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PubMed2005

Frontal-striatal dysfunction during planning in obsessive-compulsive disorder.

BACKGROUND: Dysfunction of frontal-striatal, particularly orbitofrontal-striatal, circuitry has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD), characterized by obsessions, ritualistic behavior, anxiety, and specific cognitive impairments. In addition, neuropsychological studies in OCD have reported impairments in visuospatial tasks and executive functions, such as planning. OBJECTIVE: To determine whether dorsal prefrontal-striatal dysfunction mediates planning impairment in patients with OCD. DESIGN: A parametric self-paced pseudorandomized event-related functional magnetic resonance imaging version of the Tower of London task was used in 22 medication-free patients with OCD and 22 healthy control subjects. This paradigm, allowing flexible responding and post hoc classification of correct responses, was developed to compare groups likely to differ in performance. RESULTS: Behavioral results showed significant planning impairments in OCD patients compared with control subjects. During planning, decreased frontal-striatal responsiveness was found in OCD patients, mainly in dorsolateral prefrontal cortex and caudate nucleus. In addition, OCD patients showed increased, presumably compensatory, involvement of brain areas known to play a role in performance monitoring and short-term memory processing, such as anterior cingulate, ventrolateral prefrontal, and parahippocampal cortices. CONCLUSIONS: These findings support the hypothesis that decreased dorsal prefrontal-striatal responsiveness is associated with impaired planning capacity in OCD patients. Because the described frontal-striatal dysfunction in OCD is independent of state anxiety and disease symptom severity, we conclude that executive impairment is a core feature in OCD.

Adult↗
PubMed2006

Family-based association study of TPH1 and TPH2 polymorphisms in autism.

The TPH1 and TPH2 genes encode the rate-limiting enzymes that control serotonin biosynthesis, and serotonin is clearly altered in autism. In the current study, eight SNPs in the TPH1 gene region and eight SNPs within the TPH2 gene were examined by family-based association tests in a large cohort of 352 families with autism and in clinically defined subsets of these families with either severe obsessive-compulsive behaviors (sOCB) or self-stimulatory behaviors (SSB). We found no evidence for association between autism and single SNPs or haplotypes of the TPH1 and TPH2 genes in the cohort of all families or in the sOCB and SSB subsets. In particular, we failed to replicate the association between autism and variants of the TPH2 gene, rs4341581 (TRANSMIT P = 1; PDT P = 0.323; FBAT P = 0.446) and rs11179000 (TRANSMIT P = 0.174; PDT P = 0.293; FBAT P = 0.374). Furthermore, no evidence for linkage was observed between autism and SNPs in the TPH1 and TPH2 genes (although linkage at the TPH2 locus was observed in the SSB subset). Thus, it appears unlikely that the TPH1 and TPH2 genes play a significant role in the susceptibility to autism or to autism endophenotypes including sOCB and SSB.

Autistic Disorder↗
PubMed2001

Possible serotonin syndrome associated with clomipramine after withdrawal of clozapine.

OBJECTIVE: To report on the possible development of serotonin syndrome in a patient receiving clomipramine after clozapine was withdrawn from the treatment regimen. CASE REPORT: A 44-year-old white man with a 23-year history of undifferentiated schizophrenia and obsessive-compulsive behavior had been treated with clozapine and clomipramine for several years. He tolerated both agents together well, with the exception of experiencing chronic constipation. Clomipramine was tapered and reduced to 50 mg over a period of 10 days. A worsening of ritualistic behavior was noted, and the clomipramine dosage was increased to 150 mg/d over 14 days. Simultaneously with the clomipramine dosage increase, clozapine was tapered and stopped ever a period of 19 days. The day after clozapine was stopped, while he was still receiving clomipramine 150 mg/d, he began behaving oddly, started sweating profusely, shivering, and became tremulous, agitated, and confused. He was diagnosed with possible serotonin syndrome; his symptoms resolved after clomipramine was stopped but before clozapine was restarted eight days later. DISCUSSION: There are similarities in symptoms between serotonin syndrome and clozapine withdrawal. This article discusses the reasons why this case may represent serotonin syndrome rather than clozapine withdrawal and the possible pharmacologic mechanisms involved. CONCLUSIONS: Clinicians should be aware that removing a serotonin-2a (S-HT2a) antagonist 1mm a treatment regimen including an agent that increases serotonin in the synaptic cleft may worsen clozapine withdrawal or potentially result in serious adverse drug reactions, such as serotonin syndrome.

