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PubMed1998

Using objects of obsession as token reinforcers for children with autism.

We assessed the effectiveness of using objects of obsession as token reinforcers to increase task performance for children with autism. The use of obsessions as tokens (e.g., letter "A", a picture of a train) was compared with the use of typical tokens (e.g., stars, happy faces). A multiple baseline design across children with a reversal within child was used. Data were collected on percentage correct of task responses and on the occurrence of inappropriate behaviors during work sessions. Results indicated that percentage correct on task performance was higher when objects of obsession were used as tokens as opposed to when typical tokens were used. Concomitant decreases in inappropriate behaviors during work sessions were also noted. Results are discussed in terms of primary versus secondary reinforcement and the effects of saliency and novelty of the reinforcing stimuli.

Adolescent↗
PubMed2003

[Obsessive-compulsive disorders in children and adolescents--a review].

OBJECTIVE: Presented is a review of the literature on the medium- and long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. METHODS: Using the data bank MEDLINE, relevant studies published since 1983 were investigated. Older studies were included if their results complemented those of recent studies. RESULTS: Follow-up studies point to a rather unfavorable course of childhood OCD. At the time of follow-up investigations, 30% to 70% of the patients still suffered from obsessive-compulsive symptoms or had a diagnosis of OCD. Other clinical disorders were diagnosed in 20% to 95% of them. One to two thirds of former patients had received at least one diagnosis of a personality disorder. Multicomorbidity was common. Impairment of the patients' psychosocial adjustment especially affected relationships and sexuality. Most of the variables examined in childhood or adolescence had no significant predictive power as to the course of obsessive-compulsive disorders. CONCLUSIONS: Differences between the results of the follow-up studies can partly be explained by the different study designs employed. Results on the course of childhood OCD point to the high stability of the disorder and the accompanying rate of comorbidity. This has to be taken into account in the diagnosis (supplementary diagnosis of comorbid disorders and family diagnostics) and therapy of childhood OCD (offering long-term therapeutic advice and booster sessions, treatment of comorbid disorder, inclusion of the family).

Adolescent↗
PubMed2000

Symptoms of eating disorders in obsessive-compulsive disorder.

OBJECTIVE: Despite some empirical evidence suggesting an association between primary OCD and eating disorder (ED) within the 'obsessive-compulsive spectrum', the relationship at a symptomatological level has not been investigated. METHOD: First, comparisons of Eating Disorder Inventory (EDI) scores between 61 patients with primary OCD and 288 control subjects were performed. Secondly, the associations between EDI subscores and Hamburg Obsessive-Compulsive Inventory (HZI) dimensions in OCD patients were investigated by multiple regression analyses, controlling for the impact of general psychopathology. RESULTS: The OCD patients showed significantly higher EDI-scores than controls. However, only distinct OCD symptom dimensions were significantly associated with the core symptoms of ED in females. CONCLUSION: Our results point to a differential gender and symptom-specific relationship between OCD and ED, calling into question a simple dimensional conceptualization of the 'obsessive-compulsive spectrum'.

Adult↗
PubMed1996

The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program.

This article examines the hypothesis that cognitive therapy (CT) is more effective than interpersonal therapy (IPT) for treatment of depressed patients with an elevated level of avoidant personality, whereas the reverse holds for depressed patients with elevated level of obsessive personality. This hypothesis was derived in part from the preliminary results of previous unpublished pilot work, which examined the course of dynamic and cognitive therapies for avoidant and obsessive-compulsive personality disorders. With the "completer" data set available from the Treatment for Depression Collaborative Research Program (I. Elkin et al., 1989), the expected significant interactions between treatment (CT vs. IPT) and avoidance and between treatment and obsessiveness were found. A significant interaction was also found between marital status and treatment, indicating that married patients did better after CT, whereas single and noncohabiting patients improved more after IPT. Similar patterns of results were found using the Hamilton Rating Scale for Depression and the Beck Depression Inventory. A matching factor formula of patients to CT vs. IPT is presented.

Adult↗
PubMed2006

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder.

