.

BACKGROUND: Ghrelin is a peptide produced mainly by the gut and hypothalamus. Ghrelin is able to stimulate food-seeking behavior. Alcohol-craving and food-seeking behavior could share common neural circuits. Ghrelin is related to nutritional status, but few data are available in alcoholic patients on the relationship between ghrelin and nutritional disorders. METHODS: Plasma ghrelin was evaluated in 15 current alcoholic male patients compared with 15 healthy male volunteers. Craving was evaluated by the Obsessive-Compulsive Drinking Scale. Body composition was assessed by dual-energy X-ray absorptiometry. Energy substrate utilization was evaluated by indirect calorimetry. RESULTS: Ghrelin was significantly reduced in alcohol-dependent patients with respect to healthy subjects (p=0.0278). A significant positive correlation was found between ghrelin and craving (r=0.55; p=0.034). A preferential utilization of lipids as an energy substrate with a reduction of the fat mass (p=0.01) and an increase of the free fat mass (p=0.0091) was found in alcoholic patients. CONCLUSIONS: Within our sample showing low ghrelin levels probably related to the impaired nutritional status; patients with higher levels of ghrelin showed higher levels of alcohol craving. These preliminary data indicate that ghrelin could be implicated in the neurobiological mechanisms of alcohol craving, other than a hormone influenced by the nutritional status.

Absorptiometry, Photon↗
PubMed2002

Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial.

Anecdotal reports in Tourette's syndrome (TS) have suggested that marijuana (cannabis sativa) and delta-9-tetrahydrocannabinol (Delta(9)-THC), the major psychoactive ingredient of marijuana, reduce tics and associated behavioral disorders. We performed a randomized double-blind placebo-controlled crossover single-dose trial of Delta(9)-THC (5.0, 7.5 or 10.0 mg) in 12 adult TS patients. Tic severity was assessed using a self-rating scale (Tourette's syndrome Symptom List, TSSL) and examiner ratings (Shapiro Tourette's syndrome Severity Scale, Yale Global Tic Severity Scale, Tourette's syndrome Global Scale). Using the TSSL, patients also rated the severity of associated behavioral disorders. Clinical changes were correlated to maximum plasma levels of THC and its metabolites 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) and 11-nor-Delta(9)-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). Using the TSSL, there was a significant improvement of tics (p=0.015) and obsessive-compulsive behavior (OCB) (p = 0.041) after treatment with Delta(9)-THC compared to placebo. Examiner ratings demonstrated a significant difference for the subscore "complex motor tics" (p = 0.015) and a trend towards a significant improvement for the subscores "motor tics" (p = 0.065), "simple motor tics" (p = 0.093), and "vocal tics" (p = 0.093). No serious adverse reactions occurred. Five patients experienced mild, transient side effects. There was a significant correlation between tic improvement and maximum 11-OH-THC plasma concentration. Results obtained from this pilot study suggest that a single-dose treatment with Delta(9)-THC is effective and safe in treating tics and OCB in TS. It can be speculated that clinical effects may be caused by 11-OH-THC. A more long-term study is required to confirm these results.

Adolescent↗