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PubMedDate not supplied

[The obsessive-compulsive syndrome: reflection of fronto-caudate dysregulation of the left hemisphere?].

Neuropsychological studies of the obsessional syndrome reveal bilateral frontal dysfunction. Early onset is characteristic of males, who have a more chronic course than females, and who are more often non-dextral. Hypermetabolic activity of the frontal and caudate, bilaterally, is found in most PET investigations, although one report is of relative hypofrontality and global cortical hypometabolism for absolute values. Given the frequency with which basal ganglia disease leads to obsessive-compulsive phenomena (Cf Sydenham's Chorea, Gilles de La Tourette) and frontal lobe inertia, a perturbation of frontal-caudate regulatory motor and ideational sub-systems in the obsessional syndrome appears probable. Bilateral caudate atrophy on CT scan has been reported. Further, EP investigations, both somatosensory and auditory, implicate the left hemisphere in obsessions; together with reduced P300 latencies and during imaginal flooding there is increased left (frontal) hemisphere flow (rCBF). Single case studies document the relationship of obsessions to left frontal-left caudate unilateral pathology. It is suggested that lateralized dysregulation of the left fronto-caudate network is the major cerebral determinant of obsessive-compulsive states.

Brain Diseases↗
PubMed1990

A clomipramine dosage reduction study in the course of long-term treatment of obsessive-compulsive disorder patients.

Ten patients with DSM-III-R obsessive-compulsive disorder (OCD) who were being treated chronically with clomipramine (270 +/- 20 mg/day) were studied to determine the minimum dose of clomipramine needed to maintain therapeutic benefit. These 10 patients were among the 17 of 18 patients recently reported to develop a return of OC symptoms following discontinuation of clomipramine under double-blind, placebo-controlled conditions. Each patient was rated twice--open and double-blind--at both initial and minimum doses of clomipramine, using the following three OC measures: the Yale-Brown Obsessive Compulsive Scale (YBOCS), the National Institute of Mental Health-Obsessive Compulsive Scale (NIMH-OC), and the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH Global OC Scale). Gradual, open dosage reduction resulted in a mean dosage of 165 +/- 19 mg/day, a reduction of 105 mg/day (approximately 40%, t = 5.55, p less than .001). This decrease in dose was accompanied by no significant change in the three OC measures, as determined by paired t-test. These results suggest that even though OCD patients were not able to discontinue medication completely, they were able to do well at lower doses than those used initially in treatment of the disorder.

Adult↗
PubMed1990

Results of a double-blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive-compulsive disorder.

Eighty-seven patients with a DSM-III diagnosis of obsessive-compulsive disorder (OCD) without depression were entered into a double-blind, placebo-controlled study of the efficacy of sertraline, a new serotonin uptake inhibitor. After a 1-week washout period, patients were randomly assigned to receive either placebo or sertraline. After a 2-week titration period in which the once-daily sertraline dose was increased from 50 mg/day to a maximum of 200 mg/day, dosage was maintained until the end of the eighth week, then patients were titrated off medication over the next 2 weeks. Efficacy was measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), NIMH General Obsessive-Compulsive Scale, Maudsley Obsessive Compulsive (MOC) Inventory, and Clinical Global Impressions (CGI) Severity and Improvement scales. Results on the MOC Inventory showed trends in favor of active drug that were not statistically significant compared with placebo. Results of the Y-BOCS total score, the NIMH score, and the global severity and improvement scores demonstrated a statistically significant superiority of sertraline compared with placebo.

1-Naphthylamine↗
PubMed1990

Phenomenology of obsessive compulsive disorder.

A syndrome related to obsessive compulsive disorder (OCD) has been recognized for more than 300 years. Early descriptions focused on different aspects of this syndrome, reflecting the prevailing culture of the observer. English explanations stressed religious aspects and a relationship to melancholy. French phenomenologists emphasized the importance of doubt and loss of will. The German view focused on the irrational nature of the thoughts, finding a link to psychosis. Currently, OCD is considered an anxiety disorder in which either obsessions or compulsions contribute to significant distress or interference with functioning. However, obsessions and compulsions are also part of normal mental life. One current challenge is to understand the relationship between normal obsessions and compulsions and those that lead to interference and distress. The author presents a working model which helps resolve issues relating to our understanding of OCD.

History, 17th Century↗
PubMed1989

Conceptual and methodological issues in studies of obsessive-compulsive and Tourette's disorders.

