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PubMed2006

Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome.

OBJECTIVE: A significant number of patients with obsessive-compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. METHOD: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. RESULTS: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. CONCLUSION: Our results strongly indicate that in-patients with obsessive-compulsive hoarding respond poorly to CBT.

Adult↗
PubMed2003

Stress situation reveals an association between perfectionism and drive for thinness.

OBJECTIVE: Several theorists have hypothesized that stress situations may trigger abnormal eating and even eating disorders in individuals with a perfectionistic personality. The purpose of this study was to assess whether a stress situation would reveal an association between perfectionism and measures of eating disorders among female high school students. METHODS: A sample of 42 female high school students completed the Multidimensional Perfectionism Scale and the Eating Disorder Inventory three times: on an average school day, on the day of an examination, and on the day they received the evaluation of the examination. Linear regression analysis was calculated to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Body Dissatisfaction was associated with perfectionism on all the three occasions, whereas Drive for Thinness was associated with perfectionism only on the day the students received the results of the examination. DISCUSSION: The results suggest that among nonclinical female individuals, stress may make significant a previously absent association between perfectionism and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in individuals with a perfectionistic personality.

Adolescent↗
PubMedDate not supplied

Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia.

The impact of concurrent axis I diagnoses and axis II traits on the efficacy of a 22-session exposure-based treatment program for 43 outpatients with panic disorder and agoraphobia (PDA) and 63 with obsessive-compulsive disorder (OCD) was examined. Trained interviewers used the Structured Clinical Interview for DSM-III-R (SCID) to assess axis I diagnoses and the SCID-II to identify the number of axis II criteria met for anxious, dramatic, and odd clusters. Among axis I diagnoses, secondary major depressive disorder (MDD), dysthymia, social phobia, and generalized anxiety disorder (GAD) were present in sufficient numbers to study their effects on treatment outcome. Outcomes were assessed on self-rated target fears and functioning and on a behavioral avoidance test at post-treatment and at 6 months follow-up. Only GAD comorbidity predicted dropout, whereas MDD and all three personality cluster traits predicted post-treatment outcomes. Follow-up analyses showed significant effects of MDD and GAD, but axis II cluster criteria were not predictive.

Adolescent↗
PubMed2006

A randomized clinical trial of cognitive-behavioral group therapy and sertraline in the treatment of obsessive-compulsive disorder.

BACKGROUND: Cognitive-behavioral group therapy (CBGT) and serotonin reuptake inhibitors have proven efficacy in reducing symptoms of obsessive-compulsive disorder (OCD). There is no consensus about which of these forms of treatment is more effective. This study was conducted to evaluate the efficacy of CBGT as compared to that of sertraline in reducing OCD symptoms. METHOD: Fifty-six outpatients with an OCD diagnosis, according to DSM-IV criteria, participated in the randomized clinical trial: 28 took 100 mg/day of sertraline and 28 underwent CBGT for 12 weeks. Efficacy of treatments was rated according to the reduction in scores on the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the Clinical Global Impressions-Severity of Illness scale. The trial was performed in 4 successive periods from March 2002 to December 2003. RESULTS: Both treatments were effective, although patients treated with CBGT obtained a mean YBOCS reduction of symptoms of 44%, while those treated with sertraline obtained only a 28% reduction (p = .033). Cognitive-behavioral group therapy was also significantly more effective in reducing the intensity of compulsions (p = .030). Further, 8 patients (32%) treated with CBGT presented a complete remission of OCD symptoms (YBOCS score < or = 8) as compared to only 1 patient (4%) among those who received sertraline (p = .023). CONCLUSION: Cognitive-behavioral group therapy and sertraline have shown to be effective in reducing OCD symptoms. Nevertheless, the rate of symptom reduction, intensity reduction of compulsions, and percentage of patients who obtained full remission were significantly higher in patients treated with CBGT.

Adult↗
PubMed1984

Abnormal dexamethasone suppression test in primary obsessive-compulsive patients: a confirmatory report.

The dexamethasone suppression test (DST) was administered after baseline cortisol measurements in 20 patients (10 males, 10 females) who met DSM-III criteria for obsessive-compulsive disorder (OCD). Six patients (30%) showed an abnormal escape from dexamethasone suppression. DST suppressors vs. DST nonsuppressors showed no differences on age, rate of secondary depressive disorders, or scores on the Hamilton Rating Scale for Depression, the Minnesota Multiphasic Personality Inventory D scale, or OCD rating scales. Surprisingly, there was a trend for suppressors to have a stronger family history of depressive disorders, and for nonsuppressors to include an excess of male subjects. Moreover, there was a significant correlation between levels of cortisol before and after DST. In five of six nonsuppressors, both depressive symptoms and obsessive-compulsive behaviors showed a diminution in response to antidepressant therapy combined, in one case, with intensive behavior therapy. The relationships between OCD and endogenous depression, as well as the specificity of the DST, are discussed.

