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Clozapine and obsessions in patients with recent-onset schizophrenia and other psychotic disorders.

BACKGROUND: The increase or emergence of obsessions was compared in young patients with recent-onset schizophrenia or other psychotic disorders taking clozapine and other antipsychotic drugs. METHOD: We conducted a retrospective cohort study. Subjects were 121 consecutively admitted patients diagnosed with DSM-III-R schizophrenia, schizoaffective disorder, schizophreniform disorder, or psychotic disorder not otherwise specified. Obsessions were diagnosed according to DSM-IV criteria. RESULTS: More clozapine-treated subjects (20.6%) than subjects treated with other antipsychotic drugs (1.3%) experienced an emergence or increase of obsessions (p<.01). CONCLUSION: Use of clozapine is associated with the emergence or increase of obsessions in early-phase schizophrenia.

Adult↗

Right versus left prefrontal transcranial magnetic stimulation for obsessive-compulsive disorder: a preliminary investigation.

BACKGROUND: There is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful for the treatment of obsessive-compulsive disorder (OCD), but no definitive study has been published, and the effect of laterality of stimulation is uncertain. METHOD: Subjects (N = 12) with resistant OCD were allocated randomly to either right or left prefrontal rTMS daily for 2 weeks and were assessed by an independent rater at 1 and 2 weeks and 1 month later. RESULTS: Subjects had an overall significant improvement in the obsessions (p < .01), compulsions (p < .01), and total (p < .01) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after 2 weeks and at 1-month follow-up. This improvement was significant for obsessions (p < .05) and tended to significance for total Y-BOCS scores (p = .06) after correction for changes in depression scores on the Montgomery-Asberg Depression Rating Scale. There was no significant difference between right- and left-sided rTMS on any of the parameters examined. Two subjects (33%) in each group showed a clinically significant improvement that persisted at I month but with relapse later in I subject. CONCLUSION: A proportion (about one quarter) of patients with resistant OCD appear to respond to rTMS to either prefrontal lobe, although in the absence of a sham treatment group in this study, we cannot rule out the possibility of this being a placebo response. This treatment warrants further investigation to better establish its efficacy and examine the best parameters for response.

Adult↗

How common is obsessive-compulsive disorder in a dermatology outpatient clinic?

BACKGROUND: This study was prompted by reports suggesting a high prevalence of unrecognized obsessive-compulsive disorder (OCD) in the dermatology clinic. METHOD: 92 consecutive dermatology referrals were screened for DSM-IV OCD using the Mini-International Neuropsychiatric Inverview (MINI), the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the 5-item screening questionnaire from the International Council on OCD. Illness severity was rated on the YBOCS, and symptom profiles and dermatologic diagnoses were established for screen-positive cases. RESULTS: 18 patients (20%) qualified for a DSM-IV diagnosis of OCD, of whom 17 were previously undiagnosed. The range and type of OCD symptoms covered the normal clinical spectrum. Most patients had more than 1 symptom, and among obsessions (including somatic obsessions), checking, washing, and symmetry were common. The mean total YBOCS score was 16/40 (SD = 7.2), indicating moderate OCD, and 40% of the positive cases scored 16 or higher. Dermatologic diagnoses were various and did not seem to bear a direct relationship with the OCD. CONCLUSION: These results suggest that there is a high prevalence of clinically relevant OCD in the dermatology clinic. This is an area that merits attention with regard to better recognition and treatment for OCD sufferers.

Adolescent↗

Severe obsessive-compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications.

