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PubMed2004

Temperamental factors in children and adolescents with obsessive-compulsive disorder (OCD) and in normal controls.

We studied parent-rated temperamental traits in patients (n=83) with obsessive-compulsive disorder (OCD) as compared with children and adolescents matched for age and gender (n=85) using the EAS (Emotionality, Activity, Sociability) questionnaire. Specifically, two hypotheses of OCD were studied: (1) the presence of behavioural inhibition (BI) and (2) of high levels of emotionality utilising ANOVA analyses, controlling for gender and age group (children vs. adolescents). The presence of BI in OCD patients was confirmed in that they scored higher than controls on 'Shyness' [F (df=7)=2.69, p<0.012] but lower on 'Activity' [F (df=7)=3.01, p<0.005]. Also, our second hypothesis was corroborated in that OCD patients scored higher than controls on 'Emotionality' [F (df=7)=3.59, p<0.001]. A third hypothesis, the presence of temperamental heterogeneity in OCD, was likewise confirmed. We found, using hierarchical cluster analyses, two subgroups of about equal size, an 'Inhibited/Shy' group (n=44), high in 'Shyness' and low in 'Emotionality', 'Sociability' and 'Activity', and an 'Uninhibited' group (n=32) that was high in 'Emotionality', 'Sociability' and 'Activity', but low in 'Shyness'. However, the temperamental subgroups gave no clear picture with regard to the most common symptom patterns.

Adolescent↗
PubMedDate not supplied

Auditory event-related potential (ERP) and difference-wave topography in schizophrenic patients with/without active hallucinations and delusions: a comparison with young obsessive-compulsive disorder (OCD) and healthy subjects.

Event-related potentials (ERPS) in schizophrenics have been reported to show a reduced P3 on the left and less frontal mismatch negativity (MMN). But the specificity of such findings to component, its locus, the type of eliciting event and patient group remains uncertain. Hence, we examined ERP topography for P3, N2 and 3 precursor peaks according to stimulus (3-tone oddball), attention condition (diffuse/focused) and four types of difference-waves. We contrasted 24 healthy and 13 OCD subjects with schizophrenic patients with high versus low ratings of active delusions and hallucinations (12 paranoid-hallucinatory, PH; 12 nonparanoid, NP). P3 peaks were delayed and reduced in NP and PH groups. Midline peaks were usual in focused attention and a right bias in diffuse attention. P3 responses to irrelevant standards remained lateral in NP and small in OCD patients. All showed a small left and anterior bias in the P3-like peak in difference-waves. Mismatch negativity waveform (MMN) peaks shifted to the right in OCD, to both sides in PH and posteriorly in NP patients. Frontal processing negativity was biased to the left (early) in NP and to the right (late) in PH groups. Early peak topography reflected some later changes (e.g. PH and NP groups; P1-like peak, right bias absent; N1-like peak depressed and widely distributed; NP group, P2-like peak smaller on the left). In OCD patients, peak latencies were topographically undifferentiated (P1, P2) or delayed (N2). The OCD group showed an unusual regional allocation of processing effort. Before 200 ms frontocentral activity was more widespread in Ph and NP groups. Lateralization of negativity in target- and nontarget-derived difference-waves may reflect differential disruption of the frontal-temporal dialogue in registering important vs unimportant features. NP patients, in particular, treated irrelevant stimuli anomalously.

Adolescent↗
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↗
PubMed2006

Are responsibility beliefs inflated in non-checking OCD patients?

Cognitive models of obsessive-compulsive disorder [e.g., Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37(Suppl. 1), S29-S52] propose a key role for inflated responsibility for harm. Studies evaluating such beliefs typically use heterogeneous samples including several OCD subtypes. A recent investigation by Foa et al. [Foa, E. B., Sacks, M. B., Tolin, D. F., Prezworski, A., & Amir, N. (2002). Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension. Journal of Anxiety Disorders, 16(4), 443-453] found responsibility to be elevated in OC checkers, but not in non-checking OCD patients, relative to non-anxious controls. In that study, the responsibility measure included checking scenarios, thus leaving the possibility that these findings may have been due to criterion contamination. The present study investigated responsibility beliefs in OC checkers (n=39) and non-checkers (n=20), anxious controls (n=22), and non-clinical controls (n=69), using measures of responsibility which do not have item overlap with OCD symptoms. Results indicated that both OC groups showed greater responsibility beliefs relative to anxious and non-anxious controls. OC checkers endorsed greater responsibility appraisals than anxious and non-clinical control groups. In contrast, non-checking OCs reported greater responsibility appraisals than non-clinical controls, but did not differ from anxious controls and OC checkers. Results are discussed in the context of the cognitive model of OCD.

