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PubMed2006

Perceived quality of life in obsessive-compulsive disorder: related factors.

BACKGROUND: Obsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres. METHODS: We measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamilton's depression scale and the SF-36 self-administered global QOL perception scale. RESULTS: We found a correlation among Hamilton's scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamilton's scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health. CONCLUSION: Quality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status.

Adult↗
PubMed1983

Impulsiveness in obsessive-compulsive patients.

Obsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.

Adult↗
PubMed1994

Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients.

The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.

Adult↗
PubMed1997

Prolactin response to d-fenfluramine in obsessive-compulsive patients, and outcome of fluvoxamine treatment.

BACKGROUND: Although several studies have directly explored serotonin (5-HT) transmission in patients with obsessive-compulsive disorder (OCD), their results have been inconsistent and their clinical relevance is doubtful. METHOD: According to a double-blind placebo-controlled design, plasma prolactin (PRL) response to a specific serotonergic probe, d-fenfluramine, was measured in 20 drug-free obsessive-compulsive patients and in 20 matched healthy controls. After the neuroendocrine test, 15 patients completed a 10-week treatment with fluvoxamine. Psychopathological assessment was performed before and after therapy. RESULTS: PRL response in OCD patients was blunted under the drug-free condition; correlated inversely with pretreatment ratings of obsessive-compulsive and depressive symptomatology; and correlated inversely with the improvement in obsessive-compulsive score observed after fluvoxamine treatment. CONCLUSIONS: These results support the idea of a dysfunction of 5-HT transmission in OCD, and suggest that the greater this impairment, the better the response to drugs which selectively block the reuptake of 5-HT.

Adolescent↗
PubMed2006

Error-related electrocortical responses are enhanced in children with obsessive-compulsive behaviors.

The error-related negativity (ERN or Ne) and positivity (Pe) are event-related potential components elicited during simple discrimination tasks after an error response. The ERN and Pe have a fronto-central scalp distribution and may be an indirect measure of anterior cingulate (AC) activity as it relates to performance monitoring. Brain imaging studies suggest that obsessive-compulsive disorder (OCD) is associated with exaggerated activity of the AC while electrophysiological studies have found an association between OCD and pronounced ERNs in adults. The present study explored the relation between obsessive-compulsive behaviors, the ERN, and the Pe in a sample of nonclinical 10-year-old children. It was found that more parent-reported obsessive-compulsive behaviors were associated with larger ERN and Pe components in the children. Results suggest unique contributions of the ERN and Pe in predicting obsessive-compulsive behaviors.

Anxiety↗
PubMed2003

Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder.

OBJECTIVE: Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder. METHODS: We stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment. A blinded random crossover design was used to assess four of those patients, who underwent continuous stimulation thereafter. RESULTS: The psychiatrist-rated Yale-Brown Obsessive Compulsive Scale score was lower in the stimulation-on condition (mean, 19.8 +/- 8.0) than in the postoperative stimulator-off condition (mean, 32.3 +/- 3.9), and this stimulation-induced effect was maintained for at least 21 months after surgery. The Clinical Global Severity score decreased from 5 (severe; standard deviation, 0) in the stimulation-off condition to 3.3 (moderate to moderate-severe; standard deviation, 0.96) in the stimulation-on condition. The Clinical Global Improvement scores were unchanged in one patient and much improved in the other three during stimulation. During the stimulation-off period, symptom severity approached baseline levels in the four patients. Bilateral stimulation led to increased signal on functional magnetic resonance imaging studies, especially in the pons. Digital subtraction analysis of preoperative [(18)F]2-fluoro-2-deoxy-d-glucose positron emission tomographic scans and positron emission tomographic scans obtained after 3 months of stimulation showed decreased frontal metabolism during stimulation. CONCLUSION: These observations indicate that capsular stimulation reduces core symptoms 21 months after surgery in patients with severe, long-standing, treatment-refractory obsessive-compulsive disorder. The stimulation elicited changes in regional brain activity as measured by functional magnetic resonance imaging and positron emission tomography.

Adult↗
PubMed1999

Treatment of obsessive-compulsive disorder using clomipramine in a very old patient.

