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PubMed2007

Sequential cognitive-behavioral therapy for children with obsessive-compulsive disorder with an inadequate medication response: a case series of five patients.

Few data have been reported on the efficacy of cognitive-behavioral therapy (CBT) for youth with obsessive-compulsive disorder (OCD) who have not responded to prior treatment with medication. Given this, we report an open trial of CBT for children who have remained symptomatic following medication trials. Five children with OCD who had an inadequate response to psychotropic medications (e.g., limited response and/or unable to be titrated to a complete dose due to side effects) received treatment in a 3-week intensive CBT program. Assessments were conducted at baseline and after treatment. All participants were classified as treatment responders (much improved or very much improved) and the severity of clinician-rated OCD symptoms and impairment significantly decreased after the intervention. Although a number of limitations of this preliminary report exist, this study provides preliminary support for the utility of an intensive intervention for youth with OCD who have had an inadequate response and/or adverse side effects.

Adolescent↗
PubMed1999

Cognitive and behavioral changes after unilateral posteroventral pallidotomy: relationship with lesional data from MRI.

We investigated cognitive and behavioral changes after unilateral posteroventral pallidotomy, and their relationship with lesion size and location as identified in magnetic resonance image quantitative analysis. Fifteen consecutive patients with Parkinson's disease were assessed neuropsychologically before and after unilateral posteroventral pallidotomy (five right and 10 left). Immediate postsurgery evaluation (1 week) demonstrated significant worsening of memory, motor learning, motor speed, and verbal fluency. In the 3-month follow up, learning, memory, and speed returned to the presurgical level, but verbal fluency remained below the baseline. Significant improvements were observed in visuospatial functions and obsessive-compulsive behavior. Lesional volume did not correlate with neuropsychologic changes. Left lesions produced more impairment in verbal fluency than right-sided lesions. Regression analysis identified two lesional areas in the pallidum mediale internum. These regions accounted for 68% of the variance in the visuospatial changes.

Aged↗
PubMed2006

Maternal age at the birth of the first child as an epistatic factor in polygenic disorders.

The identification of the genes for complex, polygenic disorders has proven difficult. This is due to the small effect size of each gene and genetic heterogeneity. An additional important factor could be the presence of unidentified epistatic factors. In the broad definition of epistasis, the effect of one unit is not predicable unless the value of another unit is known and one of the units may not be a gene. We have previously identified maternal age as an epistatic factor for the effect of the LEP gene on the age of onset of menarche. We report here the effect of maternal age and the age of the mother at the birth of her first child (maternal age 1st) as epistatic factors for the interaction of the dopamine D1 gene (DRD1) with obsessive-compulsive behaviors and with stuttering. The epistatic effects of maternal age 1st were stronger than maternal age. This type of epistatic factor may be generalizable to many other gene-trait interactions.

Adolescent↗
PubMed1997

The clinical risk management of stalking: "someone is watching over me....".

I have offered ten guidelines for the clinical risk management of stalking: a team approach, personal responsibility for safety, documentation and recording, no initiated contact, protection orders, law enforcement and prosecution, treatment if indicated, segregation and incarceration, periodic violence risk assessment, and the importance of dramatic moments. Although criminal stalking is not expected in mental health practice, the interpersonal anguish that often erupts in psychotherapy, and the reporting of relational intrusions that disrupt the safety of treatment, may foreshadow such distressing and potentially dangerous behavior. It is my hope that the clinician will be prepared for such untoward events, and these guidelines will shape an appropriate professional response. For as Racine wrote in 1667, "The heart that can no longer love passionately, must with fury hate." (Andromache, 1, trans. Robert Henderson).

Anger↗
PubMed2002

Home-based cognitive-behavioral treatment of chronic, refractory obsessive-compulsive disorder can be effective. Single case analysis of four patients.

Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.

Adult↗
PubMed2006

Influence of gender and experience on college students' stalking schemas.

Although stalking has been increasingly recognized as a serious social problem, surprisingly few studies have investigated perceptions of the specific behaviors that comprise stalking. The focus of this article, therefore, was to further delineate college students' stalking schemas and to examine the influence of gender and personal knowledge of stalking on their schemas. Participants judged whether or not a variety of behaviors were examples of stalking. Behaviors were designed to range from mild, somewhat ambiguous, examples of stalking to more severe examples. Results revealed an interaction between gender and experience on ratings of mild stalking behaviors. Men who had personal knowledge of stalking (by having been stalked themselves or knowing someone who had been stalked) were significantly more likely to rate mild stalking behaviors as stalking than men who had no experience. In contrast, experience did not affect women's perceptions of mild stalking, as no differences were found between women as a function of experience. Results are discussed in terms of overall relationship schemas.

