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PubMed1995

Effects of acute intravenous clomipramine on obsessive-compulsive symptoms and response to chronic treatment.

The aim of this study was to test the hypothesis that obsessive-compulsive symptoms are temporarily worsened by acute intravenous clomipramine, suggesting that there is a basal hypersensitivity of serotonin (5-HT) receptors in obsessive-compulsive (OC) patients. We also investigated the relationship of the effects of acute (intravenous) and chronic (oral) administration of clomipramine. Twenty-eight OC patients were recruited. The first part of the study included placebo and clomipramine infusions and monitoring of OC symptoms by 100 mm Visual Analogue self-rated scales (VAS). There was significant worsening of obsessions in the whole sample during clomipramine infusion. The second part included standardized 10-week oral treatments with clomipramine and evaluation of clinical efficacy. Among the 18 patients who completed the second part of the study, oral clomipramine significantly reduced OC symptoms, but OC patients who had become worse after clomipramine infusion showed higher Y-BOCS scores.

Administration, Oral↗
PubMedDate not supplied

Drug treatment of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) traditionally has been considered a rare, treatment refractory disorder of psychological origin. However, OCD appears to be much more common than was previously believed. Moreover, in recent years controlled studies demonstrated that clomipramine is more effective than placebo and than other tricyclics for reducing obsessive-compulsive symptoms. Although it has been suggested that clomipramine was effective in treating obsessive-compulsive symptoms by an antidepressant mechanism, the majority of the controlled studies found that its antiobsessional effects occurred whether the patient was depressed or not. The apparent specificity of clomipramine, and, to some extent, newer serotonin selective antidepressants, suggests a serotonergic role in the psychobiology of OCD.

Clomipramine↗
PubMed1988

Obsessive-compulsive symptoms in agoraphobia: changes with treatment.

Ten patients suffering from agoraphobia with panic attacks reported significantly more obsessive-compulsive symptoms on the Comprehensive Psychopathological Rating Scale and Marks' Compulsion Checklist than healthy control subjects matched to the patients on sociodemographic variables. Behavioral treatment directed toward agoraphobia was associated with significant improvement in obsessive-compulsive complaints. On retesting, there were no significant differences in such symptoms between patients and controls. The results should alert the physician to inquire about the presence of agoraphobia in patients complaining of obsessive-compulsive disturbances.

Adult↗
PubMed1990

Urinary free cortisol levels in obsessive-compulsive disorder.

Seventeen obsessive-compulsive disorder (OCD) patients and 25 normal control subjects submitted 24-hour urine samples for measurement of urinary free cortisol (UFC). Thirteen of the 17 OCD patients submitted a second 24-hour urine collection after a 10-week trial of either clomipramine (n = 6) or placebo (n = 7). At baseline, the OCD patients had significantly higher UFC levels than the control group. After 10 weeks of clomipramine or placebo, however, the UFC levels for both OCD groups decreased and were comparable with those of the control group. Obsessive-compulsive symptomatology, as assessed by the Yale-Brown and the NIMH Global Obsessive-Compulsive Scales, improved in the clomipramine group but did not improve in the placebo group. There was a relationship between UFC levels and depressive symptoms.

Adult↗
PubMed1992

Urinary indoleamines in Tourette syndrome patients with obsessive-compulsive characteristics.

Tourette syndrome patients with high levels of obsessive-compulsive symptoms were compared with patients without these symptoms on urinary measures of serotonin and its major metabolite, 5-hydroxyindoleacetic acid (5HIAA). Both groups were compared with normal controls, and it was hypothesized that patients with obsessive-compulsive symptoms would have lower levels of serotonin. Both groups of Tourette syndrome patients had lower levels than controls, but there was no difference between them. Obsessive symptoms were related to higher levels of 5HIAA and to a higher turnover of serotonin.

Adolescent↗
PubMed1994

The Yale-Brown Obsessive-Compulsive Scale: measures of internal consistency.