Anxiety Disorders↗
PubMed2004

The importance of importance in OCD memory research.

Investigations of memory and associated phenomena in obsessive-compulsive disorder (OCD) can advance our understanding of this often debilitating problem. Theoretical models predict both the presence and absence of memory biases in favour of threat-relevant information in association with anxiety disorders generally, and with OCD specifically. Two previous experiments (one involving compulsive washing and another involving compulsive checking) that demonstrated such a memory bias are reviewed in the context of the existing literature. Additionally, a new experiment failing to demonstrate such a bias (in association with compulsive ordering and arranging) is presented. The results are discussed in terms of cognitive-behavioural and information processing approaches to understanding OCD. It is argued that experiments which utilize stimuli that are low in ecological validity are unlikely to detect explicit memory biases in OCD. As such, experimental paradigms that are perceived as particularly significant, relevant and important to participants with OCD are encouraged.

Adult↗
PubMed1998

Acute intravenous administration of ondansetron and m-CPP, alone and in combination, in patients with obsessive-compulsive disorder (OCD): behavioral and biological results.

Obsessive-compulsive disorder (OCD) has been linked to abnormal function of brain serotonin (5-HT) pathways. Since ondansetron is a highly selective 5-HT3 receptor antagonist, the present study was undertaken to investigate 5-HT3 function in OCD. We administered m-CPP (0.08 mg/kg i.v.) and the potent 5-HT3 antagonist, ondansetron (0.15 mg/kg i.v.), to 11 OCD patients. All of the subjects received four separate challenges (m-CPP + placebo, m-CPP + ondansetron, ondansetron + placebo and placebo + placebo). In comparison to placebo, administration of m-CPP was associated with significant behavioral effects, particularly self-rated measures of anxiety, altered self-reality, functional deficit and OCD symptoms. Pretreatment with ondansetron did not affect any of the self-rated behavioral symptoms. After administration of m-CPP relative to placebo, significant increases in plasma cortisol and prolactin were found. These changes were not affected by ondansetron. In conclusion, our results do not support the hypotheses that 5-HT3 receptor-mediated mechanisms modulate m-CPP's behavioral and neuroendocrine effects in patients with OCD.

Adult↗
PubMed2001

OCD and transvestism: is there a relationship?

OBJECTIVE: There have been reports of obsessive-compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association. METHOD: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM-IV were assessed using semi-structured interviews. RESULTS: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross-dressing was more egodystonic responded better to treatment. CONCLUSION: It is possible that some cases of transvestism are OCD-related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders.

Adult↗
PubMed2006

Fluvoxamine treatment and D2 receptors: a pet study on OCD drug-naïve patients.

Changes in D(2) receptors during antidepressant therapy have been reported in patients with major depressive disorder using PET/SPET. The aim of this study was to evaluate modifications in D(2) receptors that might occur in patients affected by obsessive-compulsive disorder (OCD) during serotonin reuptake sites inhibitors (SSRIs). To this purpose, we measured the in vivo binding of [(11)C]raclopride ([(11)C]Rac)in the brain of a group of OCD naïve patients before and after the repeated administration of the inhibitor SSRI fluvoxamine. Eight patients with a Diagnostic and Statistical Manual of Mental Disorders IVth edition diagnosis of OCD completed the study undergoing a PET scan and a complete clinical evaluation before and during treatment with fluvoxamine. Patients have been compared also with a group of nine age-matched normal volunteers. Fluvoxamine treatment significantly improved clinical symptoms and increased [(11)C]Rac binding potential (BP) in the basal ganglia of OCD patients (7.5+/-5.2, 6.9+/-6.9, and 9.9+/-9.3% in dorsal caudate, dorsal putamen, and ventral basal ganglia, respectively; p<0.01) to values closer to those observed in the group of normal subjects. Chronic treatment with fluvoxamine induces a slight but significant increase in striatal [(11)C]Rac BP of previously drug-naïve OCD patients. The modifications in D(2) receptor availability might be secondary to fluvoxamine effects on serotoninergic activity.

Adult↗
PubMed2002

Obsessive-compulsive disorder (OCD) patients are impaired in remembering temporal order and in judging their own performance.