As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases of PubMed, PsychINFO (1967-2005), Embase (1974-2000) and the Cochrane Central Register of Controlled Trials (CENTRAL, as of 2005, Issue 3) were searched for relevant double-blind trials using keywords 'antipsychotic agents' or 'neuroleptics' and 'obsessive-compulsive disorder'. Search results and analysis were limited to double-blind, randomized control trials involving the adult population. The proportion of subjects designated as treatment responders was defined by a greater than 35% reduction in Yale Brown Obsessive-Compulsive Scale (Y-BOCS) rating during the course of augmentation therapy. Nine studies involving 278 participants were included in the analysis. The meta-analysis of these studies demonstrated a significant absolute risk difference (ARD) in favor of antipsychotic augmentation of 0.22 (95% confidence interval (CI): 0.13, 0.31). The subgroup of OCD patients with comorbid tics have a particularly beneficial response to this intervention, ARD=0.43 (95% CI: 0.19, 0.68). There was also evidence suggesting OCD patients should be treated with at least 3 months of maximal-tolerated therapy of an SRI before initiating antipsychotic augmentation owing to the high rate of treatment response to continued SRI monotherapy (25.6%). Antipsychotic augmentation in SRI-refractory OCD is indicated in patients who have been treated for at least 3 months of maximal-tolerated therapy of an SRI. Unfortunately, only one-third of treatment-refractory OCD patients show a meaningful treatment response to antipsychotic augmentation. There is sufficient evidence in the published literature, demonstrating the efficacy of haloperidol and risperidone, and evidence regarding the efficacy of quetiapine and olanzapine is inconclusive. Patients with comorbid tics are likely to have a differential benefit to antipsychotic augmentation.

Adult↗
PubMed1998

Combination of clomipramine and nortriptyline in the treatment of obsessive-compulsive disorder: a double-blind, placebo-controlled trial.

OBJECTIVE: There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone. METHOD: Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo. RESULTS: Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD. CONCLUSION: As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD.

Adrenergic Uptake Inhibitors↗
PubMed2002

Hoarding in obsessive-compulsive disorder and related disorders: a preliminary report of 15 cases.

Hoarding, the repetitive collection of excessive quantities of poorly useable items of little or no value with failure to discard these items over time, is characterized in DSM-IV as a symptom of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) but has, until recently, received scant empirical investigation. We describe the demographics, phenomenology, associated psychopathology and family history in 15 subjects presenting with hoarding behavior. Fifteen subjects were recruited from an OCD clinic and newspaper advertisement and assessed with the comprehensive Structured Clinical Interview for DSM-IV (SCID I and II), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and a hoarding questionnaire (devised by the authors). The sample comprised 11 women and four men who hoarded a mean of seven item types, with a mean duration of 13.2 +/- 3.9 years (range 2-15 years). Their mean age was 41.8 +/- 14.3 years (range 20-65 years). The most common motive for hoarding was the fear of discarding items of practical value. Nine subjects met DSM-IV criteria for OCD, 9 met criteria for OCPD, for symptoms and behaviors other than hoarding, while six subjects met criteria for a putative OCD spectrum disorder (Tourette's, body dysmorphic disorder, trichotillomania). Six subjects reported little or no control over their hoarding, but only one subject saw her symptoms as an 'illness' warranting treatment. Pathological hoarding is usually a covert and chronic behavior causing distress and/or impairment, and may be related to OCD and OCPD. Hoarding may meet the criterion for a compulsion in DSM-IV, yet there is evidence to suggest that hoarding may manifest in a variety of other psychiatric conditions. While a range of pharmacologic and behavioral treatments have been tried, their effectiveness in managing hoarding behaviors requires additional research.

Adult↗
PubMedDate not supplied

Comorbid conditions in obsessive-compulsive disorder.

The objective of this study was to investigate axis I comorbidity in obsessive-compulsive disorder (OCD). A total of 147 patients diagnosed as OCD for DSM-III-R criteria were included in the study. At least one comorbid axis I disorder was present in 68.7% of the patients. Major depression was the most common comorbid disorder (39.5%). Uncomplicated (n = 46) and comorbid (n = 101) OCD groups were compared with respect to the demographic variables and the scores obtained from the Hamilton Rating Scale for Anxiety (HRSA), the Hamilton Rating Scale for Depression (HRSD) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). No significant difference in terms of age, sex, marital status, age at onset, or duration of illness was found between the groups. The scores on the HRSA, HRSD, and Y-BOCS were significantly higher in the comorbidity group. Our results demonstrate that at least one psychiatric disorder is present in approximately two thirds of OCD patients, the majority being depressive disorders and anxiety disorders. The fact that comorbid conditions raise not only anxiety and depression levels, but also the severity of obsessions and compulsions, is noteworthy.