We examined the construction of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and performance of subscale items based on data from 204 patients with obsessive-compulsive disorder (OCD) who participated in a multicenter drug treatment study. Factor analysis was used to examine the relationship among the 10 items that make up the Y-BOCS instrument. Models were computed in which both two- and three-factor solutions were estimated. Within the two-factor solution analyses, the factor distribution was not so consistent as in the three-factor solution analyses, and a shift in the factor distribution was noted after treatment. In the three-factor solution analyses, an independent resistance construct emerged in addition to the obsessive and compulsive constructs. Examination of the postreatment factor scores showed that the Y-BOCS resistance items did not assess OCD symptom change as sensitively as the rest of the Y-BOCS items did.

Adult↗
PubMed1985

Fluoxetine in the treatment of obsessive compulsive disorder.

In a 9-week open-label study, 7 outpatients with obsessive compulsive disorder were treated with fluoxetine, a selective inhibitor of neuronal reuptake of serotonin. A significant improvement was found in the symptomatology of patients as measured on the obsessive compulsive subscale of the Comprehensive Psychopathological Rating Scale (p less than 0.001) and the Clinical Global Impression of severity of illness (p less than 0.01). These findings support the hypothesis that serotoninergic antidepressants may be useful in the treatment of obsessive compulsive disorder.

Adult↗
PubMed1985

Tricyclic response in obsessive compulsive disorder.

Therapeutic responses to the tricyclic antidepressant clomipramine have been demonstrated in five double blind studies of patients with obsessive compulsive disorder. Biological alterations in patients with obsessive compulsive disorder resemble those of depressed patients for the dexamethasone suppression test, for some measures of sleep physiology, and in similar neuroendocrine responses to clonidine. Clomipramine's antiobsessional effect does not require high baseline depression ratings or biological abnormalities similar to those seen in depressives. Preliminary results suggest that in contrast to depressives, patients with obsessive compulsive disorder may respond to clomipramine but not to the tricyclic antidepressant desipramine.

Adolescent↗
PubMed1996

Obsessive compulsive disorder and depression--first results of a prospective study on 74 patients.

1. Seventy-four patients who met DSM-III-R criteria for Obsessive Compulsive Disorder received a serotonin reuptake inhibitor and cognitive behavior therapy for 6 months (baseline to follow-up I). 2. In order to maximize therapeutic effects, different kinds of treatment were applied between follow-up I and follow-up II (12 months). 3. Patients were followed-up twice with respect to long-term outcome of obsessive compulsive disorder and depression. Forty % of the sample showed marked improvement at follow-up. No specific variant of treatment could be identified to be significantly more effective. 4. Cross-sectional investigations showed significant correlations between extent of depressive and obsessive compulsive symptomatology (admission, follow-up I and II).

Adolescent↗
PubMed1991

Current treatment approaches to obsessive-compulsive disorder.

The two most useful treatments in obsessive-compulsive disorder are pharmacotherapy with potent serotonin reuptake-blocking agents and behavioral techniques, such as exposure and response prevention. Based on the authors' cumulative clinical experience, it is suggested that patient education, cognitive therapy, and psychodynamic psychotherapy are helpful adjuncts during various treatment stages of obsessive-compulsive disorder. The patient's strengths and knowledge of the illness can be used by the nurse-therapist to determine the implementation and timing of these therapeutic measures. Specific behavioral and cognitive techniques that may be useful in treating specific symptoms of obsessive-compulsive disorder are highlighted. Suggestions for future nursing research are outlined.

Behavior Therapy↗
PubMed2004

Effects of suppressing neutral and obsession-like thoughts in normal subjects: beyond frequency.

Recent cognitive-behavioral theories on obsessive-compulsive disorder (OCD) show that deliberate attempts to suppress intrusive and undesirable thoughts lie at the genesis of clinical obsessions. In this paper the results of an experimental study on the suppression of neutral and obsession-like thoughts in normal subjects are presented. Eighty-seven university students performed in three experimental periods: (1) base-line monitoring, (2) experimental instruction, and (3) monitoring. For each of these periods, the frequency of the occurrence of a "white bear" thought or a personally relevant intrusive thought was registered. Half of the subjects received instructions to suppress the target-thought in period 2, and the other half were instructed to only monitor the target-thought in each of the experimental periods. Several measures were also obtained before and after the experiment: annoyance caused by the intrusion, suppression effort, subjective success, and evaluative appraisals of the target-thought. The results showed neither immediate nor delayed frequency increases of the target thought. However, evidence was found that deliberate thought suppression efforts, regardless of their content, had greater negative consequences than did non suppression. These results are discussed in relation to the recent cognitive proposals about OCD.