Adolescent↗
PubMed2006

Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status.

An interactive model of perfectionism, perceived weight status, and self-efficacy was tested on 406 women to predict the bulimic symptoms of binge eating and inappropriate compensatory behaviors separately. This longitudinal study assessed hypothesized vulnerabilities of high perfectionism and low self-efficacy and the stressor of feeling overweight at Time 1 and then gathered weekly assessments of binge eating, vomiting, laxative use, fasting, and diet pill use for 11 weeks. As predicted, results showed that perfectionism, weight perception, and self-efficacy interacted to prospectively predict binge eating. In particular, women high in perfectionism who felt they were overweight and who had low self-efficacy reported the most number of weeks of binge eating. This interactive model did not predict inappropriate compensatory behaviors. Future directions and clinical implications are discussed.

Adolescent↗
PubMed2005

"Frontal variant Alzheimer's disease": a reappraisal.

Two cases of clinically diagnosed sporadic Alzheimer's disease with early and prominent behavioural features (social disinhibition, emotional blunting, stereotyped verbal utterances) sufficient to prompt an initial diagnosis of frontotemporal dementia are presented. It is suggested that the term "frontal variant AD" be used for this clinically defined phenotype, which has also been described in cases of inherited AD associated with certain presenilin-1 gene mutations. This differs from previous usage of the term "frontal variant AD" to describe AD with predominant frontal lobe neuropathological change (although the clinical phenotype may reflect regional distribution of pathology), but parallels the clinical definition of visual agnosic, aphasic and apraxic presentations of AD. The proposed usage would also emphasise differential diagnosis.

Alzheimer Disease↗
PubMed2001

Predicting violent behavior in stalkers: a preliminary investigation of Canadian cases in criminal harassment.

This study examined the factors associated with violent/aggressive behavior in stalkers using a sample of 100 Canadian cases of persons charged with criminal harassment (more commonly known as stalking). Results revealed that the typical profile of a "simple obsessional" type of stalker was a middle-aged male, single or separated/estranged, with a history of emotional and/or anger management problems. The most common initial strategies used by the victims to cope with the stalkers were oriented towards legal resources. Initial legal remedies, including court orders or police warnings, seemed to be ineffective as a strategy to stop stalking given that most stalkers chose to ignore them. The study also provided partial support for a preliminary model of predictors of violent/aggressive behavior in stalkers. Stalkers with previous violent behaviors, strong negative emotions. and obsessional tendencies toward the victim may be most at risk of future violent and aggressive acts.

Adolescent↗
PubMed1987

Methylphenidate in primary obsessive-compulsive disorder.

An acute methylphenidate challenge was performed on 13 patients with primary obsessive-compulsive disorder. There was no overall effect of methylphenidate on mood or obsessive-compulsive behavior. However, on various behavioral scales, four patients had an antiobsessive-compulsive response and one patient an antidepressant response to methylphenidate. The clinical and theoretical implications of these findings are discussed.

Adult↗
PubMed2005

Psychostimulant-induced behavior as an animal model of obsessive-compulsive disorder: an ethological approach to the form of compulsive rituals.

Rats treated chronically with the D2/D3 dopamine receptor agonist quinpirole show a pattern of behavior that meets a set of ethologically derived criteria of compulsive behavior in obsessive-compulsive disorder (OCD). Moreover, in both quinpirole-treated rats and OCD patients, the structure of compulsive rituals appear similar in being composed of relatively few motor acts that are organized in a flexible yet recurrent manner. In addition, the development of compulsive behavior in quinpirole-treated rats is attenuated by the OCD pharmacotherapeutic drug clomipramine. These similarities support the validity of quinpirole-treated rats as a psychostimulant-induced animal model of OCD. Considering that the induction of compulsive behavior in the rat model involves chronic hyperstimulation of dopamine receptors, this raises the possibility that dopaminergic mechanisms may play a role in OCD, at least in some subtypes of this disorder.

Animals↗
PubMed1999

Family accommodation of obsessive-compulsive symptoms: instrument development and assessment of family behavior.

Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study's purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives' own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient's clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.

Adaptation, Psychological↗
PubMed2006

Examining exercise dependence symptomatology from a self-determination perspective.

