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PubMed1995

An examination of the phenomenology and the reliability of ratings of compulsive behavior in autism.

To clarify the nature of compulsive behavior in autism, staff reports of behavioral patterns of 17 young autistic adults living in a farmstead residential facility were analyzed. Three staff members, who had worked most closely with each resident for at least 3 months completed three questionnaires, including Quantitative and Qualitative compulsive behavior scales, and the Childhood Autism Rating Scale (CARS). The questionnaires were completed on two occasions with a 2-week interval between administrations. Test-retest and interrater consistencies were examined for each of the scales. Both the Qualitative and Quantitative questionnaires show promise as instruments that could be used as objective baselines or descriptors for compulsive behavior in autism. Information gathered from these scales could be utilized to determine how to intervene in the behavior, and to assess progress in treatment programs.

Adult↗
PubMed1999

Obsessive-compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders: measuring the effects of depression.

Obsessive-compulsive symptoms have been related to severity in the clinical presentation of eating disorders, whereas the impact of depression on the correlations between their severity and the severity of eating disorders has not been investigated. This paper assesses the effects of depression in 42 adolescent patients who met DSM-IV criteria for anorexia nervosa or bulimia nervosa by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). The results indicate that patients who show elevated obsessionality and compulsivity on the Y-BOCS display a significantly higher degree of disturbed attitudes and behaviours concerning eating than patients with limited obsessionality and compulsivity. However, when the effects of depression are considered, all the differences found disappear. Our study suggests that depression is more directly associated with the severity of eating disorders than obsessive-compulsive symptoms and that the intensity of obsessive-compulsive symptoms in eating disorders is influenced by the intensity of depression. The relations between obsessive-compulsive symptoms, depression and eating disorders are not known. Even so this study highlights the importance of assessing depression when using obsessive and compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders.

Adolescent↗
PubMed2004

[Body dysmorphic disorder. Epidemiology, clinical symptoms, classification and differential treatment indications: an overview].

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a relatively common disorder that consists of preoccupation with some imagined or slight defect in physical appearance. The preoccupation causes emotional distress and social impairment. Overvalued ideation and referential thinking are prevalent. BDD has a rich tradition in European psychiatry, but it first entered the official psychiatric nomenclature as a separate disorder in DSM-III-R in 1987. In the last 10 years it has received increasing empirical attention. BDD has been hypothesized to be related to obsessive-compulsive disorder (OCD) or may be conceptualized as hypochondriacal disorder. According to its body image disturbance it has been related to cenesthesia, eating disorders, and transsexualism. This paper presents the current level of awareness about BDD based on an analysis of the relevant literature. Empirical data are summarized and clinical signs are described. Varying therapies are critically reviewed.

Combined Modality Therapy↗
PubMed2003

The Leyton obsessional inventory - child version in Greek adolescents: standardization in a national school-based survey and two-year follow-up.

OBJECTIVE: The aims of this study were a) to standardize the survey form of the Leyton Obsessional Inventory - Child Version (Leyton-CV) in Greece, and estimate its sensitivity and specificity, and b) to assess high-risk factors for the development of adolescent obsessive-compulsive disorder (OCD) within a two year period. METHOD: The Leyton-CV was administered to a national, representative, school-based population of 2552 Greek adolescents. Adolescents with a wide range of Leyton-CV scores were interviewed with the SADS-LA to determine the sensitivity and specificity of the instrument. Adolescents with high Leyton scores but no OCD diagnosis, and those with obsessive-compulsive symptoms (OCS), were re-interviewed after two years with the SADS-LA. Family history data on OCD and other mental illness were obtained through the Family Informant Schedule at follow-up. RESULTS: Using a cut-off point of 35 for the total score, the sensitivity of the Leyton-CV was 79.4 % and the specificity 72.6 %. High Leyton-CV scores and a positive family history for OCD/OCS appeared to constitute high risk factors for later OCD/OCS in adolescents.

Adolescent↗
PubMed2003

Is juvenile obsessive-compulsive disorder a developmental subtype of the disorder?--Findings from an Indian study.

