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The perseveration of checking thoughts and mood-as-input hypothesis.

This paper describes two experiments designed to investigate how a current model of task perseveration, the mood-as-input hypothesis, might be applied to activities relevant to compulsive checking. The mood-as-input hypothesis predicts that perseveration at an open-ended task will be determined by a combination of the "stop rules" adopted for the task, and the valency of the mood state in which the task is conducted. Experiment 1 required participants to generate items that should be checked for safety/security if they were leaving their home unattended. Experiment 2 used an analogue recall task, in which participants were asked to recall items from a comprehensive list of items that should be checked if they were to leave their home safe/secure. Both experiments found that perseveration at the tasks was determined by particular configurations of mood and stop rules for the task. Of most relevance to compulsive checking was the fact that facilitated perseveration occurred when participants were asked to undertake the tasks in a negative mood using "as many as can" stop rules. Implications for the factors that develop and maintain compulsive checking are discussed.

Adolescent↗

The contribution of thought-action fusion and thought suppression in the development of obsession-like intrusions in normal participants.

Both thought-action fusion (TAF: i.e., a cognitive bias implying an inflated sense of responsibility for one's own thoughts) and thought suppression have been claimed to contribute to the development of obsession-like intrusions. Therefore, it seems plausible that conjunction of these phenomena results in highly intense intrusions. However, possible interactions between TAF and thought suppression have not yet been investigated experimentally. In the current study, healthy volunteers were exposed to a TAF-like intrusion. They were, then, randomly assigned to a suppression (n=21) or non-suppression condition (n=19). Next, visual analogue scales (VASs) were completed measuring anxiety, feelings of responsibility and guilt, urge to neutralise and so on. Contrary to expectation, several VAS scores were lower for participants in the suppression group than for those in the non-suppression group. Hence, it is concluded that thought suppression may, at least in the short term, alleviate discomfort caused by TAF-like intrusions.

Adolescent↗

Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder.

UNLABELLED: Patients with Body Dysmorphic Disorder (BDD) may spend many hours in front of a mirror but little is known about the psychopathology or the factors that maintain the behaviour. A self-report mirror gazing questionnaire was used to elicit beliefs and behaviours in front of a mirror. Two groups were compared, which consisted of 55 controls and 52 BDD patients. RESULTS: Prior to gazing, BDD patients are driven by the hope that they will look different; the desire to know exactly how they look; a belief that they will feel worse if they resist gazing and the desire to camouflage themselves. They were more likely to focus their attention on an internal impression or feeling (rather than their external reflection in the mirror) and on specific parts of their appearance. They were also more likely to practise showing the best face to pull in public or to use "mental cosmetic surgery" to change their body image than controls. BDD patients invariably felt worse after mirror gazing and were more likely to use ambiguous surfaces such as the backs of CDs or cutlery for a reflection. CONCLUSION: Mirror gazing in BDD consists of a series of complex safety behaviours. It does not follow a simple model of anxiety reduction that occurs in the compulsive checking of obsessive-compulsive disorder. The implications for treatment are discussed.

Adult↗

Obsessionality and the attempted suppression of unpleasant personal intrusive thoughts.

To explore the role of the thought enhancement and thought rebound effects in obsessionality, the relationship between obsessional symptomology and responding during and after the attempted suppression of unpleasant personal intrusive thoughts was examined. Ss first completed the Maudsley Obsessive Compulsive Inventory (MOCI) [Rachman and Hodgson, 1980]. Later, Ss indicated their most frequent intrusive thought and then completed a thought suppression protocol in which they first expressed, then suppressed, and, again, expressed that thought. Ss' scores on the MOCI were examined in relation to their pattern of responding in the suppression protocol to investigate whether Ss who were higher in obsessionality were more prone to enhancement and/or rebound effects with an unpleasant personal intrusive thought than Ss who were lower in obsessionality. The following results were obtained: (1) there was a positive relationship between obsessionality levels and thought enhancement for female Ss; (2) there was a negative relationship between obsessionality levels and thought enhancement for male Ss; and (3) there was no relationship between obsessionality levels and thought rebound. These findings suggest that the rebound effect is unrelated to obsessionality and that the enhancement effect relationship to obsessionality may be more complex than previously hypothesized.

Adult↗

Thought suppression produces a rebound effect with analogue post-traumatic intrusions.