Adolescent↗
PubMed2000

Pathophysiology and treatment of secondary obsessive-compulsive behaviors and tics.

Advances in neurobiological research suggest that certain frontal-subcortical circuits play important roles in idiopathic obsessive-compulsive disorder and Tourette's syndrome. Tics and obsessive-compulsive behaviors secondary to neurologic insult appear to involve the same neural circuitry. There are few systematic studies of the treatment of obsessive-compulsive behaviors and tics associated with neurologic disorders. However knowledge of the circuitry and associated neurochemistry of these disorders can help to outline a rational approach to these behaviors.

Akathisia, Drug-Induced↗
PubMed2000

[Neurobiological aspects of the etiology and pathophysiology of obsessive-compulsive disorder].

Obsessive-compulsive disorder (OCD) is a common psychiatric illness characterized by intrusive, repetitive thoughts and behaviours which cause marked distress. During the last decade, different models were developed for the pathophysiology of the obsessive-compulsive-disorder. Three different neurobiological models are introduced in this article: 1. model of dysfunctional kortikostriatal circuitry, 2. amygdalocentric model, 3. neurochemical model. These models don't exclude themselves mutually but supplement themselves and should ideally be integrated into a biopsychosocial concept. Such increased understanding of the neurobiology can be translated into better diagnosis and treatment for those patients who suffer from obsessive-compulsive-disorder.

Humans↗
PubMed2003

[Compulsive-obsessive disorder after severe head trauma: diagnosis and treatment].

An 18-year-old man suffered a severe head trauma from a car accident. Eight months later the patient had a good general state of health. But at this time he was referred to our psychiatric hospital and he reported increased checking compulsions and aggressive obsessions. In addition there was increased impulsivity. The patient was treated with an selective-serotonin-reuptake-inhibitor (SSRI) and showed a clinical response. Obsessive-compulsive disorder (OCD) has rarely been described after traumatic brain injury. Clinical symptoms, neuropsychological dysfunctions, brain imaging and therapy are illustrated. The represented connections of the frontal brain lesions and OCD-symptoms with interventions in the serotonin system support the neurobiological hypotheses of the obsessive-compulsive disorder.

Adult↗
PubMed2006

[Subjective quality of life of patients with obsessive-compulsive disorder compared to the general population].

BACKGROUND: Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with impaired social functioning, which impact their everyday life negatively. OBJECTIVE: Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population. METHODS: 75 patients with OCD (ICD-10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. Patients showing psychiatric co-morbidity were excluded. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD and in a sample of the general population of Saxony/Germany. RESULTS: Compared with the general population, QoL in patients with obsessive-compulsive disorders was lower in all domains of the WHOQOL-BREF. CONCLUSION: OCD has a substantial adverse effect on patients' subjective QoL. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Adolescent↗
PubMed2006

Obsessive-compulsive disorder due to neuroacanthocytosis treated with citalopram. A case report.

Neuroacanthocytois is a rare hereditary disease, which causes a degeneration of the striatum. Patients develop a choreatic movement disorder and also complex psychiatric symptoms, such as psychosis or Tourette's syndrome. We report a case of obsessive-compulsive disorder due to neuroacanthocytosis. The striatum plays an important role in the pathophysiology of obsessive-compulsive disorder. In Huntington's disease we also find obsessive-compulsive disorders, due to impairment of the fronto-striatal loop. Encouraged by similar pathophysiology and promising reports of selective serotonin reuptake inhibitors in this disease, we started a treatment with citalopram to which the patient responded very well.

Adult↗
PubMed1989

[Anamnestic and psychopathologic studies of obsessive-compulsive patients].

Twenty-eight patients, that is 0.8% of all 3,225 patients admitted between 1981 and 1986 in the Free University of Berlin, Department of Psychiatry, had a primary diagnosis of obsessive-compulsive disorder (ICD-9: 300.3). These patients were compared with random samples of equal size (N = 28) of schizophrenic psychoses paranoid type (ICD 295.3), manic depressive psychoses depressed type (ICD 296.1) and neurotic depressions (ICD 300.4) using an AMDP-based multiaxial diagnostic description. It turned out, that although obsessive-compulsive patients were best discriminated from the other clinical groups by their typical symptoms, they were characterized likewise by other psychopathological, especially depressive symptoms. In view of the course of obsessive-compulsive disorder, the findings were compatible with those of other reports. Beyond it, a subgroup of patients with relatively unfavourable course could be described by AMPD-items.