OBJECTIVE: To describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia. CASE SUMMARY: A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to Alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration. RESULTS: At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23. CONCLUSIONS: Clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of Alzheimer disease.

Aged↗
PubMed2001

OCD patients and non-patient groups reporting obsessions and compulsions: phenomenology, help-seeking, and access to treatment.

This article offers a preliminary examination of factors that may be important to seeking help and receiving treatment for obsessive-compulsive symptoms. Community studies typically reveal individuals who display significant obsessive-compulsive symptomatology. Such individuals are often used in analogue research that attempts to understand various symptom dimensions and associated characteristics relevant to clinical obsessional states. This article questions why, if these non-patient groups are sufficiently similar to patients in terms of phenomenology, there should exist a disparity in treatment status. This question is addressed in the following way: first, obsessive-compulsive symptoms and associated features that may be central to help-seeking are considered in both patient and non-patient groups. A central argument in this part of the article is that cross-study phenomenological comparisons are hindered by diversity in research selection criteria. Secondly, general factors that may be considered important to help-seeking for psychological distress are considered, as too are those factors that may be applied to the consideration of help-seeking for obsessive-compulsive problems specifically. Finally, the implications of these issues in the literature for research and clinical practice are considered.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

Three case reports on the relationship between anorexia nervosa and obsessive compulsive disorder.

The literature has demonstrated that both food-related and non food-related obsessions and compulsions are common in patients with eating disorders and that eating disorders are common in patients with obsessive-compulsive disorder (OCD). It has become increasingly important, therefore, to evaluate the clinical and etiological relationships between these disorders. The authors present three patients with anorexia nervosa and obsessive-compulsive disorder. In two of the cases, OCD symptoms preceded onset of the eating disorder by several years. In the third case, OCD symptoms began after the onset of weight loss. In all three cases, obsessive-compulsive symptoms had a significant effect on attempts to treat the eating disorder. Medication, utilized in one of the three patients, was helpful in treatment of the OCD but did not have a major effect on the eating disorder. There remains much to learn about the epidemiology, etiology, treatment and outcome of those who have comorbid eating disorders and OCD. These cases highlight some of the issues encountered in management of patients with these combined conditions.

Adolescent↗
PubMed1996

Obsessions of infanticide and imminent psychosis.

In young mothers an obsession of infanticide, that is, fear that they may murder their children, may be coupled with an obsession of imminent psychosis, that is, fear that the first obsession is a sign of approaching insanity. Sixteen mothers with this clinical picture were evaluated in interviews. Seven of them entered psychotherapy and improved. The causative factors in childhood and adolescence wich led to the later development of these obsessive difficulties are analyzed. Even when psychotherapy was not possible, as was the case in nine patients, they should be strongly reassured and explanations should be given about the nature of the problem, for such encouragement and clarification helps them to improve to a significant extent. The prognosis of patients who have systematic psychoterapy is good.

Adult↗
PubMed2005

Frequency of obsessive and compulsive symptoms in patients with blepharospasm and hemifacial spasm.

BACKGROUND: Blepharospasm (BS) is a form of central focal dystonia recently associated with psychiatric disorders, particularly obsessive and compulsive symptoms. Hemifacial spasm (HFS) represents a focal myoclonus with peripheral origin in the facial nerve. OBJECTIVE: To determine the frequency of obsessive and compulsive symptoms in patients with BS in comparison with patients with HFS. METHODS: 30 patients from each group (BS and HFS) followed by the botulinum toxin clinic at the HC-UFPR were evaluated using a structured interview based on the DSM-IV criteria and the Yale-Brown scale. Results were compared by the mean two-tailed t test. RESULTS: We found obsessive or compulsive symptoms in 20 (66.6%) patients with BE and 21 (70%) with HFS. Yale-Brown scale scores for each group were higher among BS patients; however, diferences were not statisticaly significant. CONCLUSION: Our study did not show a significant diference in the comparison of the prevalence of obsessive and compulsive symptoms among patients with BS and HFS.

Adult↗
PubMed1990

Clomipramine. An overview of its pharmacological properties and a review of its therapeutic use in obsessive compulsive disorder and panic disorder.