Adult↗
PubMed1997

A Tourette-like syndrome following cardiopulmonary bypass and hypothermia: MRI volumetric measurements.

We present the case of an adolescent boy who developed a variety of simple and complex motor and vocal tics (Tourette-like syndrome), along with inattentiveness and obsessive-compulsive behaviors after cardiac surgery with cardiopulmonary bypass and profound hypothermia. A single photon emission computed tomography study 2 months after surgery showed reduced uptake in the left hemisphere and 2 years later a perfusion defect in the basal ganglia. Serial magnetic resonance imaging (MRI) studies were normal. Volumetric MRI studies were obtained 4 years after surgery and compared with published values for normal individuals and children with Tourette syndrome (TS), including subsets matched for age, sex, and handedness. Measurement of basal ganglia structures showed a right-dominant asymmetry of the caudate and putamen, in part similar to findings previously reported in patients with TS. Other volumetric abnormalities included a > 2-SD reduction of cortical gray matter, a small decrease of total cerebral volume, and increase in cerebral white matter. Although a variety of neurological problems may occur after cardiopulmonary bypass, to our knowledge this case represents the first report of a chronic tic disorder following cardiac surgery with cardiopulmonary bypass and hypothermia.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Personal standards and evaluative concerns dimensions of "clinical" perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003).

Shafran, Cooper, and Fairburn (2002, 2003) provided a cognitive-behavioral analysis of "clinical" perfectionism, a construct they considered to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation. They argued against a multidimensional perspective to studying perfectionism. We respond to Shafran et al. (2002, 2003) and Hewitt, Flett, Besser, Sherry, and McGee's (2003) reply to Shafran et al. (2002) by considering the theoretical, empirical, and clinical implications of findings identifying two higher-order dimensions of perfectionism reflecting personal standards (PS) and self-critical evaluative concerns. Analyses of data from two diverse study groups, a college student sample (N = 527) and a clinical sample of patients with binge eating disorder (N = 236), revealed that self-criticism accounts for the relation between perfectionism measures and depressive, anxious, and eating disorder symptoms. We conclude that possessing high PS is not by itself maladaptive. Rather, self-critical evaluative tendencies are more relevant than PS to the critical processes Shafran et al. (2002) suggested contribute to the maintenance of clinical perfectionism.

Adult↗
PubMed1994

Bilineal transmission in Tourette's syndrome families.

We assessed the frequency of bilineal (from maternal and paternal sides) transmission of Tourette's syndrome (TS) in two groups of pedigrees: (1) 39 high-density families in which five or more relatives were reported to have TS, and (2) the families of 39 consecutively ascertained probands referred for evaluation of TS. We used two designations for the TS phenotype (tics, tics or obsessive-compulsive behavior [OCB]), and we attempted to verify bilineal transmission with direct examinations. For the high-density pedigrees, bilineal transmission was evident in 33% (considering tics) and 41% (considering tics or OCB) of families, which was confirmed by examination in 77% of the kindreds. For the consecutive pedigrees, bilineal transmission was seen in 15% (tics) and 26% (tics or OCB) of families, which was verified by examination in 66% of the kindreds. Both parents of the proband were affected (tics or OCB) in 38% of the high-density pedigrees and 10% of the consecutive pedigrees. For the high-density families only, the frequency of bilineal transmission appeared to be related to the proband's severity of TS, and for both pedigree groups, the frequency of both parents being affected was higher in families in which the proband's symptoms were most severe. Our findings support the contention that bilineal transmission and homozygosity are common in TS. These genetic phenomena might play a role in determining severity of illness and may explain current difficulties in localizing the gene defect by linkage analysis.

Fathers↗
PubMed1998

Is propranolol effective in primary polydipsia?