Juvenile obsessive-compulsive disorder (OCD) has been hypothesized to be different from adult-onset OCD suggesting that juvenile OCD may be a developmental subtype of the disorder. There is some evidence that juvenile OCD may be phenotypically different from juvenile-onset adult OCD. This study examines the phenotypic characteristics of juvenile OCD (current age < or = 18 years, n = 39), juvenile-onset adult OCD (onset < or = 18 years, current age >18 years, n = 87) and adult-onset OCD (onset > 18 years, n = 105). Qualified psychiatrists expert in evaluating OCD subjects conducted clinical and structured interviews. In the multinomial logistic regression analysis, controlling for chronological age and gender, the juvenile OCD was associated with male preponderance, elevated rates of certain obsessive-compulsive symptoms, attention-deficit hyperactivity disorder, chronic tics, body dysmorphic disorder and major depression. In addition, juvenile-onset adult OCD differed from juvenile OCD by having later age-at-onset and low rate of ADHD. The juvenile-onset adult OCD was positively associated with social phobia and chronic tics compared to adult-onset OCD. The juvenile OCD appears to be different from both juvenile-onset adult OCD and adult-onset OCD supporting previous observations that juvenile OCD could be a developmental subtype of the disorder.

Adolescent↗
PubMed2004

Re-examining comorbidity of Obsessive Compulsive and Attention-Deficit Hyperactivity Disorder using an empirically derived taxonomy.

BACKGROUND: Using an empirically derived instrument to reduce the assessor bias inherent in structured diagnostic interviews, we sought to re-examine and validate the putative comorbidity between Obsessive Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. METHOD: We examined the correlation between Child Behavior Checklist (CBCL) syndrome, competence, and composite scores in children with: 1) OCD plus ADHD (OCD + ADHD), N = 47; 2) OCD without comorbid ADHD (OCD), N = 33; 3) ADHD without comorbid OCD (ADHD) N = 43; and 4) comparison controls recruited from general pediatric clinics,N = 32. RESULTS: CBCL findings in our ADHD children were similar to previous findings reported in ADHD youth, irrespective of the presence or absence of comorbid OCD. Comorbid youth generally had additive scores on the CBCL scales, reflecting the independent contribution of symptomatic and functional impairment from each disorder. CONCLUSION: These findings suggest that when ADHD-like symptoms are seen in OCD youth, they reflect a true comorbid state of OCD plus ADHD. The CBCL may provide a rapid assessment tool to identify comorbid ADHD in OCD youth.

Adolescent↗
PubMed2005

Epidemiology and phenomenology of obsessive-compulsive disorder in non-referred young adolescents: a Polish perspective.

OBJECTIVE: The aim of this study was to investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in a non-referred population of young Polish adolescents. METHOD: A two stage ascertainment procedure (school screening and diagnostic evaluation) was used to identify affected individuals. In the first stage, 3,100 pupils were asked to complete the Polish version of the 20-item Leyton Obsessional Inventory-Child Version (LOI-CV). In the diagnostic stage, the presence of obsessions and compulsions was assessed with the author's structured interview questionnaire based on DSM-IV and ICD-10 diagnostic criteria for OCD; the Polish version of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to rate the symptom severity. RESULTS: A frequency of 0.38 % was found for OCD and 2.7 % for subclinical OCD. There was no significant difference in the phenomenology, demographic characteristic or socio-familial variables comparing the diagnosed OCD and subclinical OCD subjects. CONCLUSIONS: The identified OCD cases had characteristics similar to those of previously described clinical and non-referred samples.

Adolescent↗
PubMed2007

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma.

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.

Accidents, Traffic↗
PubMed1990

Long-term neurologic outcome in psychogenic water drinkers with severe symptomatic hyponatremia: the effect of rapid correction.