An association between recurrent motor and phonic tics and obsessive-compulsive behaviors has been noted since Tourette's Syndrome (TS) was first described. Obsessive-compulsive disorder (OCD) until recently was considered a rare disorder with poor prognosis. Currently, OCD is considered among the most common psychiatric diagnoses, and new treatments have spurred the development of considerable clinical, epidemiological, genetic, and biological research. Recent studies suggest a high rate of obsessive-compulsive symptoms in Tourette's Syndrome patients. A high rate of OCD among relatives of TS probands, both with and without OCD symptoms, suggest that some forms of OCD may represent an alternative expression of factors responsible for TS and/or chronic motor tics. Areas of conceptual controversy in the differentiation of tics, impulsions, and compulsions are discussed, confusing aspects of differential diagnosis are explored, and the relationship of diagnostic issues to clinical and familial studies are highlighted. There is considerable evidence for neuropsychiatric abnormalities in both OCD and TS; however, no studies have directly compared both disorders with similar methodological design. While studies of neurotransmitter function have primarily implicated dopaminergic dysfunction in TS and serotonergic function in OCD, other systems may be involved in each disorder, and neurotransmitter systems may be tightly linked, such that alterations of one system will affect other systems. This article reviews and discusses some of the conceptual and methodological issues associated with clinical, familial, neuropsychiatric and biological studies attempting to elucidate the association among tics, obsessive-compulsive disorder, and Tourette's Syndrome.

Brain Damage, Chronic↗
PubMed1988

[EEG frequency analyses in children and adolescents with obsessive-compulsive neuroses].

A controlled clinical study was conducted of 25 girls and boys (mean age: 12;7 years) with obsessive-compulsive disorders and 26 patients (mean age: 13;4 years) with other neurotic disorders. None of the subjects had any organic brain disorders. The question addressed was whether there are any EEG findings specific to the group of patients with obsessive-compulsive disorders, as several authors have reported. The EEG frequency analyses (power spectra) showed abnormal findings (fronto-temporal dysfunction and/or electrobiologically delayed maturation) in two thirds of the subjects with obsessive syndromes. The difference between the two groups was not significant, however. Thus the hypothesis of specific EEG patterns in obsessive-compulsive disorders could not be supported.

Adolescent↗
PubMed1981

Obsessive-compulsive behavior: an overview of four psychological frameworks.

Four frameworks for understanding obsessive-compulsive behavior have been presented. It is apparent that there is no single, simple basis for obsessive-compulsive symptomatology. Obsessions and compulsions are manifestations of different psychological processes and may exist in conjunction with many types of mental illness in addition to those presented. With increased knowledge about the dynamics of obsessions and compulsions, the mental health professional will achieve a greater understanding of the client who expresses himself through these symptoms.

Cognition↗
PubMed1980

Antitheses and the obsessive-compulsive.

The characteristic "style" of the obsessive-compulsive is examined and is seen to be marked by an antithetical quality. The major defense mechanisms used--undoing, isolation, and reaction formation--al involve opposites: contradictory acts following each other, the keeping apart of ambivalent feeling states, and the turning of wishes into their opposites. The cognitive modes of the obsessive-compulsive are marked by dichotomies: sharply focused attention which misses essential points and a non-inclusive all-inclusiveness. The obsessive's regression to the anal phase produces ambivalent emotions, contradictory attitudes to feces and defecation and related future sublimations, and doubt over sexual identity. A harsh superego creates an alternation between obedience to it and defiance, and feelings of both perfection and imperfection. The ambivalent and contradictory early family environment is seen as an influencing factor in the creation of the antithetical style of the future obsessive-compulsive: the natural ambivalence of the anal stage is confronted by ambivalent mothering, and antitheses then predominate.

Cognition↗
PubMed1994

Predictors of treatment response in obsessive-compulsive disorder: multivariate analyses from a multicenter trial of clomipramine.

There have been many attempts to find predictors of the therapeutic response to the clomipramine treatment of obsessive-compulsive disorder. The majority of studies have failed to identify such predictors. Possible reasons for this failure include the small sample size of most studies, samples homogeneous with respect to the study factors of interest, and the use of statistical procedures that are insensitive to individual differences or that inadequately control for confounding. We have reanalyzed data from Ciba-Geigy's large, multicenter clinical trial of clomipramine for obsessive-compulsive disorder, using stratification and regression techniques to identify multiple prognostic factors and control for confounders. We assessed the relationship between therapeutic response and baseline measures such as severity of symptoms, type of symptoms (obsessions, compulsions, depression), length of illness, age of onset, and other demographic factors (age, race, and sex). We found age of onset to be a strong predictor of response to clomipramine: people who develop obsessive-compulsive disorder later in life have a better chance of responding than do those who become ill earlier, independent of length of illness. We also found that baseline depression is associated with response, but the association appears to be nonlinear.

Adolescent↗
PubMed1994

Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.