OBJECTIVE: Psychiatric patients presenting with polydipsia are often difficult to treat with standard psychiatric interventions. Pharmacological intervention was attempted in these patients based on the hypothesis that angiotensin II, a potent dipsinogen, may be involved in the drinking behavior of patients with polydipsia. Beta-blockers inhibit renin release (and thus indirectly angiotensin II) by blocking beta receptors in the kidney. METHODS: Three patients were identified as excessive water drinkers during their hospital admissions. All three patients were eunatremic but polydipsic at the time of study. Two of the three had histories of hyponatremia and required emergency medical treatment on more than one occasion. No patients had been controlled by strict fluid restriction. Trials of propranolol were initiated to control their water drinking. RESULTS: After starting propranolol, two patients responded quickly. In one patient, fluid intake decreased from 2650 +/- 647 to 1577 +/- 361, p < .001. In the other, fluid intake decreased from over 7000 ml before starting propranolol to around 3000 ml. The mean noon body weight of the third patient, in whom it was not possible to document fluid intake or urine volume before and after administering beta-blocker, was 72.6 +/- 2.6 Kg and 66.0 +/- 1.0 Kg, respectively (p < .0001). CONCLUSIONS: These results suggest that propranolol may be useful for the treatment of polydipsia in patients with schizophrenia. Its efficacy could be related to inhibition of the renin-angiotensin system. Additional research using the controlled pharmacotherapeutic trials is required to confirm these findings.

Adrenergic beta-Antagonists↗
PubMed1999

Bilineal transmission in Tourette syndrome.

OBJECTIVE: To investigate the frequency and pattern of bilineal transmission in families of patients with Tourette syndrome (TS) compared with normal control subjects. METHODS: The study population consisted of two groups: 1) consecutive patients with TS with both parents (51 family sets; 153 individuals), and 2) normal control subjects randomly selected from public schools (20 family sets; 60 individuals). All patients with TS, normal control subjects, and their parents were evaluated for evidence of TS and associated features. Structured interviews and detailed questionnaires designed to assess tics, obsessive-compulsive behavior (OCB), and attention deficit disorder (ADD) were administered to all people in both groups. RESULTS: In addition to tics, 43 (84.3%) patients with TS had ADD, 33 (64.7%) had OCB, and 31 (60.8%) had both ADD and OCB. In 42 (82.4%) of the 51 patients, at least one parent exhibited features of TS; unilineal transmission (only one parent with tics, OCB, or ADD) was present in 29 (56.9%) TS families and an additional 13 (25.5%) TS families manifested evidence of bilineal transmission (both parents affected). More fathers than mothers of patients with TS had tics (31.4% versus 15.7%), whereas more mothers had OCB than did fathers (33.3% versus 15.7%). Features of ADD were equally distributed among fathers (35.3%) and mothers (33.3%) of patients with TS. Eight of 1,142 (0.7%) children in the general school population had some evidence of TS. One of 40 parents of the normal control subjects (2.5%) had symptoms of ADD, but none of the parents of normal control subjects manifested any features of TS or OCB. CONCLUSIONS: This study found evidence for bilineal transmission in one fourth of TS families. Features of the TS spectrum were rare in normal control families. Evidence of tics, OCB, and ADD should be investigated in both parents of patients with TS.

Adolescent↗
PubMed2004

Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial.

BACKGROUND: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. METHOD: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. RESULTS: OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p <.05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p <.05) predicted degree of improvement. CONCLUSION: CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.

Adult↗
PubMed1998

The preoccupation scale: its development and relationship with depression scales.

Self-focus has been thought to be an important factor in the development and maintenance of depression. The disposition to focus attention inward has been measured by the Private Self-Consciousness Scale (PSCS), which does not reflect the duration of self-focusing. Study 1 aimed to develop a Self-Preoccupation Scale (SPS) that would reflect both the degree and duration of self-focusing. In addition, a new concept, external-preoccupation-the maintenance of external-focus on a specific object-was proposed as a risk factor of depression. An External-Preoccupation Scale (EPS) was developed to measure this. Both the SPS and EPS showed excellent internal consistency and test-retest reliability. Study 2 aimed to examine the relationship between the SPS, EPS, and PSCS and depression. The EPS was not significantly correlated with depression scales. The moderate correlations of the SPS with the depression scales were significantly higher than the correlations of the PSCS with the depression scales.

Adult↗
PubMedDate not supplied

Adjustment to perceived ovarian cancer risk.

Eighty-three women who perceived themselves to be at risk for ovarian cancer completed a battery of surveys. In addition to demographics, subjects were asked to complete the Brief Symptom Inventory, Multidimensional Health Locus of Control, Death Anxiety Scale, Taylor Anxiety Scale, Index of Sexual Satisfaction, Impact of Event Scale, and the Marlowe-Crowne Social Desirability Scale. Overall, the respondents were more similar to normal controls than to psychiatric outpatients. A correlation was drawn between higher levels of education and lower scores on the Brief Symptom Inventory, which measures characteristics such as somatization, obsessive compulsive behaviors, interpersonal sensitivity, and anxiety. However, those who had the highest scores on the Death Anxiety Scale were less likely to comply with the recommendation for a physical/gynecological examination. Patients who were most influenced by an external locus of control or 'powerful other' were more compliant with their physicians' recommendations for testing and examination. It is the authors' belief that individualized educational efforts and the presence of a solid support system may increase women's adherence to the recommended health care practices.