OBJECTIVE: Chronic hair pulling and trichotillomania are putative obsessive-compulsive spectrum disorders. This study determined the prevalence of hair pulling in an inpatient obsessive-compulsive disorder (OCD) population and compared clinical characteristics and treatment response between subgroups with and without comorbid hair pulling. METHOD: Patients with severe DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to an OCD residential treatment facility between August 2000 and July 2003 were included. Clinician-rated (Yale-Brown Obsessive Compulsive Scale) and patient-rated (Massachusetts General Hospital Hairpulling Scale, Beck Depression Inventory, and Posttraumatic Diagnostic Scale) measures were administered at index evaluation. OCD patients with and without moderate to severe hair pulling were statistically compared on clinical and treatment characteristics and treatment response. RESULTS: Of the OCD subjects, 18.8% (N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to severe hair pulling, and 7.8% (N = 12) had severe hair pulling comparable to that of a specialty trichotillomania clinic population. OCD patients with moderate to severe hair pulling were more likely to be women (p < .001), endorse > 1 comorbid tic (p < .05), and have earlier-onset OCD (p = .001). This cohort also had fewer contamination obsessions (p = .04) and checking compulsions (p = .04) and was more likely to be receiving stimulant (p = .006) or venlafaxine (p = .02) medication than those patients without hair pulling. Posttraumatic Diagnostic Scale scores were nearly significantly higher in the OCD + hair pulling group (p = .08). OCD treatment response was unaffected by the presence of comorbid hair pulling. CONCLUSION: Hair pulling is a highly common comorbidity in severe OCD. Women and early-onset OCD patients appear to be more vulnerable to comorbid hair pulling. OCD sufferers with comorbid hair pulling also exhibit an increased risk for tics and may present with different OCD symptomatology.

Adolescent↗

Behavior therapy augments response of patients with obsessive-compulsive disorder responding to drug treatment.

OBJECTIVE: In many patients with obsessive-compulsive disorder (OCD), residual symptoms persist despite a clinically meaningful response. The objective of this study was to examine whether addition of behavior therapy would augment treatment outcome in these patients. METHOD: Ninety-six patients with DSM-IV OCD who had responded to 3 months of drug treatment were randomly assigned to either receive addition of behavior therapy or continue on drug treatment alone for 6 months. Patients who continued on drug treatment alone eventually received addition of behavior therapy for 6 months. Data were gathered from October 1998 to June 2002. RESULTS: OCD patients who received addition of behavior therapy showed a greater improvement in obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score change = -3.9 in the completers sample) than those who continued on drug treatment alone (Y-BOCS score change = +3.9 for completers). Significantly more patients who received addition of behavior therapy were in remission compared with those who continued on drug treatment alone (p < .0001 for completers). Patients who received behavior therapy after 6 months of drug treatment alone showed a nonsignificant decline in obsessive-compulsive symptoms (Y-BOCS score change = -2.7 for completers); however, the remission rate found in this group was comparable to the remission rate found in the group of patients receiving addition of behavior therapy directly after responding to drug treatment. CONCLUSION: The results indicate that addition of behavior therapy is beneficial for patients who have responded to drug treatment. The data also suggest that the effect is greater when behavior therapy is added immediately after attainment of the drug response.

Adult↗

[Presentation of obsessive-compulsive symptoms in a patient with schizophrenia treated with clozapine].

PURPOSE: Clozapine is an atypical antipsychotic agent for the treatment of schizophrenic patients whose symptoms do not respond to traditional antipsychotic drugs. The emergence of obsessive-compulsive symptoms during treatment of clozapine has been reported in some case studies. We report on the case of a 31-year old man with chronic schizophrenia who had shown obsessive-compulsive symptoms during treatment with clozapine. RESULTS: A 31-year old patient with treatment refractory schizophrenia was treated with clozapine. During clozapine treatment, positive symptomatology decreased, but after 4 months after starting clozapine the patient showed obsessive and compulsive symptoms. This symptomatology had previously not been a feature of this patient's illness. CONCLUSIONS: Obsessive-compulsive symptoms were observed during treatment of clozapine in a schizophrenic patient. This may be explained either by the serotonin-receptor antagonism of clozapine or its atypical dopaminergic receptor effects.

Adult↗

[Schizophrenic with obsessive-compulsive disorder or symptoms].

The concept of pseudo-obsessive schizophrenia has been often used in the past. Clinically, severe obsessive-compulsive disorders (OCD) are closed from psychotic symptoms and ask questions about differential diagnosis with schizophrenia. Moreover some characterized schizophrenia may present in some cases obsessive compulsive symptoms (OCS). Finally, schizophrenia treated by atypical antipsychotics can be complicated by obsessive compulsive symptoms following the onset of the drug. Until now, there have been no control trials on this specific topic. Reviewing data of studies exploring the prevalence of OCD in schizophrenia this current article summarizes the different pharmaceutical approaches used in treating this disorder. In addition, a review about antipsychotics causing either emergence or exacerbation of OCS is presented.

Adolescent↗

The prevalence of obsessive compulsive symptoms in a sample of Egyptian psychiatric patients.