Despite advances in our understanding of the pathology and genetics of obsessive compulsive disorder (OCD) and in our ability to successfully treat patients with medications and behavioral psychotherapy, the identification of homogeneous subgroups of patients with OCD has remained elusive. Once identified, such subgroups may be found related to treatment response, biological markers, or genetic transmission of OCD. To clarify identification of symptom subtypes, my colleagues and I administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist to 107 patients with OCD and applied principal components analysis (e.g., factor analysis) to these data. We then examined the correlations between these factor scores and the presence of comorbid tic and personality disorders, which are thought to be related to OCD. We found that three factors, which we named "symmetry/hoarding," "contamination/cleaning," and "pure obsessions," best explained the symptoms of the Y-BOCS Symptom Checklist. Only the first factor was significantly related to comorbid obsessive compulsive personality disorder or to a lifetime history of Tourette's syndrome or chronic tic disorder. Implications of these findings regarding possible clinical utility are discussed.

Adolescent↗
PubMed1993

A predictive study of obsessive-compulsive disorder response to clomipramine.

Studies on predictive factors of the obsessive-compulsive disorder response to pharmacologic treatment, specifically clomipramine, are relatively scarce. Forty-five patients treated for a mean period of 18.6 months were classified as having poor response, intermediate response and excellent response, defined by change scores on the Yale-Brown Obsessive-Compulsive Scale. Poor and intermediate response patients were grouped together and compared with the excellent response subgroup. Univariate analysis showed length of illness, family history (siblings), initial compulsiveness score, and cleaning rituals as significant predictors. Two multiple regression analyses with these as independent or predictive variables showed higher initial scores on the Yale-Brown Obsessive-Compulsive Scale associated with poorer response to treatment but, most importantly, cleaning rituals as a predictor of poor or modest response to clomipramine. It may be important for the clinician to assess cleaning habits separately from the more frequently mentioned obsessive-compulsive symptom, hand washing. This distinction may have important clinical, therapeutic, and prognostic implications.

Adult↗
PubMed1996

Risperidone augmentation of SRI treatment for refractory obsessive-compulsive disorder.

BACKGROUND: Although serotonin reuptake inhibitors (SRIs) are the mainstay of pharmacologic treatment for obsessive-compulsive disorder (OCD), many patients do not have an adequate response to these medications. One approach to treating SRI-refractory OCD patients has been to add other classes of medications to the SRI. We predicted that augmentation with risperidone would alleviate symptoms in SRI-refractory OCD patients. METHOD: 21 patients were treated openly with the combination of an SRI and adjunctive risperidone (mean dose = 2.75 mg/day). All met DSM-IV criteria for obsessive-compulsive disorder and had a variety of comorbid disorders. Prior to addition of risperidone, all patients had failed to respond to at least one adequate trial of an SRI. Response was determined by clinical judgment and standardized rating scales. RESULTS: 5 (24%) of the 21 patients experienced side effects (most commonly, akathisia), which forced discontinuation of risperidone. Of the 16 patients who tolerated combined treatment, 14 (87%) had substantial reductions in obsessive-compulsive symptoms within 3 weeks. Patients with horrific mental imagery had the strongest and fastest response, often within a few days. Patients with comorbid psychotic disorders improved gradually over 2 to 3 weeks. Patients with comorbid tic disorders had the poorest rate of response and highest rate of akathisia. CONCLUSION: These results suggest that risperidone augmentation is effective and well tolerated in patients with SRI-refractory obsessive-compulsive disorder. Response to risperidone augmentation appears to be influenced by symptom subtypes and comorbid conditions. Controlled trials are required to confirm the efficacy of risperidone augmentation for refractory OCD.

Adult↗
PubMedDate not supplied

[Clinical aspects of obsessive-compulsive syndromes: results of phase 2 of a large French survey].

Obsessive-Compulsive Disorder (OCD) had received a new interest from fundamental research (psychopharmacology, neurobiology and brain imagery...). Although more investigation of OCD clinical aspects are needed, especially in large cohorts of patients, not seen nor investigated only in high specialized psychiatric units. A large french survey "Screening-Understanding-Treating OCD" was conducted in 1994 with the participation of 240 psychiatrists. The survey had included 4,363 new consecutive patients consulting in out-patient psychiatry. The phase 1 had shown a point prevalence rates of 9.2% for OCD (full criteria of DSM III-R) and 17% for OCS (Obsessive-Compulsive Syndromes). From 731 patients, the phrase 2 was conducted on a cohort of 646 patients with OCD or OCS and had explored in details in the clinical aspects of the OC illness (typology, symptomatic categories, comorbidity, OCD spectrum, psychiatric family history and treatment history...). The results of the french survey phase 2 had confirmed a variety of classical and current literature data, especially: the ICD 10 proposal for diagnostic sub-typology according to symptomatic predominance (obsessions, compulsions or both); the symptomatic clustering of obsessions and compulsions into three major categories, suggested by a recent study from the Boston University; the high rate of comorbidity with anxiety and depressive disorders and with disorders related to the large OCD spectrum (somatoform disorders, eating disorders, impulse-control disorders, compulsive buying...); the impact of clinical parameters (as slowness, avoidance, lack of insight) on clinical global OCD and OCS severity; the high rate of intrafamilial psychiatric morbidity (OCD, depression, anxiety disorders).