Obsessive-compulsive disorder (OCD) has been related to frontostriatal dysfunction, but some inconsistencies between studies and a relative paucity of neuropsychological research still characterizes the study of OCD. We compared 28 patients with OCD and matched healthy controls on two neuropsychological tests sensitive to frontal dysfunction: temporal ordering and a "feeling-of-doing" (FOD) judgment about ordering. The OCD group performed significantly worse than controls in the temporal ordering task despite showing normal recognition memory. Patients were also impaired in "feeling-of-doing" judgments suggesting they have a lack of self-awareness of their performance. Thus, the results of the current study reinforces previous research that indicates that OCD patients fail on tasks that require adequate functioning of the frontal-striatal pathways.

Adolescent↗
PubMed1994

Radiological aspects on the course of development of porcine epiphyseal osteochondrosis (OCD) from 42 up to 147 days of age.

The articular-epiphyseal (A-E) cartilage complex of the distal humeral and femoral epiphyseal condyles of eight intact pigs (4 male & 4 female) of the same age were radiologically examined every 3 weeks, beginning at 42 days up to 147 days of age; to determine the age of onset, the course and trend of development of osteochondrosis (OCD). The earliest Dyschondroplasia (Osteochondrotic) lesions were demonstrated radiologically in the A-E complexes of the humeral condyles of 42-day-old pigs and in the femoral condyles at 63 days of age. Thus the radiographic examination of live animals to demonstrate subchondral radiolucency typical for OCD lesions in the condylar A-E complexes of pigs is not of limited value until the animals were > 100 days old as indicated in earlier reports. Also the course of further development of OCD lesions associated with A-E complexes was followed. The radiolucency was seen to develop to a certain extent, and then either to regress, and stabilize or even to progress as the animal grows. Some lesions regressed completely. Also some of the regressed lesions may become active again and become progressive. However, the course of development of femoral condyle A-E complexes OCD lesions was seen to be progressive continuously, or progressive then stable and then progressive again. The regressive course and trend of osteochondrotic lesions was not observed in the femoral condyle A-E complexes up to day 147 of age. Therefore, the course and trend of development of the A-E complexes OCD is not constantly the same.

Animals↗
PubMed2002

Association of QEEG findings with clinical characteristics of OCD: evidence of left frontotemporal dysfunction.

OBJECTIVE: Our objectives were 1) to determine hemispheric asymmetry and regional differences on the EEGs of patients with obsessive-compulsive disorder (OCD); and 2) to investigate the effects of sex, treatment response, illness duration, and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores on quantitative electroencephalographic (QEEG) measurements. METHOD: We recorded EEGs (12-channel) from 22 unmedicated patients with OCD but no depression and from 20 age- and sex-matched control subjects. All patients and control subjects underwent detailed neurological and psychiatric evaluations including the Hamilton Depression Rating Scale (HDRS) and Y-BOCS. RESULTS: QEEG revealed higher frequencies of slow-wave bands and lower frequencies of alpha activity at predominantly left frontotemporal localization in patients with OCD, compared with control subjects. Analysis of variance of QEEG parameters and clinical characteristics showed that sex had a significant effect on delta and alpha frequencies of frontotemporal areas during hyperventilation (HV). Increasing total Y-BOCS score correlated positively with increased frequencies of right parietal delta activity and decreased frequencies of right frontotemporal alpha activity during HV. A significantly increased left frontal slow-wave activity and decreased beta activity during HV in treatment responders led us to consider that frontal lobe functions were better in this group of patients. Illness duration had no important effect on QEEG. CONCLUSION: Patients with OCD showed important frontotemporal dysfunction, predominantly in the left hemisphere. This was particularly evident in female subjects and in treatment responders. QEEG may be beneficial in understanding the neurobiological basis of OCD.

Adolescent↗
PubMed2003

Quantitative electroencephalography in OCD patients treated with paroxetine.