Adolescent↗
PubMed1995

A seizure, and electroencephalographic signs of a lowered seizure threshold, associated with fluvoxamine treatment of obsessive-compulsive disorder.

A 38-year-old patient with severe obsessive-compulsive disorder received fluvoxamine in a clinical study. Psychometric ratings showed marked clinical improvement in the third week of fluvoxamine administration, but after 8 weeks, at a dose of 300 mg per day, he suffered a grand mal seizure after drinking a glass of beer (0.2 liter). He had no history of previous epileptic seizures. Careful neurological evaluation including computer tomography and magnetic resonance imaging of the brain revealed no signs of acute disease. EEG before the fit did not show epileptiform activity; after the fit, spikes and spike-wave complexes appeared, which disappeared upon discontinuation of fluvoxamine. Since his obsessive-compulsive symptoms had responded well to fluvoxamine and worsened after its discontinuation, the drug was cautiously reintroduced. Improvement of the obsessive-compulsive symptoms was observed again, but spikes and spike-wave complexes reappeared at a dose of 50 mg per day. Under anticonvulsant treatment with carbamazepine, fluvoxamine was increased to 100 mg per day. No seizures occurred during a follow-up to two years.

Adult↗
PubMed1998

[Development of the AMDP module for identification of obsessive- compulsive symptoms. Conceptualization and empirical results].

Results of epidemiology and comorbidity studies have recently demonstrated the psychopathological relevance of obsessive-compulsive symptoms. Therefore the "Arbeitsgemeinschaft für Methodik und Diagnostik in der Psychiatrie" (AMDP) has started to develop a rating scale for a quick and precise assessment of obsessive-compulsive symptoms. The actual version of the scale comprises 20 items on the dimensions "description", "distress and impairment" and "emotion and cognition". The results of a first empirical study (n = 137, psychiatric in- and outpatients) demonstrated excellent internal consistency (Cronbach's alpha = 0.92), a split-half reliability of 0.89 (Spearman-Brown), a test-retest reliability of r = 0.86 and good convergent validity with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamburger Zwangsinventar (HZI). The factor-analytical distribution of the 20 items revealed a 4-factor structure of the scale. The results are presented and their implications on further steps of the development of the scale are discussed.

Adult↗
PubMed2005

Mood in relation to subclinical obsessive-compulsive symptoms.

Obsessive-compulsive disorder (OCD) is considered an anxiety disorder, but shows comorbidity with other disorders in the affective and impulsive-compulsive spectra, including anxiety disorders, major depression, and drug addictions. Subclinical OCD symptoms are relatively common in nonclinical populations and share common neurobiological substrates with clinical OCD. In this nonclinical community sample, the relationship between the severity of obsessions and compulsions, as measured by the Yale-Brown Obsessive Compulsive Scale, related to the intensity of negative emotions (anger, depression, tension, confusion, and fatigue) but not positive emotion (vigor), as measured by the Profile of Mood States. These relationships were independent of demographic influences and psychoactive drug use frequency (alcohol, cannabis, opioid, major stimulants, MDMA, and hallucinogens). These likely reflect common neurobiological substrates for emotional and behavioral regulation in prefrontal-subcortical/limbic circuits, which show normal variations in the general population.

Adolescent↗
PubMed2005

Right basal ganglion hypoperfusion in obsessive compulsive disorder patients demonstrated by Tc-99m-HMPAO brain perfusion spect: a controlled study.

The aim of this study is to demonstrate the regional cerebral blood flows (rCBF) of obsessive-compulsive disorder (OCD) patients compared to controls by using Tc-99m-HMPAO SPECT. Sixteen OCD and seven control subjects were admitted into the study. Yale-Brown Obsessive Compulsive Rating Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS) were applied to the patients. The rCBF was found to be decreased in right basal ganglion in OCD patients. The right basal ganglion rCBF was negatively correlated with Y-BOCS total and compulsion scores. The left thalamus rCBF was negatively correlated with Y-BOCS obsession score. Right and left cingulate rCBF were negatively correlated with HDRS score. The results indicating hypoperfusion in right basal ganglion in OCD patients support previous findings about dysfunction of frontal-subcortical circuits in this disorder.

Adolescent↗