Adult↗
PubMed2005

Inferential confusion in obsessive-compulsive disorder: the inferential confusion questionnaire.

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.

Adolescent↗
PubMed2005

A cognitive behavioral workshop for subclinical obsessions and compulsions.

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.

Adolescent↗
PubMed2005

The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study.

Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms.

Adolescent↗
PubMed2006

Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study.

Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands. Hoarding in relatives was associated with indecision in probands, independently of proband hoarding status. The findings suggest that hoarding behavior may help differentiate a distinct clinical subgroup of people with OCD and may aggregate in some OCD families. Indecision may be a risk factor for hoarding in these families.

Adolescent↗
PubMedDate not supplied

The predictors of health care seeking behavior in obsessive-compulsive disorder.

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non-health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly higher levels of QOL in psychological health and level of independence domains [corrected]. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals' ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD.

Adult↗
PubMedDate not supplied

A quick and reliable screening measure for OCD in youth: reliability and validity of the obsessive compulsive scale of the Child Behavior Checklist.

BACKGROUND: The high prevalence and morbidity of obsessive compulsive disorder (OCD) in youth, the secretive nature of the disorder leading to under-recognition, and the lack of specialized child psychiatry services in many areas suggest that a simple, quick, and reliable screening tool to identify cases could be very useful to clinicians who work with children. METHOD: We used 8 items from the Child Behavior Checklist (CBCL), an empirically derived instrument free of clinician bias, to investigate the usefulness of a previously reported CBCL-based obsessive compulsive scale (OCS) by Nelson et al [Nelson EC, Hanna GL, Hudziak JJ, Botteron KN, Heath AC, Todd RD. Obsessive-compulsive scale of the Child Behavior Checklist: Specificity, sensitivity, and predictive power. Pediatrics 2001;108(1):E14] in a separate cohort of youth with OCD. We computed the psychometric properties of the OCS in our sample of youth with OCD and in psychiatric and normal controls, and compared these to the published values. RESULTS: Using the recommended cutoff between the 60th and 70th percentiles of the OCS to best predict the presence of OCD, we found very high sensitivity (92%-78%), specificity (86%-94%), negative predictive value (96%-90%), and positive predictive value (77%-86%). CONCLUSIONS: The OC scale of the CBCL shows good reliability and validity and acceptable psychometric properties to help discriminate youth with OCD.

Case-Control Studies↗
PubMedDate not supplied

Obsessive-compulsive disorder in a dermatology outpatient clinic.

OBJECTIVE: The aims of present study were to (a) to determine the prevalence of obsessive-compulsive disorder (OCD) in dermatological patients, (b) to determine the possible relationship between dermatological lesions and OCD and (c) to determine the clinical and phenomenological features of the OCD subgroup. METHOD: The sample consisted of 166 out of 250 consecutively presenting dermatological patients who agreed to participate in the study. The subjects were assessed with the Structured Clinical Interview for DSM-IV Turkish Version (SCID-I) and also completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Of the whole sample, 41 (24.7%) met DSM-IV criteria for OCD. Only 14.6% of them had previously been diagnosed as OCD. The mean score of Y-BOCS in the OCD group was 17.05 +/- 9.75. The most common obsessions were contamination (61%) and pathologic doubt (53.7%), while washing (61%) and checking (51.2%) were the most frequent compulsions. Those suffering from diseases of sebaceous glands were the only group that showed a significant difference between the OCD and non-OCD group. CONCLUSION: There is a high prevalence of OCD in dermatological patients, although the nature of the relationship between OCD and dermatology has not previously been ascertained. Genetic-based studies and future researches focused on individual anxiety, and sensitivity may provide information that better explains this relationship.

Ambulatory Care Facilities↗