Adult↗
PubMedDate not supplied

Obsessive-compulsive disorder: diagnosis and treatment in the primary care setting.

BACKGROUND: Obsessive-compulsive disorder is a common anxiety disorder found in 1 to 2 percent of the population. Obsessions are recurrent and persistent thoughts that cause marked anxiety or distress. Compulsions are repetitive behaviors or mental acts done to prevent or reduce anxiety. Patients might underreport symptoms or complain of coexisting depression or anxiety instead. The primary care physician is often the first to encounter this disorder in patients. METHODS: The authors cared for and observed a patient with obsessive-compulsive disorder at a family practice office and used her case to illustrate a literature review gathered by means of a MEDLINE search. RESULTS AND CONCLUSIONS: A combination of patient education, selective serotonin reuptake inhibitors, and behavioral techniques allow the family physician to maximize patient recovery and play a major role in the diagnosis and treatment of obsessive-compulsive disorder.

Adult↗
PubMed2001

Fluvoxamine in obsessive-compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine.

Some meta-analyses have suggested that the selective serotonin reuptake inhibitors (SSRIs) are less effective than clomipramine in the treatment of obsessive-compulsive disorder (OCD). The aim of this double-blind, randomised, multicentre study was to directly compare the efficacy and safety of fluvoxamine and clomipramine in patients with OCD. A total of 227 patients were randomised to flexible doses of fluvoxamine or clomipramine (both 150-300 mg/day) for 10 weeks. Fluvoxamine and clomipramine were both clinically effective and there were no statistically significant differences between the two treatment groups, at any visit, on the National Institute of Mental Health Obsessive-Compulsive global rating scale, the Yale-Brown Obsessive-Compulsive scale (total score and obsession and compulsion subscores), the Clinical Global Impression severity of illness and global improvement subscales, the Clinical Anxiety Scale and the 17-item Hamilton Depression Rating Scale. However, there were differences in safety between the two treatments. Compared with fluvoxamine-treated patients, those treated with clomipramine had more anticholinergic side effects (dry mouth, constipation and tremor) and premature withdrawals due to adverse events (18 versus 9). The results from this controlled study indicate that fluvoxamine is as effective as clomipramine in the treatment of OCD but has a better tolerability profile. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2003

Efficacy of telephone-administered cognitive behaviour therapy for obsessive-compulsive spectrum disorders: case studies.

Cognitive behaviour therapy is effective for obsessive-compulsive disorder and for obsessive-compulsive spectrum disorders such as trichotillomania. Unfortunately, many people with these disorders, especially those living in rural areas, have limited access to treatment. Telephone-administered cognitive behaviour therapy may help address this problem. In a recent study of telephone treatment for obsessive-compulsive disorder, we found that such treatment was often effective (42% in remission at post-treatment, and 47% in remission at 12-week follow-up). This article presents 2 case reports of the same treatment, applied to obsessive-compulsive spectrum disorders (trichotillomania and compulsive skin picking). Treatment was associated with symptom reduction for both participants, although one subsequently relapsed. Possible reasons for relapse are discussed. The findings encourage further studies to identify the characteristics of people most likely to benefit from telephone treatment for spectrum disorders.

Journal Article↗
PubMed2005

Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.

OBJECTIVE: This study tracked the individual criteria of four DSM-IV personality disorders-borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years. METHOD: This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. CONCLUSIONS: These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V.

Adolescent↗
PubMed2002

Exploratory factor analysis of obsessive-compulsive patients and association with 5-HTTLPR polymorphism.

The determination of a genetic basis for obsessive-compulsive disorder (OCD) depends on how phenotypic boundaries are defined. Although a hypothesis for serotonin dysfunction in OCD has been advanced, no genes specifically responsible for serotonin regulation have as yet been definitively related to the etiology of OCD. The phenotypic variability of OCD could be at the basis of the failure of molecular biology investigations to find any genes involved in the liability to the disorder. Obsessive and compulsive contents can aggregate in OCD patients differently; multifactorial description may therefore be able to account for OCD phenotypic variance. Using principal component analysis, we derived five factors from 13 main contents of the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and considered them as quantitative phenotypes to evaluate their possible association with an insertion/deletion polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR). A trend toward positive association between the fifth factor, including counting and repeating rituals, and 5-HTTLPR was found. However, only considering the subgroup of patients with tic codiagnosis, we found a significantly higher score for the fifth factor for patients with L/L genotype with respect to L/S and S/S genotypes.

Adolescent↗