During the 20 years that have elapsed since clomipramine (chlorimipramine) was first marketed, it has become well established in the treatment of depressive illness, particularly treatment-resistant depression. However, in addition to its role as an antidepressant, attention is being focused on the use of clomipramine in 2 other areas of psychiatry: obsessive compulsive disorder and panic disorder. Short term clinical trials have shown that clomipramine is generally more effective than amitriptyline, imipramine, desipramine, nortriptyline or clorgiline in reducing obsessive compulsive symptoms. Clomipramine appears to produce some short term benefit with exposure therapy in patients with obsessive compulsive disorder. However, the efficacy of the drug after long term follow-up has not been fully investigated. The antiobsessional efficacy of clomipramine appears to be independent of its antidepressant activity. In patients with panic disorder with or without agoraphobia (DSM-IIIR), clomipramine reduces the frequency and severity of panic attacks within 7 to 21 days of beginning treatment and efficacy is maintained for at least 12 months. Clomipramine is more effective than imipramine, the generally accepted standard treatment for patients with panic disorder after 2 weeks' treatment, but after 6 or 10 weeks both drugs are similarly effective. Other double-blind studies have shown that clomipramine is more effective than placebo and at least as effective as fluvoxamine and oxitriptan (5-hydroxytryptophan) in reducing panic attacks and associated anxiety. Adverse effects associated with clomipramine treatment are mild to moderate in nature and are predominantly a result of the drug's anticholinergic activity. The incidence of seizures is dose related, occurring in 0.48% of all patients receiving clomipramine less than or equal to 250 mg/day and 2.1% of patients receiving greater than or equal to 300 mg/day. In conclusion, the available data indicate that clomipramine is a worthwhile addition to the limited treatments available for obsessive compulsive disorder and panic disorder, two psychiatric disorders which have previously been difficult to manage pharmacologically.

Animals↗
PubMed2004

Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment.

There is a considerable overlap of schizophrenia and obsessive-compulsive disorder (OCD) in the structural and functional brain abnormalities involved, role of the dopamine/serotonin neurotransmitter systems, and some demographic and clinical characteristics. Although OCD co-occurs in a substantial proportion of schizophrenia patients, a systematic evaluation of the clinical features and treatment of this population is lacking. This review critically evaluates findings of recent studies pertaining to the rate of occurrence of OCD or obsessive-compulsive symptoms (OCS) in schizophrenia and the clinical characterisation of the schizo-obsessive subtype. Specifically, interrelationships between obsessive-compulsive and schizophrenic symptoms in terms of temporal relationships and their association with specific schizophrenia subtypes and the effect of OCS on the severity of schizophrenia symptoms are addressed. In the absence of evidence-based data, tentative therapeutic approaches in this difficult-to-treat patient subgroup are suggested. These include monotherapy with atypical antipsychotic agents or a combination of either typical or atypical antipsychotics with SSRIs or clomipramine. The clinical characteristics of antipsychotic-induced OCS/OCD are also presented to facilitate identification and management of this rare but clinically significant adverse effect. Finally, future directions of research in schizophrenia-OCD comorbidity relevant to clinical practice are discussed.

Antipsychotic Agents↗
PubMed1991

Low MMPI diagnostic performance for the DSM-III--R obsessive-compulsive personality disorder.

This study investigated the diagnostic performance of the MMPI validity and clinical scales, and especially of Scale 7 (Pt), for the DSM-IIII--R obsessive-compulsive personality disorder by comparing the MMPI variables for 24 obsessive-compulsive with those for 58 nonobsessive-compulsive inpatients. Both groups were diagnosed by semistructured interview (SCID-II). The obsessive-compulsive group obtained for the mean MMPI profile a 2-(6-1) (D-Pa-Hs) code, with a tendency for a lowered Scale 4 (Pd) score, compared to the nonobsessive-compulsive group. Neither the ROC analysis of the individual MMPI scales, including Scale 7 (Pt), nor the analyses of frequency of two-point codes and elevated (T greater than 69) scales showed any clear indications of good diagnostic performance for the DSM-III--R obsessive-compulsive personality disorder.