Adult↗
PubMed2005

The diverse phenotype and genotype of pantothenate kinase-associated neurodegeneration.

Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal-recessive disorder caused by mutations in the PANK2 gene. The authors report clinical and genetic findings of 16 patients with PKAN. The authors identified 12 mutations in the PANK2 gene, five of which were new. Only nine patients could be classified as classic or atypical PKAN, and intermediate phenotypes are described. Two patients presented with motor tics and obsessive-compulsive behavior suggestive of Tourette syndrome.

Adolescent↗
PubMed2000

Breaking up is hard to do: unwanted pursuit behaviors following the dissolution of a romantic relationship.

This study investigated the prevalence and predictors of unwanted pursuit behaviors among college students. Participants (n = 282) had experienced the termination of a meaningful romantic relationship. Two questionnaires were administered. One assessed unwanted pursuit behaviors that were perpetrated by individuals who had not initiated the relationship breakup (breakup sufferers; n = 120); the other assessed individuals who had initiated the relationship breakup (relationship dissolvers; n = 162). Results indicated that most breakup sufferers had engaged in at least one act of unwanted pursuit (i.e., unwanted phone calls, unwanted in-person conversations) after the breakup. Breakup sufferers were more likely than relationship dissolvers to perceive a positive impact from their unwanted pursuit behavior. Partner-specific attachment experiences and love styles emerged as significant predictors of unwanted pursuit behavior perpetration, according to both victims and perpetrators of unwanted pursuit. However, only victims of unwanted pursuit revealed an association between levels of relationship violence and unwanted pursuit behavior perpetration. Victims also reported that their unwanted pursuit was related to a lack of friendship between themselves and their expartners. In contrast, there was a positive association between feelings of friendship and unwanted pursuit for perpetrators. The implications of these findings and their application to the stalking literature are discussed.

Adolescent↗
PubMedDate not supplied

[Gilles de la tourette syndrome: clinical spectrum and management].

OBJECTIVE: To present the current concepts of the clinical phenomenology and natural history of Gilles de la Tourette syndrome (GTS), differential diagnosis with other involuntary movements, its pathogenesis and current management. DEVELOPMENT: GTS is a disorder characterized by a spectrum of both motor and sonic tics, and a spectrum of behavioral disorders. There is not a biological marker that confirms or refutes the diagnosis of GTS, so this diagnosis remains purely clinical. It has been found to be present in 1 to 3% of school population. An specific cause for GTS is unknown, though most cases appear to occur on an hereditary polygenetic basis. Observations that drugs increasing dopamine neurotransmission, including levodopa and the dopamine receptor agonist pergolide lessen tics, have called into question the dopamine receptor supersensibility hypothesis. The hypothesis proposing basal ganglia and frontostriatal pathways involvement in the pathophysiology of the disorder is the most likely. Frequently, disruption due to tics is overshadowed by comorbid conditions, like obsessive compulsive behaviors, attention deficit hyperactivity disorder, other behavioral disorders and learning disabilities, so the management should be targeted to them. CONCLUSION: The knowledge about the basic mechanisms and the integral definition of the clinical spectrum of tics and neurobehavioral manifestations, and its natural history in a patient with GTS, allow us to establish a more rational approach for management and prognosis

Behavior Therapy↗
PubMed1996

Elevated cerebrospinal fluid corticotropin-releasing factor in Tourette's syndrome: comparison to obsessive compulsive disorder and normal controls.

Stress- and anxiety-related fluctuations in tic severity are cardinal features of Tourette's syndrome (TS), and there is evidence for involvement of noradrenergic mechanisms in the pathophysiology and treatment of the disorder. To examine further the pathobiology of this enhanced vulnerability to stress and anxiety, we measured central activity of corticotropin-releasing factor (CRF) in patients with TS and the related condition, obsessive compulsive disorder (OCD). Lumbar cerebrospinal fluid (CSF) was obtained in a standardized fashion for measurement of CRF from 21 medication-free outpatients with TS, 20 with OCD, and 29 healthy controls. The TS patients had significantly higher levels of CSF CRF than both the normal controls and the OCD patients. However, there was no difference in CSF CRF between the OCD patients and the normal controls. Group differences in CSF CRF were unrelated to current clinical ratings of depression, anxiety, tics, and obsessive compulsive behaviors. Although the functional significance of this finding remains to be elucidated, these results are consistent with the hypothesis that stress-related neurobiological mechanisms may play a role in the pathobiology of TS.

Adolescent↗
PubMed2000

The tonic/phasic model of dopamine system regulation and its implications for understanding alcohol and psychostimulant craving.