Attempts to suppress traumatic material may be involved in the development and maintenance of post-traumatic stress disorder (PTSD). In order to investigate this possibility, analogue post-traumatic intrusions were induced in normal participants by means of a distressing film. For comparison, a second film was used to induce intrusions about polar bears. It was hypothesized that the suppression of these intrusions would produce an immediate decrease but a delayed increase ("rebound effect") in their frequency. It was also predicted that the rebound effect would be larger for the analogue traumatic intrusions. Each film was followed by two consecutive time periods during which participants' thoughts were recorded. During the first period, the suppression group was instructed to suppress thoughts about the film whilst the control group merely recorded their thoughts. During the second period, both groups merely recorded their thoughts. The results supported the immediate decrease hypothesis for both types of intrusion. As predicted, there was a rebound effect for analogue traumatic intrusions although not for polar bear thoughts. Several methodological issues relating to the findings are highlighted. The possible implications of a rebound effect with trauma-relevant intrusions are discussed with reference to PTSD.

Adult↗

The effect of attempted thought suppression in acute stress disorder.

Attempted suppression of traumatic memories was investigated in survivors of motor vehicle accidents with acute stress disorder (ASD; n = 24) and without ASD (n = 24). Participants monitored their trauma-related thoughts for three 5-minute periods. In Period 1, participants were instructed to think about anything. For Period 2, participants were administered suppression or non-suppression instructions relating to thoughts of the trauma. In Period 3, participants were again instructed to think about anything. ASD participants reported higher ratings of anxiety, frequency of trauma-related thoughts, and attempted suppression of trauma-related thoughts than non-ASD participants. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression.

Accidents, Traffic↗

Appraisal and control of sexual and non-sexual intrusive thoughts in university students.

This study examined differences in the appraisal and thought control strategies associated with the perceived control of unwanted sexual and non-sexual intrusive thoughts. Eleven appraisal dimensions, subjective physiological arousal and 10 thought control strategies were measured in 171 university students who were administered the Revised Obsessive Intrusions Inventory-Sex Version, a self-report measure of unwanted intrusive thoughts. Thought-action fusion (TAF) likelihood was a significant unique predictor of the perceived controllability of respondents' most upsetting sexual and non-sexual intrusive thought. Moreover greater subjective physiological arousal was a significant predictor of reduced control over sexual intrusions, whereas worry that one might act on an intrusive thought and greater effort to control the intrusion were significant unique predictors of the control of non-sexual intrusive thoughts. Various thought control strategies were more often used in response to non-sexual than sexual cognitions. The results are discussed in terms of the differential role of various appraisal processes in the control of unwanted sexual and non-sexual thoughts.

Adolescent↗

Dopamine uptake by platelet storage granules in first-degree relatives of Tourette's syndrome patients.

BACKGROUND: Considering that platelets have been established to be good peripheral markers for the study of catecholaminergic neurons, we have applied an assay to measure the uptake of (3H)-dopamine (DA) into platelet storage granules (PSG). Recently, we reported that Tourette's syndrome (TS) patients (pts) show decreased DA uptake into PSG. METHODS: In the present study, 28 first-degree relatives (3 with chronic motor tics, 3 with transient tics, 6 with obsessive-compulsive behavior, and 16 without symptomatology) belonging to the families of 13 patients, and 14 unrelated healthy controls were studied. RESULTS: Double reciprocal plots were constructed for each subject, and the apparent maximum velocity (Vmax) and Michaelis constant (K(m)) were determined by linear regression analysis (Lineaweaver-Burke plots). The uptake of DA (0.5-5 mumol/L) (mean +/- SEM) by PSG from relatives with symptomatology was similar to the TS patients (symptomatic relatives Vmax 181 +/- 22.2 fmol/mg protein, K(m) (mumol/L) 6.42 +/- 0.29; TS pts Vmax 108 +/- 6.9, K(m) 7.79 +/- 0.64). Relatives without symptomatology on the contrary showed DA affinity characteristics similar to the controls (t test, paired t test, multivariate analysis of variance, and log transformation). CONCLUSIONS: The data presented suggest that TS is hereditary, but they do not distinguish between an autosomal dominant inheritance and a mixed or polygenic model.

Blood Platelets↗

Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III.