Adaptation, Psychological↗
PubMed1990

Stress in surgeons.

A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.

Adult↗
PubMed2004

Time course of symptom remission in eating disorders.

OBJECTIVE: The study was carried out to test whether time to remission varies for different eating disorder symptoms. METHOD: Sixty-five patients (35 anorexic patients and 30 bulimic patients) treated with psychotherapy were interviewed 2 1/2 years after initial assessment. RESULTS: The anorexic physical symptoms remitted before the psychological symptoms of anorexia and bulimia nervosa, as did the bulimic behaviors: binging and purging. Nonpurging compensatory behavior and obsession with weight and shape were the last symptoms to remit. Differences between the anorexic and bulimic groups were found between the remission order of psychological symptoms. DISCUSSION: In spite of different treatments and symptoms between patients, the results support the notion of a common pattern in the process of change including a long and stepwise course. The results detail a template of the course to recovery for eating disorders.

Adolescent↗
PubMed2006

Parent-adolescent relationships and the development of weight concerns from early to late adolescence.

OBJECTIVE: This work describes the developmental course of adolescents' weight concerns and examines links with changes in parent-adolescent relationships for girls and boys. METHOD: Adolescents and parents in 191 families participated in 3 annual home interviews; adolescents rated their weight concerns and their intimacy and conflict with parents. Parental knowledge was measured based on the match between adolescents' and parents' reports of youth's experiences each day during 7 evening telephone calls. RESULTS: Girls' weight concerns increased from age 11 to 16 and then declined, whereas boys' concerns declined beginning at age 11. Increases in girls' weight concerns were linked to increases in conflict with mothers and fathers and decreases in maternal intimacy and knowledge. At a trend level, declines in boys' weight concerns were associated with declines in father conflict. CONCLUSION: Mothers and fathers may have unique influences on adolescent weight concerns. Intervention programming should target parent-adolescent relationships.

Adolescent↗
PubMed2001

Psychological profile of abstinent recreational Ecstasy (MDMA) users and significance of concomitant cannabis use.

The popular recreational drug Ecstasy (3,4-methylenedioxymethamphetamine, or MDMA, and related congeners) is neurotoxic upon central serotonergic systems in animal studies. So far, the most convincing evidence for neurotoxicity-related functional deficits in humans derives from neurocognitive studies demonstrating dose-related memory problems in Ecstasy users. The aim of the current investigation was to study the relationship between the psychological profile of recreational Ecstasy users and the patterns of their drug use. Twenty-eight abstinent recreational Ecstasy users with concomitant use of cannabis only and two equally sized, matched groups of cannabis users and non-users were administered standardized self-rating scales for the assessment of psychological problems which are thought to be related to central serotonergic function. Ecstasy users had elevated scores on subscales measuring impulsiveness, anxiety, sensation seeking, somatic complaints, obsessive-compulsive behavior and psychoticism. Higher scores were associated with both heavier Ecstasy and heavier cannabis use. After controlling for cannabis use, most group differences in psychometric scores no longer achieved statistical significance. The present data are in line with other reports demonstrating a broad range of psychological problems in Ecstasy users. However, the concomitant use of other drugs, specifically cannabis, seems to be crucial in this respect. Therefore, compared with cognitive deficits, psychological problems appear to be less suitable functional indices of Ecstasy-related neurotoxic damage of central serotonergic systems in humans. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2002

Defenses against goodness.

This paper examines the fantasies and conflicts of analysands who avoid the experience and expression of positive reactions to the goodness of others and who hide feelings that would elicit that goodness. Envious wishes to spoil good objects, attachments to bad objects, defenses against gratitude and dependence, negative therapeutic reactions, and other such conflictual developments can help forestall depressive anxiety in these analysands. They dread abandoning narcissistic, omnipotent, sadomasochistic, and persecutory paranoidschizoid positions, and fear moving toward the mature depressive position, with its burdens of seemingly intolerable guilt, concern, felt ambivalence, and vulnerability to humiliation and disappointment.

Adult↗