All drugs of abuse have been shown to act either directly or indirectly by increasing dopamine neurotransmission within the limbic system. Thus, alcohol has been shown to increase dopamine transmission primarily by activating dopamine cell spike activity, whereas psychostimulants increase dopamine transmission by inhibiting the removal of dopamine from the synaptic space after its release. The spike-dependent release of dopamine that is modulated by drugs of abuse to lead to their rewarding actions has been termed the phasic dopamine response. In contrast, with repeated drug administration, dopamine will also accumulate in the extracellular space of the nucleus accumbens in concentrations too low to stimulate postsynaptic receptors, but of sufficient magnitude to activate dopamine release-inhibiting autoreceptors. In addition, the level of extracellular dopamine is proposed to be under the regulatory influence of cortico-accumbens afferents. This steady-state level of extrasynaptic dopamine has been termed the tonic dopamine response. In this paper it is proposed that several of the aspects of drug addiction, withdrawal and craving associated with the continued use of these drugs can be explained on the basis of their effects on tonic versus phasic dopamine system function. Thus, the increase in tonic dopamine levels that occurs with repeated drug administration would serve to oppose phasic dopamine release via stimulation of dopamine terminal autoreceptors, causing the subject to increase drug administration to restore the phasic response. Moreover, after withdrawal from the drugs, exposure to priming doses of drug or to drug-related stimuli are proposed to increase tonic dopamine levels, again triggering drug-seeking behavior in order to restore balance between the tonic and phasic dopamine systems. Therefore, one consequence of continued drug use is that these parameters of dopamine system function that normally serve to keep the system stable will enter into a new steady-state homeostasis, from which the system is particularly susceptible to destabilizing influences that may precipitate relapse.

Animals↗
PubMed2001

Manual-Driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study.

OBJECTIVE: Concerns about isolation, compromised development, partial pharmacotherapy response, therapist scarcity, and inadequate cognitive-behavioral therapy (CBT) adherence led the authors to adapt a CBT protocol to a group format for adolescents with obsessive-compulsive disorder (OCD). A naturalistic, open trial of group CBT for adolescent OCD is described. The authors predicted symptom improvement and format acceptability. METHOD: Over a 1 -year period, 18 adolescents aged 13 to 17 years with OCD received 14-week group CBT based on March and Mulle's OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual in four consecutive sessions of five to nine patients. Eighty-three percent had undergone at least one medication trial, and 78% had previous CBT experience. RESULTS: OCD symptoms measured by the Children's Yale-Brown Obsessive Compulsive Scale improved significantly, both statistically and clinically. Adolescents consistently shared information and designed exposure interventions for themselves and others during sessions. Repeated self-report measures confirmed adolescents' satisfaction with therapy. CONCLUSIONS: This pilot study demonstrates that a manual-based treatment protocol may be exported for clinical use, adaptable for the end-user's needs, and palatable to adolescent patients. Clinical improvement and patient satisfaction justify further investigation in a controlled study.

Adolescent↗
PubMed1980

Schizophrenia and sexuality: a review and a report of twelve unusual cases--part I.

This review brings together the considerable, scattered literature on the sexuality of the schizophrenic. It encompasses the reports pertaining not only to the overt sexual behavior of schizophrenics but also their subjective experience including various delusions and hallucinations related to sexuality. Also reviewed are the sexual side effects of antipsychotic medication and sexual crimes and perversions occurring among individuals suffering from schizophrenia. The effectiveness of various treatment modalitites, including sex therapy, in controlling the bizarre sexual behavior that often accompanies schizophrenia, is also considered. Twelve unusual cases are also briefly reported. A greater awareness of these "sexual" symptoms of schizophrenia may be utilized to sharpen diagnostic sensitivity to the incipient forms of the disorder, to estimate prognosis in a given case, and to better understand some sexual crimes. In certain cases, such knowledge may alter the choice of antipsychotic medication.

Adolescent↗
PubMed2002

[Stalking--from psychoterror to murder].

Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behavior that leads to the victim's perception of being harrassed and rendered afraid. This paper summarizes relevant aspects of the current stalking concept and reviews its historical development. Furthermore, different typologies of stalking behavior, associated psychiatric diagnoses, frequency and demographic data, therapeutic approaches, and the psychomedical effect on victims are described and discussed. Stalking is not restricted to celebrities but can affect everybody. Members of the medical profession and other socially exposed people are especially potential victims of stalkers. Therefore, information on this topic is necessary in order to deal with it in a professional manner.

Aggression↗
PubMed1998

Serotonin neuronal function and selective serotonin reuptake inhibitor treatment in anorexia and bulimia nervosa.

Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior and weight regulation, and disturbances in attitudes toward weight and shape and the perception of body shape. Emerging data support the possibility that substantial biologic and genetic vulnerabilities contribute to the pathogenesis of AN and BN. Multiple neuroendocrine and neurotransmitter abnormalities have been documented in AN and BN, but for the most part, these disturbances are state-related and tend to normalize after symptom remission and weight restoration; however, elevated concentrations of 5-hydroxyindoleacetic acid in the cerebrospinal fluid after recovery suggest that altered serotonin activity in AN and BN is a trait-related characteristic. Elevated serotonin activity is consistent with behaviors found after recovery from AN and BN, such as obsessionality with symmetry and exactness, harm avoidance, perfectionism, and behavioral over control. In BN, serotonergic modulating antidepressant medications suppress symptoms independently of their antidepressant effects. Selective serotonin reuptake inhibitors (SSRIs) are not useful when AN subjects are malnourished and under-weight; however, when given after weight restoration, fluoxetine may significantly reduce the extremely high rate of relapse normally seen in AN. Nonresponse to SSRI medication in ill AN subjects could be a consequence of an inadequate supply of nutrients, which are essential to normal serotonin synthesis and function. These data raise the possibility that a disturbance of serotonin activity may create a vulnerability for the expression of a cluster of symptoms that are common to both AN and BN and that nutritional factors may affect SSRI response in depression, obsessive-compulsive disorder, or other conditions characterized by disturbances in serotonergic pathways.

Anorexia Nervosa↗
PubMed2001

Influence of treatment of Tourette syndrome with delta9-tetrahydrocannabinol (delta9-THC) on neuropsychological performance.

Previous studies have suggested that marijuana (cannabis sativa) and delta-9-tetrahydrocannabinol (delta9-THC), the major psychoactive ingredient of marijuana, are effective in the therapy of tics and associated behavioral disorders in Tourette Syndrome (TS). Because there is also evidence that cannabis sativa may cause cognitive impairment in healthy users, we performed a randomized double-blind placebo-controlled crossover trial for delta9-THC in 12 adult TS patients to investigate whether treatment of TS with a single dose of delta9-THC at 5.0 to 10.0 mg causes significant side effects on neuropsychological performance. Using a variety of neuropsychological tests, we found no significant differences after treatment with delta9-THC compared to placebo treatment in verbal and visual memory, reaction time, intelligence, sustained attention, divided attention, vigilance, or mood. Only when using the Symptom Checklist 90-R (SCL-90-R) did our data provide evidence for a deterioration of obsessive-compulsive behavior (OCB) and a trend towards an increase in phobic anxiety. However, these results should be interpreted with caution as SCL-90-R has known limitations on measuring OCB. We suggest that the increase in phobic anxiety is mainly due to the fact that a single-dose treatment rules out the possibility of administering the dosage slowly. In contrast to results obtained from healthy marijuana users, a single-dose treatment with delta9-THC in patients suffering from TS does not cause cognitive impairment. We therefore suggest that further investigations should concentrate on the effects of a longer-term therapy of TS with delta9-THC.

Adolescent↗
PubMed2000

Same-gender stalking.

Although stalkers most commonly target victims of the opposite gender, the results of larger and less selective studies suggest that same-gender stalking occurs with greater frequency than formerly thought. This study reviews the exiguous literature on same-gender stalking and presents the findings from a clinical study of 29 same-gender stalking cases that were referred to a forensic psychiatry center. The demographic characteristics, behavior, motivations, and psychopathology of same-gender stalkers are compared with a sample of 134 opposite-gender stalkers. The two groups were similar in many respects, with some discrepancies evident in the prior relationship between victim and stalker, harassment methods, and stalking motives. The impact of same-gender stalking on its victims is examined, and the implications of these findings are discussed.

Adolescent↗
PubMed2006

An examination of sheltered battered women's perpetration of stalking and other unwanted pursuit behaviors.

In the current study, sheltered battered women (n = 105) self-reported whether they had perpetrated stalking or other unwanted pursuit behaviors (e.g., harassment, threat) during relationship separations from their abuser. Results indicated that sheltered battered women who admitted perpetrating stalking behavior (about 25% of the sample) had more self-blame, depression, and a greater tendency to leave the shelter within the first week (45%) than did battered women who did not report perpetrating stalking behaviors. The majority of battered women who reported perpetrating stalking behavior also reported being victimized by stalking behaviors (bidirectional stalking). Although these women reported similarly high levels of fear toward their abuser as did unidirectionally stalked women, bidirectionally stalking women were less likely to perceive that their abuser was using his violence to obtain control over them and were more depressed and self-blaming. Directions for future research, recommendations for shelter staff, and the potential treatment implications of these findings are discussed.

Adaptation, Psychological↗