PURPOSE: The purpose of our study was to ascertain the safety of rapidly correcting acute symptomatic hyponatremia in psychogenic water drinkers, particularly in regard to any delayed adverse neurologic sequelae. PATIENTS AND METHODS: We reviewed the medical records of all known psychogenic water drinkers (34) in our hospital from 1977 to 1989. Using seizure as a marker of severity, we identified 13 patients having a total of 27 episodes associated with severe hyponatremia. We evaluated the charts of those patients in detail to assess the mode of treatment, rate of correction, and long-term neurologic outcome. None of the patients experienced respiratory arrest before treatment, which was initiated within 2 hours of seizure. RESULTS: For all 27 episodes, the initial serum sodium level (mean +/- SE) was 110.9 +/- 1.2 mmol/L, and the rate of correction (mean +/- SE) was 1.65 +/- 0.2 mmol/L/hour. All but one episode were corrected "rapidly" (initial correction rate of 0.7 or more mmol/L/hour) to 120 to 130 mmol/L within 12 hours. The absolute change in the serum sodium level was 15.1 +/- 1.2 mmol/L in 12 hours, 21.6 +/- 1.4 mmol/L in 24 hours, and 25.9 +/- 1.4 mmol/L in 48 hours. In no instance did therapy induce hypernatremia. All patients recovered immediately after treatment. There was no clinical or radiologic evidence of adverse neurologic sequelae immediately after treatment or after 6 years of follow-up. CONCLUSION: In this series of male psychogenic water drinkers, early "rapid" correction of acute symptomatic hyponatremia by raising the serum sodium level 15 mmol/L in 12 hours while maintaining an absolute change in the serum sodium level of 26 mmol/L within 48 hours produced no long-term neurologic sequelae.

Adult↗
PubMed1989

Invited case transcript. Obsessive-compulsive disorder: a behavioral case formulation.

The interviewing skills of many behavior therapists are inadequate and several possible reasons are discussed. The present manuscript focuses on construction of initial clinical hypotheses. A strategy for developing and testing initial hypotheses is presented and illustrated by transcripts from a complex case. The transcript is taken from the initial interviews with a 26 year old woman presenting the problems of emotional distress related to thoughts of harming others, and anxiety concerning her difficulty in controlling physical aggression. A behavioral analysis of the origins and maintaining factors indicated that while the patient's compulsions were a vehicle to manage anxiety, the wellspring of her attempts to exert control over her thoughts was a fear of anger, loss of control, negative evaluation, criticism, and rejection. Distal and proximal predisposing events were examined in order to help explain the development of this maladaptive behavioral pattern, and to plan therapeutic strategy.

Adult↗
PubMed1991

Prompting and fading in the exposure treatment of compulsive checking.

Compulsive checking can be treated effectively through the use of in vivo exposure with response prevention. However, the clinical application of these procedures can become quite complex. The therapist must help teach the client new coping skills for managing anxiety. However, many compulsive clients report a substantial reduction in the urge to check whenever accompanied by another adult. Therefore, the therapist must not be so intrusive as to reduce the impact of the exposure. Treatment procedures used with two clients are described to show how prompting can be useful for facilitating the early stages of exposure and how fading is essential in promoting self-control. Portable electronic communication devices were used to bridge the gap between therapist-assisted and self-controlled exposure sessions. Therapy was successful in reducing the frequency of checking behaviors and the subjective urge to check.

Adaptation, Psychological↗
PubMed1992

An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder.

Flooding and response prevention have been widely used in the treatment of adult obsessive compulsive disorder but have been overlooked in favor of less restrictive procedures when treating children. The present case investigates the utility of these procedures in an adolescent with severe compulsive handwashing. Treatments were introduced hierarchically to minimize subject distress; graded exposure decreased the frequency of handwashing, but flooding was required to eliminate the compulsion. Guidelines for the ethical use of flooding and exposure therapies with children are offered.

Adolescent↗
PubMed1995

Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms.

Subjects with obsessive compulsive disorder, bulimia nervosa, or trichotillomania selected cues which elicited or worsened their symptoms from a 339 item list. Principal components analysis suggested a four-component solution. Each disorder was significantly associated with one of these components. Diagnostic assignment based on component scores yielded 85% correct classification. The diagnostic groups did not differ on a negative feeling state component. The results indicate that both disorder-specific and generic components exist. This approach has potential for defining clinical subtypes, studying the interaction of feeling states and environmental cues in evoking symptoms, and designing treatment strategies.

Adolescent↗