Obsessions can occur in many psychiatric disorders or they may constitute the entire illness, which is then referred to as an obsessional state (Rees, 1993). The relationship of obsessive compulsive symptoms (OCS) to different psychiatric disorders is still controversial. This work was undertaken to study the co-occurrence and phenomenology of OCS with other psychiatric disorders. We examined a sample of 372 psychiatric outpatients using the arabic version of Yale Brown obsessive-compulsive symptom (Y-BOCS) checklist and compared them with a control group composed of 308 non-psychiatric subjects. Subjects were additionally assessed by means of the obsession symptom section of the PSE (10th) edition for trait rating, the arabic version of the Eysenck rigidity scale and the arabic version of the religious orientation scale. OCS were found to be significantly higher in the different psychiatric categories than in the non-psychiatric categories; 83% of patients with neurotic, stress related and somatoform disorders, 51% of patients with mood disorders and 47% of patients with schizophrenia, schizotypal and delusional disorders were found to have OCS in their symptomatology. Furthermore, the data suggest that OCS in psychiatric patients have a distinct phenomenology from that in non-psychiatric subjects. The results did not however reveal a relationship between OCS and either rigidity or religious orientation.

Ambulatory Care↗

Group behavioral therapy of obsessive-compulsive disorder: seven vs. twelve-week outcomes.

Previous research has demonstrated that individualized behavioral exposure and response prevention therapy is an effective treatment for Obsessive-Compulsive Disorder. In our prior preliminary report, 7-week group exposure and response prevention therapy was also found effective in reducing obsessions and compulsions. The present report describes a larger sample (N=113) of treatment seeking obsessive-compulsives who received group behavioral therapy. As before, group exposure and response prevention significantly improved ratings of obsessions, compulsions, and depression. These improvements were maintained at 3-month and long-term follow-up. A sub-sample of patients who received 12 weeks of treatment had outcomes at the end of the group and at follow-up that did not significantly differ from those who received 7 weeks of treatment. These results confirm the efficacy of a 7-week behavioral treatment program administered in a group format.

Adult↗

In-patient treatment for resistant obsessive-compulsive disorder.

Obsessive Compulsive Disorder is one of the increasing psychological disorders. If not detected early and treated properly, obsessive-compulsive disorder usually becomes an incapacitating illness adversely affecting almost all aspects of the patient's life. Outpatient behavioral and pharmacotherapies frequently fail. This is a report on a severe case of obsessive-compulsive disorder that was treated as an in-patient with both behavior and pharmacotherapies, she was then followed up for 5 years with no relapse. The case reflects the importance and the need for in-patient units for severe resistant obsessive compulsive cases especially in Saudi Arabia where we have an increasing number of such cases.

Adult↗

[Current and lifetime prevalence of obsessive compulsive disorders in eating disorders].