BACKGROUND & AIMS: Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a biological disease marker is similar to irritable bowel syndrome, in which many patients exhibit visceral hyperalgesia. This study tested the hypothesis that duodenal-specific visceral afferent sensitivity exists in patients with SOD type III. METHODS: Eleven patients with chronic abdominal pain after cholecystectomy and 10 controls underwent duodenal and rectal barostat studies to evaluate visceral pain perception measured with a visual analog scale. All subjects underwent psychological testing. RESULTS: Patients with SOD type III exhibited duodenal but not rectal hyperalgesia compared with controls. There were no differences in duodenal compliance between the groups. Duodenal distention reproduced symptoms in all but 1 patient. Patients showed high levels of somatization, depression, obsessive-compulsive behavior, and anxiety. CONCLUSIONS: Patients with SOD type III exhibited duodenal-specific visceral hyperalgesia, and duodenal distention reproduced symptoms in all but 1 patient. Abdominal pain in these patients may not originate exclusively from the biliary tree.

Abdominal Pain↗

Follow-up investigation in patients with anorexia nervosa.

Sixty-three female patients with anorexia nervosa were assessed for outcome, on average 27.5 months after treatment. The treatment program, in a general adolescent medical service, is multidisciplinary, stressing appropriate weight gain in conjunction with various therapeutic modalities. Half the group required at least one hospitalization; the remainder received treatment as outpatients. Mean weight of the patients was 41.8 kg at first contact, 46.2 kg at conclusion of treatment, and 52.2 kg at follow-up. Average height at the time of follow-up was in the 38th percentile. Average weight was in the 15th percentile at first contact, and in the 29th percentile at follow-up. Current weight is 8% below ideal. Ninety-three percent of the patients had amenorrhea at diagnosis, and 9.5% at follow-up. Vomiting declined from 59% of patients to 16%. Vomiting was significantly associated with poor outcome. The majority function successfully, academically and vocationally. Most continue to restrict diet, and 79% consider themselves overweight. Forty percent report chronic feelings of depression, and 22% have unsatisfactory social relationships. The data suggest no difference in outcome between those receiving psychotherapy (65%) and those who did not (35%). Type and duration of therapy were also not associated with long-range improvement.

Adolescent↗

Of human bondage: food craving, obsession, compulsion, and addiction.

Is it more than a linguistic accident that the same term, craving, is used to describe intense desires for both foods and for a variety of drugs of abuse? There is strong evidence for common pathways that are affected by most addictive drugs. As the other contributors to this volume will indicate, a strong case can also be made for some shared substrates for food and drug rewards in animals. There has been less explicit work on this topic in humans but many lines of evidence support the common mechanism view: Opioid peptides seem to influence food palatability for humans. There is mounting evidence for comorbidity between drug/alcohol abuse and excessive craving or liking for sweets. Anecdotally, elderly individuals tend to 'age-out' of drug abuse, and the elderly also experience markedly fewer food cravings with age. If we focus on the compulsive aspects of food and drug cravings, there is also evidence for overlap: for example, activity in the orbitofrontal cortex is associated with cocaine and alcohol craving. This area is also implicated in the pathology of obsessive-compulsive disorder. Although there is no direct evidence of orbitofrontal involvement in food cravings, there is indirect evidence such as higher than expected co-occurrence of obsessive-compulsive behavior and eating disorders. As a result of bringing together evidence for common substrates for food and for drug rewards, we hope to be able to advance fundamental knowledge of motivational processes and to promote the development of better treatments for drug addiction and for eating disorders.

Animals↗

Postpartum psychiatric disorders.

This review summarises the psychiatry of the puerperium, in the light of publications during the past 5 years. A wide variety of disorders are seen. Recognition of disorders of the mother-infant relationship is important, because these have pernicious long-term effects but generally respond to treatment. Psychoses complicate about one in 1000 deliveries. The most common is related to manic depression, in which neuroleptic drugs should be used with caution. Post-traumatic stress disorder, obsessions of child harm, and a range of anxiety disorders all require specific psychological treatments. Postpartum depression necessitates thorough exploration. Cessation of breastfeeding is not necessary, because most antidepressant drugs seem not to affect the infant. Controlled trials have shown the benefit of involving the child's father in therapy and of interventions promoting interaction between mother and infant. Owing to its complexity, multidisciplinary specialist teams have an important place in postpartum psychiatry.

Antidepressive Agents↗

Hypercalculia in savant syndrome: central executive failure?