Adolescent↗
PubMed2002

Manic-depressiveness, obsessive-compulsive tendencies, and suicidality in Kuwaiti college students.

In a sample of 87 Kuwaiti undergraduates (20 men, 67 women), obsessive-compulsive scores were associated with scores on measures of mania, depression, and suicidal thoughts. Multiple stepwise regression indicated that (a) obsession, suicidal attempts, and suicidal threats were predictors of depression, (b) depression, suicidal attempts, and obsession predicted suicidal thoughts, (c) age, doubting, and sex were predictors of suicidal threats, and (d) suicidal thoughts, depression, and obsession were predictors of suicidal attempts.

Adult↗
PubMed1998

Faith-assisted cognitive therapy of obsessive-compulsive disorder.

OBJECTIVE: The aim of this paper is to report the rapid resolution of obsessions when the patient invoked Christ to treat her obsessions. CLINICAL PICTURE: A 25-year-old female presented with obsessions (doubts) that: (i) while driving she will knock down a pedestrian; and (ii) she will be charged with sex abuse. TREATMENT AND OUTCOME: Cognitive therapy (cognitive restructuring and thought-stopping) was offered. After a single session a complete remission was reported when she replaced her doubts with firm convictions that 'Christ will help me drive safely' and 'Christ will not let me do anything wrong'. She was reported to have remained well at the end of 5 months at which time she relocated and was then lost to follow-up. CONCLUSION: Religious faith can have a healing effect, and cognitive therapy is not incompatible with religion. Although unusual in standard clinical practice, rapid resolution of obsessions is possible.

Adult↗
PubMedDate not supplied

Comorbidity of obsessive-compulsive and psychotic symptoms: a review.

Co-occurrence of psychotic and obsessive-compulsive symptoms was first reported nearly 70 years ago. This paper reviews published reports from two perspectives: psychotic disorders with obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) with psychotic symptoms. Older investigations reported a low rate of comorbidity between these two disorders, but more-recent studies, in which systematic diagnostic criteria have been used, have suggested that the rate of co-occurrence of symptoms is higher than was previously thought. The difficulty in diagnosing patients with obsessive-compulsive and psychotic symptoms is reviewed, and the importance of this distinction for treatment and prognosis is discussed. Although the comorbid diagnosis of schizophrenia and OCD, or of OCD and psychotic features, seems to portend a worse prognosis than for either illness alone, the available data suggest that some patients with schizophrenia and OC symptoms may improve with traditional antiobsessional treatment.

Comorbidity↗
PubMed2004

Pharmacotherapy and regional cerebral blood flow in children with obsessive compulsive disorder.

While regional cerebral blood flow (rCBF) studies on adults involving the caudate, prefrontal, orbitofrontal, and cingulated areas have been reported, no such published data on children exist. In this study, we aimed to determine the significance of pre- and post-treatment regional cerebral blood flow (rCBF) differences in children with obsessive compulsive disorder (OCD) and compared them with healthy controls. Eighteen drug-free obsessive compulsive children, aged 11 to 15, without comorbid states except for anxiety disorders--participated in this study. The control group consisted of 12 children, aged 11 to 15, with no medical or psychiatric illnesses. Using SPECT (Single Photon Emission Computerized Tomography) scans with Technetium-99m-HMPAO-hexamethly propyleneamine oxime (Tc99mHMPAO), the rCBF was calculated in 15 regions of the control group according to a standard protocol, while in the study group, it was measured at baseline and after 12 weeks of treatment with a fixed dose of paroxetine (20 mg qd). We compared the resulting pre- and post-treatment CBF values for the control group and study group. The right and left caudates, right and left dorsolateral prefrontals, and cingulate had significantly higher rCBF in children with obsessive compulsive disorder than in the control group. These areas, in addition to the right anteromedial temporal, showed significant rCBF reduction after treatment with paroxetine. The mean percentage of change in obsession scores during the treatment correlated significantly with the baseline and post- treatment rCBF level of the right caudate, post-treatment left caudate, and baseline left caudate. Our findings on children are consistent with adult studies and support the theory of a cortical-striatal-thalamic-cortical loop disturbance in OCD.

Adolescent↗