UNLABELLED: A significant proportion of patients suffering from Eating Disorders (ED) present a comorbidity with anxiety disorders. Among the anxiety disorders, Obsessive Compulsive Disorders (OCD) are the third most frequently diagnosis observed in ED. However, prevalence rates from the literature are contradictory depending on the diagnostic criteria and evaluation tools used. Studies concerning the chronology of appearance of OCD and ED and the role played by denutrition are even rarer and equally contradictory. OBJECTIVE: The aim of this study is to bring new empirical data to the study of the correlations between OCD and ED by exploring, in a significant clinical sample, the current and lifetime OCD comorbidity in the diagnostic sub-groups and sub-types of ED as defined by the DSM IV and to study the chronology of appearance of these disorders taking into account the role played by denutrition. We make the assumption that there should be a difference in the prevalence of obsessive compulsive disorders in the various ED sub-groups and sub-types and that purging anorexics should, at equivalent levels of denutrition, exhibit higher OCD prevalence rates than the other sub-types as a result of their more severe general psychopathology. METHODS: Current and lifetime prevalence were investigated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive Compulsive Scale in a sample of 89 DSM IV eating disorders in and out-patients aged between 15 and 30 (58 AN and 31 BN) and 89 matched controls. In order to increase the validity of the current diagnosis of OCD only patients presenting an OCD diagnosis on the MINI (excluding obsessions and compulsions related to food and body image) and a score of 16 or more on the Y-BOCS were included in the study. RESULTS: Current and lifetime prevalence of OCD in ED is significantly higher than in general population (15.7% and 19% vs 0% and 1.1%, p < 0.05). Anorexic and bulimic patients do not show any difference in the current and lifetime comorbidity (19% and 22.4% vs 9.7% and 12.9%, ns). Concerning the diagnostic sub-types, following our assumption purging anorexics present the higher current and lifetime prevalences (29% and 43%), followed by restrictive anorexia (16%) and purging bulimia (13%). The only significant difference is found in the lifetime prevalence of OCD between purging and non purging anorexics. In the great majority of cases (65%) OCD diagnosis precedes ED diagnosis and OCD current prevalence and Y-BOCS scores of underweight patients are not significantly higher than normal weight patients, suggesting that there are only limited links between denutrition and obsessionality. LIMITS: Some methodological limitations must be considered. First of all, the small sample size of the diagnostic sub-types of ED do not enable us to draw definitive conclusions concerning the prevalence of OCD in the clinical forms of ED. Some of the diagnostic sub-types of ED, as BN-NP, appear at different ages: in order to better investigate the prevalence of OCD in all the diagnostic sub-types, larger age ranges should be considered. Secondly, our sample of anorexics is almost made of hospitalized inpatients recrutated in a specialized university unit, whereas bulimics are all consulting outpatients. It is possible that the higher than normal rates of OCD in anorexics could be related to the severity of this sample. Comparisons with samples of consulting anorexics should be performed. Lastly, it is necessary to evoke the limitation represented by the choice of a healthy control group. OCD are rare in the general population and the differences found between the clinical and the control groups do not offer strong arguments to support the specificity of the association between OCD and ED, which would be better explored by using a pathological control group. CONCLUSIONS: So far, none of the various models proposed to explain the comorbidity observed between ED and OCD appears completely satisfactory. ED and OCD would share a genetic vulnerability to a dysregulation of serotoninergic functioning which would predispose these subjects, depending on specific clinical and biological conditions, to develop an obsessional and compulsive symptomatology more or less focused on food and body image. The knowledge of the clinical and biological specificities of the ED diagnostic sub-types presenting an OCD comorbidity could point the way towards specific therapeutic interventions in these patients. Our study of the comorbidity of OCD in ED makes a further contribution to the identification of specific links between the OCD and the various clinical forms of ED. More clinical and biological studies are needed to further explore these relationships.

Adolescent↗

[Validation of a version in Spanish of the Yale-Brown Obsessive-Compulsive Scale].

INTRODUCTION: The objective of this study is to validate a version in Spanish of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). METHOD: We administered to 20 patients with obsessive-compulsive disorder (OCD) the Maudsley Obsessive-Compulsive Inventory (MOI) and a version in Spanish of the Y-BOCS. The application of the last one was performed by an interviewer, filmed, and then watched and rated by other 4 observers. In addition, the opinion of the treating psychiatrist about the severity of the patient's symptoms was registered. The interviewer and the observers were named raters. RESULTS: The mean scores of the Y-BOCS assigned by the 4 observers were from 18.35 to 19.55; the maximum scores, from 34 to 35; and the minimum scores, from 1 to 5. The Pearson's correlations between raters were significant for all cases (r>0.86 and p<0.001). For all raters, Y-BOCS scores significantly correlated with MOI scores (p<0.001) and the opinion of the treating psychiatrist (p<0.05). We did not find significant correlation between the last one and MOI scores. The Cronbach's coefficients ranged from 0.8789 to 0.9488. CONCLUSIONS: The Spanish version of the Y-BOCS is reliable, homogeneous and valid for quantification of the obsessive-compulsive symptoms, and has more correlation with the opinion of the treating psychiatrist than the MOI.

Adolescent↗

[The inheritance of obsessive-compulsive disorders].

Obsessive-compulsive disorder is a chronic psychiatric disorder characterised by obsessions and/or compulsions. Genetic research into obsessive-compulsive disorder is significantly limited by the difficulty in clearly defining the disease. There are only a few good studies and the populations investigated are small. Family and twin studies have provided evidence for a genetic component in obsessive-compulsive disorders. Segregation analyses suggest Mendelian inheritance of a dominant allele. In addition to one gene with a major effect, genes with smaller effects also play a role.

Chromosome Segregation↗

An integrated approach to treatment of obsessive compulsive disorder.