Background Pulling from Self-Determination Theory (SDT; Deci & Ryan, 1985), this study examined whether individuals classified as 'nondependent-symptomatic' and 'nondependent-asymptomatic' for exercise dependence differed in terms of reported levels of exercise-related psychological need satisfaction, self-determined versus controlling motivation and exercise behavior. In addition, we examined the type of motivational regulations predicting exercise behavior among these different groups, and their role as mediators between psychological need satisfaction and behavioral outcomes. Methods Participants (N = 339) completed measures of exercise-specific psychological need satisfaction, motivational regulations, exercise behavior and exercise dependence. Results Nondependent-symptomatic individuals reported higher levels of competence need satisfaction and all forms of motivational regulation, compared to nondependent-asymptomatic individuals. Introjected regulation approached significance as a positive predictor of strenuous exercise behavior for symptomatic individuals. Identified regulation was a positive predictor of strenuous exercise, and completely mediated the relationship between competence need satisfaction and strenuous exercise behavior, for asymptomatic individuals. Conclusions The findings reinforce the applicability of SDT to understanding the quantity and quality of engagement in exercise.

Adolescent↗
PubMed1977

Use of EMG biofeedback in behavioral treatment of an obsessive-phobic-depressive syndrome.

A 25 year old woman who suffered from depression (associated with obsessive, phobic thoughts of animal abuse or neglect) was treated with systematic desensitization in which EMG biofeedback was used to achieve relaxation. EMG responses were also used to aid both the therapist and the patient in the pairing of hierarchical imagery and muscular relaxation during desensitization, EMG responses were particularly useful in detecting rising muscular tension, indicating when visualization of a depression-provoking situation should be terminated. Ratings concerning frequency and intensity of depressive thoughts (made by the patient before and after therapy), as well as 6-month follow-up information, attest to the success of the therapeutic program.

Adult↗
PubMed1993

Combined dopamine and serotonin agonists: a synergistic approach to alcoholism and other addictive behaviors.

Successful phentermine and racemic fenfluramine treatment of 150 obese patients led to the use of this therapy in 12 alcoholic patients. Eleven of 12 consecutive patients, most within hours, reported a total loss or marked decrease in alcohol craving. Their reported consumption of alcohol ceased or decreased markedly. The hypothesis is proposed that this treatment is successful because of the dual and balanced increase in the bioavailability of the neurotransmitters, dopamine and serotonin, in the nucleus accumbens. The prospect is raised that cocaine, nicotine, narcotic, and amphetamine addiction, as well as various presentations of obsessive compulsive behavior, may also respond to dual aminergic agonists. The need for controlled studies to confirm these findings is clear.

Adult↗
PubMed1975

Superego factors in alcoholics.

This paper discusses superego fixations and regressions that predispose to and are caused by alcoholism. Two continua of superego functioning are explored, (1) the extent of internalization vs. externalization and (2) regulation of behavior vs. self-castigation. The superego constellations in guilty, binge, sociopathic, and deteriorated alcoholics are delineated to explain the interaction of a treatment program with these patients.

Alcohol Drinking↗
PubMed1998

The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder.

The present study investigated the relationship of depression, self-esteem, somatization, and obsessive-compulsive disorder to the incidence of body dysmorphic disorder (BDD). Female (n=83) and male (n=25) undergraduates completed measures of body esteem, self-esteem, obsessive-compulsive behavior, and somatization. Subjects were also screened for eating disorders utilizing the DSM-IV criteria for such in an effort to control for anorexia and bulimia. Upon excluding those subjects who met the criteria for eating disorders, the final sample included 78 females and 24 males. The results indicated that lower body esteem scores were linked with lower levels of self-esteem but with higher levels of obsessive-compulsive tendencies, depressive tendencies, and somatization tendencies. The findings are discussed with regard to the need for more accurate measures of body dysmorphic disorder, as well as etiology and future treatment implications.

Adolescent↗
PubMed1998

Obsessive-compulsive disorder in children and adolescents.

Significant progress has occurred over the past 10 years in the understanding and treatment of obsessive-compulsive disorder. With the recognition that one half to one third of adults experience onset of the disorder in childhood and adolescence, early identification and treatment of the disorder become essential to reduce potential long-term ramifications. Models for etiopathogenesis suggest a neuropsychiatric disorder and are supported by identification of an immune-related subtype, association with other neurological diseases, brain-imaging studies, and peripheral blood findings. Pharmacological and behavioral treatments have been shown to have efficacy in reducing compulsive behaviors and obsessive thoughts. Although treatable, many children have only a partial response. Based on the current child and adolescent literature, an overview of childhood obsessive-compulsive disorder is presented.

Adolescent↗