The effectiveness of drugs that have a specific effect on the activity of the serotonergic neurotransmitter systemhas changed the outlook for patients suffering from obsessive-compulsive disorder (OCD). With a response rate of about 70% to such compounds and the great amount of brain imaging studies conducted over the past decades, an understanding of the biochemical nature and origins of OCD is beginning to unfold. Convergent data including ethological and experimental observations, clinico-pathological findings and different imaging methods have implicated the basal ganglia along with the cortical and related thalamic structures to be involved in the pathophysiology of OCD. In a previous study using the quantitative electroencephalographic (QEEG) method known as neurometrics, in which QEEG data from OCD patients were compared statistically with those from an age-appropriate normative population, two subtypes within a clinically homogeneous patient group were classified. Patients with relative excess theta activity, especially in the frontal regions, were nonresponders to treatment with serotonin reuptake inhibitors (SSRI), while those with increased relative power in alpha activity were responders to pharmacological treatment. These findings suggested at least two subgroups in a patient population with similar symptoms but differential responses to treatment. In the present study we used neurometric QEEG to subtype a group of 20 non-depressed OCD patients, fulfilling DSM-R-III criteria, treated with paroxetine, of whom 18 were responders to treatment. Of the treatment responders, 94.4% were predicted by subtype membership to be SSRI responsers. In these subjects there was a strong relative alpha baseline activity; after successful treatment through at least 3 months this activity decreased, looking more normal. The group average topographic maps showed none of the characteristics seen in the nonresponder cluster (no excess relative power in theta). As in the previous investigation, baseline QEEG profile membership points to a predictive value with regard to therapeutic response.

Adult↗
PubMed2002

[Obsessive-compulsive disorders in children. Subtypes of OCD and their relation to infection with group A streptococci].

The present review describes the theory of a spectrum of obsessive-compulsive disorders (OCD). This spectrum includes such disorders as trichotillomania, eating disorders, body dysmorphic disorder, and possibly pervasive developmental disorders. OCD with an onset in childhood is presented as a specific subtype, with more boys affected and frequently co-morbid with tics and Tourette's syndrome. Furthermore, it seems to be more genetically determined and have more significant deviations, as measured by neuro-imaging studies, than has OCD with an adult onset. The PANDAS theory (paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections) is described. This subtype of OCD is, still on a speculative basis, connected to infections with beta-haemolytic streptococci. The obsessive-compulsive symptoms are characterised by a sudden onset, "sawtoothed" course with relapses and remissions, and are associated with neurological abnormalities. There are still no clinical consequences in terms of penicillin treatment of this PANDAS subtype of OCD.

Adolescent↗
PubMed2002

Confirmatory analysis of the adolescent obsessive compulsive drinking scale (A-OCDS): a measure of 'craving' and problem drinking in adolescents/young adults.

The A-OCDS was modeled after the Obsessive Compulsive Drinking Scale (OCDS) to establish an instrument appropriate for use in adolescent/young adult populations. Initial exploratory analysis of the A-OCDS revealed two factors, namely "irresistibility" and "interference," which were specific and sensitive to identifying problematic drinking. The study objective was to administer the A-OCDS to obtain data for confirmatory analyses regarding the dimensionality of the scale, its reliability and its sensitivity and specificity in identifying problem drinkers. The confirmatory factor analysis supported the two previously identified factors. Using logistic regression to predict drinking classifications, the predictive value of the subscale scores for predicting problem drinking was statistically significant (irresistibility p = 0.0001, and interference p = 0.0001). We concluded that the A-OCDS was confirmed as a scale for identifying certain dimensions of "craving" and problematic drinking in adolescents/young adults. This scale may be useful as a screening tool, as well as monitoring change over time.

Adolescent↗
PubMed2005

[Duration effect on neuropsychological function and treatment response of OCD].

Because of inconsistency among previous reports that examined neuropsychological function and treatment response of OCD patients, we here consider the heterogeneity of OCD; for example: symptom-based clusters, degree of insight, age of onset, and comorbid diagnoses. In this study, we examined neuropsychological function and the treatment response of OCD patients. Thirty-two OCD patients participated in this study. We examined their clinical symptoms by Y-BOCS, MOCI and other scales, and examined their cognitive function with several neuropsychological tests including: WAIS-R, Stroop test, WCST, WMS-R and R-OCFT. We then randomly assigned them to three treatment packages including: behavior therapy, pharmacotherapy by fluvoxamine, and controlled therapy. The patients were divided into two groups by duration of illness: short to middle range group (Group S, n=17, 5.5+/-3.1 years), and long range group (Group L, n=15, 20.3+/-6.1 years). The mean age of Group L was higher than that of Group S (Group S: 30.6+/-9.7 years old, Group L: 36.1+/-6.2 years old). There was no significant group difference in sex ratio or number of years of education. The mean age of onset of Group L was significantly lower than that of Group S (Group S; 25.5+/-10.2 years old, Group L; 15.3+/-7.1 years old). The total Y-BOCS mean score and MOCI score showed no group differences. These two groups showed similar clinical characteristics such as the severity of OC symptom, OC subtypes, and comorbid depression. Group S, however, demonstrated significantly more obsession with the need for correction. Group L had significantly higher levels of anxiety and compulsion. There were also no group differences in the mean HDRS or STAI scores. As a result, compared to Group S, Group L showed significant attention deficit in the Stroop test and the WMS-R though other neuropsychological dysfunctions such as intellectual level, executive function, verbal memory, and nonverbal memory were found in this group. Concerning treatment response, Group L showed little improvement by pharmacotherapy. Behavior therapy brought significant improvement to all patients of both groups. Long duration of the illness might cause attention deficit and a lowered pharmaceutical response in OCD patients.