BACKGROUND: The existence of outstanding cognitive talent in mentally retarded subjects persists as a challenge to present knowledge. We report the case of a 16-year-old male patient with exceptional mental calculation abilities and moderate mental retardation. METHODS: The patient was clinically evaluated. Data from standard magnetic resonance imaging (MRI) and two 99mTc-ethyl cysteine dimer (ECD)-single photon emission computer tomography (SPECT) (in resting condition and performing a mental calculation task) studies were analyzed. RESULTS: Main neurologic findings were brachycephalia, right-side neurologic soft signs, obsessive personality profile, low color-word interference effect in Stroop test, and diffuse increased cerebral blood flow during calculation task in 99mTc-ECD SPECT. MRI showed anatomical temporal plane inverse asymmetry. CONCLUSIONS: Evidence appears to support the hypothesis that savant skill is related to excessive and erroneous use of cognitive processing resources instigated by probable failure in central executive control mechanisms.

Adolescent↗

Worry themes in primary GAD, secondary GAD, and other anxiety disorders.

This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.

Adaptation, Psychological↗

Infection: a stimulus for tic disorders.

The object of this study was to investigate the potential association of infections, especially group A hemolytic streptococcal infection, with the abrupt onset/exacerbation of tics or obsessive-compulsive behaviors. A structured clinical interview was used to evaluate 80 consecutive children, 5-17 years of age, with a diagnosis of tic disorder. Forty-two patients (53%) described a sudden, explosive onset or worsening of tic symptoms; 15 of these 42 had their exacerbation historically associated with an infection, nine of the 15 specifically with a streptococcal infection. Comparisons between those nine individuals and the remainder of the study population are presented. The results of this study reveal that descriptions of an abrupt tic onset or exacerbation are not uncommon in children with tic disorders; approximately 11% of children with tic disorders described abrupt changes of tic behavior within a 6-week period after a streptococcal infection.

Adolescent↗

Basal ganglia germinoma with progressive cerebral hemiatrophy.

The authors describe a 7-year-old Chinese-American female with a germinoma of the basal ganglia who presented with progressive hemiparesis and cerebral hemiatrophy. The additional finding of markedly elevated antiphospholipid antibodies suggests the possibility of an autoimmune pathogenesis for the progressive cerebral atrophy, as well as the later development of cognitive decline, tics, and obsessive-compulsive behaviors.

Antibodies, Antiphospholipid↗

Self-induced carving and scarification of the forearms as a manifestation of sexual abuse in a 14-YEAR-old adolescent girl

Background: Numerous cutaneous abnormalities have been described in adolescent girls who have been sexually abused. These include bruising, bite marks, cuts, scratches, abrasions, edema, hematomas or other evidence of struggle. Victims frequently shower or bathe excessively in an effort to cleanse their skin following such an unwanted encounter. However, there is a paucity of information in the literature regarding the association of sexual abuse and removal of the superficial layers of the skin as a more desperate attempt by teenagers to rid themselves of the perpetrator. The purpose of this paper is to heighten awareness among practitioners that self-induced cutting and carving of the forearms with scarification may occur as a manifestation of sexual abuse in young women.Methods: A 14-year-old girl was seen in an adolescent medicine consultation setting during the spring of 1999 for evaluation of an anxiety disorder. During the interview the girl related that she had been under considerable stress and that she was having difficulty sleeping. She also had worsening of facial tics that had been previously noted in association with obsessive compulsive behaviors. She had been receiving psychotherapy and was being treated with fluoxetine, but the symptoms were becoming more severe. On examination she appeared very anxious and demonstrated numerous involuntary, repetitive facial grimaces. Similar twitching movements of the neck were also noted. In addition, she had several well healed scars over both forearms. The lesions were linear with a range of one half to one inch in width and three to four inches in length. The remainder of the general physical examination was entirely unremarkable.Results: The etiology of the scars was initially unknown. Upon further questioning the patient was asked directly about what had caused these marks. At that point she broke down and cried as she related that had been sexually assaulted several months earlier. She stated that she carved out tatoos on her arms to get rid of the skin that the perpetrator had touched when he forcibly held her down and raped her. She believed that the scars were "clean" as they were covered with newly regenerated skin. Her gynecologic exam was normal. Further psychiatric intervention was then obtained as it became very apparent that the patient had numerous unresolved emotional conflicts stemming from the attack. Conclusions: This paper documents that carving and scarification of the forearms may be due to self-induced injury in adolescent girls who have been the victims of a sexual assault. Clinicians who care for teens should be aware of this finding as it appears to be an important dermatologic manifestation of sexual abuse. Early recognition of this sign and prompt treatment of the underlying psychiatric issues are essential to an optimal outcome so that any further complications following such a traumatic event can be minimized.

Journal Article↗