Except for rarely performed psychosurgery, obsessive compulsive disorder seldom improved with reversible treatments before 1966. In that year, Victor Meyer reported successful treatment of OCD with behavior therapy, and clomipramine was first released. For the past 25 years, controlled research has demonstrated specific efficacy of exposure for obsessional anxiety and ritual or response prevention for reducing ritual time, interference, and associated distress. Over the same time span, clomipramine has been conclusively shown to be an effective treatment for obsessive compulsive disorder in double-blind controlled trials against placebo and other nonpotent serotonin uptake inhibitor antidepressants. Fluvoxamine, fluoxetine, and sertraline, all potent serotonin uptake inhibitors, have also demonstrated efficacy in obsessive compulsive disorder; fluvoxamine is the best studied of these three compounds. The combination of behavior therapy and a potent serotonin uptake inhibitor is currently the best treatment for most patients. Psychosurgery still has a part to play in the treatment of a small proportion of severely disabled and distressed obsessive compulsive patients unresponsive to other effective treatments.

Behavior Therapy↗

Fluvoxamine: new indication. No progress in obsessive-compulsive disorder.

(1) Four drugs are approved in France for patients with obsessive-compulsive disorders, namely clomipramine and three selective serotonin reuptake inhibitors (SSRIs): fluoxetine, paroxetine and sertraline. None of the four has emerged as a reference treatment. For children with obsessive-compulsive disorder, the treatment hierarchy is as follows: psychotherapy; behaviour therapy; clomipramine; sertraline. (2) Fluvoxamine, another SSRI, has now been approved in France for the treatment of obsessive-compulsive disorder in patients aged at least 8 years, after European harmonisation of SPCs for fluvoxamine-based preparations. (3) In adults, two placebo-controlled trials and the six trials versus clomipramine show that fluvoxamine, like clomipramine, is only partially effective (about one-third of patients "respond"). (4) In the only placebo-controlled trial in 120 children and adolescents aged from 8 to 17 years, who were treated for 10 weeks, efficacy was even more modest (response rate 15%, compared to 10% with placebo). (5) The safety profile of fluvoxamine is the same as that of all SSRIs but it has a potential for more drug interactions. (6) In practice, approval of fluvoxamine in adults or children with obsessive-compulsive disorder will have no impact on their management.

Adolescent↗

[Effect of religious culture on obsessive compulsive disorder symptomatology. A transcultural study in monotheistic religions].

Effect of religious culture on obsessive Cultural factors may influence the nature of obsessions and compulsions associated with the obsessive compulsive disorder (OCD). The aim of this review is to evaluate the effect of religious upbringing on OCD symptoms. In fact, a variety of symptoms related to religious thoughts are more prevalent in clinical populations from countries in which religion is at the central core of the society, particularly in Muslim and Jewish Middle Eastern cultures, as compared with clinical populations from the West. These findings suggest that clinicians should be sensitive to the fact that religious obsessions may be more prevalent in certain cultures with which they may not be well acquainted.

Cultural Characteristics↗

[Obsessive phenomena in schizophrenic adolescents].

Adolescent schizophrenics show obsessive-compulsive symptoms as often as adult patients. Obsessive-compulsive symptoms occur generally both in premorbid and post-acute states, whereas they are rarely observed in acute states. A particular preference of any schizophrenic subgroup doesn't seem to exist. Obsessive-compulsive phenomena are not the same as coping-techniques or (pseudo)-neurotic defense mechanisms, and don't allow a prediction of a distinct outcome. The relationship between schizophrenia and obsessive-compulsive symptoms is variable, and doesn't follow a set pattern.

Adolescent↗

Clonazepam treatment of obsessions and compulsions.

Obsessive compulsive disorder has recently been successfully treated with antidepressants that selectively inhibit serotonin reuptake, and a serotonergic hypothesis related to the etiology and treatment of obsessive compulsive disorder has been proposed. Clonazepam, a novel benzodiazepine, uniquely affects serotonergic neurotransmission. It has been employed in the treatment of other neuropsychiatric syndromes that respond to serotonergic medications. Three patients with obsessive compulsive disorder who were treated with clonazepam for periods of up to 1 year experienced substantial improvement in their symptoms. Clonazepam had a rapid onset of antiobsessive action with accompanying decreases in both depression and anxiety. One patient showed reductions in obsessions and compulsions that were equivalent to or greater than those seen during previous treatment with clomipramine: Clonazepam may be a useful alternative to serotonergic antidepressants in patients who cannot tolerate the toxic effects of these medications.

Adult↗