Adult↗
PubMed1996

Therapeutic effect and safety of adjunctive risperidone in refractory obsessive-compulsive disorder (OCD).

It has been well established that more than 40 percent of patients with obsessive-compulsive disorder (OCD) do not improve after an adequate trial with serotonin uptake inhibitors (SUIs). The first purpose of this trial was to compare the short-term efficacy and safety of two different strategies in a sample of treatment-refractory OCD patients: dose increase of the ongoing treatment versus the addition of another SUI. The second purpose was to investigate the short-term efficacy and safety of adjunctive risperidone in SUI-refractory OCD patients. Thirty-three OCD patients who were unimproved after a short-term treatment with clomipramine (150 mg/day) were admitted to the study. In the first part of the study, the dose increase of clomipramine was compared with sertraline addition, in an open-label manner. The addition of sertraline to the ongoing treatment appeared to be more effective and tolerable than the clomipramine dose increase. Seven (50%) of the 14 patients who were considered nonresponders after the first part of the study, showed good clinical improvement and good tolerability after risperidone augmentation. These results suggest that risperidone addition to ongoing SUIs may be useful in augmenting pharmacologic response in OCD.

Adult↗
PubMed2026

Sequential rTMS for MDD and OCD in a patient with left parietal perinatal ischemic infarct: a case report.

Major depressive disorder (MDD) commonly co-occurs with obsessive-compulsive disorder (OCD), resulting in greater symptom severity, functional impairment, and suboptimal response to standard pharmacologic and psychotherapeutic interventions. These challenges underscore the need for neuromodulation strategies to target distinct neural networks implicated in mood regulation and compulsivity. This report describes outcomes of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC), and low-frequency (LF) rTMS of the right orbitofrontal cortex (OFC), in a patient with comorbid MDD, OCD, and a left parietal perinatal ischemic infarct. Over the course of treatment, serial psychometric assessments demonstrated progressive reductions in frequency and intensity of depressive symptoms, anxiety, and obsessive-compulsive behaviors, measured via Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This case adds to the growing body of literature demonstrating efficacy of DLPFC and OFC stimulation for depression and OCD. Further large-scale, blinded, and randomized trials are warranted to examine the efficacy of sequential DLPFC and OFC stimulation for comorbid MDD and OCD compared with single-site DLPFC stimulation.

dorsolateral prefrontal cortex (DLPFC)↗
PubMed2006

OCD symptoms in a sample of Turkish patients: a phenomenological picture.

This study aimed to investigate the clinical features of obsessive-compulsive disorder (OCD) and the possible association between obsessive-compulsive symptoms and culture-related characteristics in a sample of Turkish patients with OCD. We studied 141 patients with OCD (according to DSM-IV criteria) consecutively admitted to our outpatient clinic during the period from February 1998 to December 2003. We used the Turkish version of the Structured Clinical Interview for DSM-IV (SCID) to interview all patients, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess obsessive-compulsive symptoms and severity. The onset of OCD symptoms was earlier in males. Major depression was the most common comorbid disorder (30.5%). The most commonly occurring obsessions were contamination (56.7%), aggression (48.9%), and somatic (24.1%), followed by religious (19.9%), symmetry (18.4%), and sexual imagery (15.6%). Symmetry and sexual obsessions, and checking compulsions and rituals, tended to be more common in male patients. Dirt and contamination obsessions and washing compulsions were slightly more common in females. The vast majority of patients with religious obsessions (83%) and half of the patients with sexual obsessions had compulsions that included religious practices. Also, patients with sexual and religious obsessions had delayed seeking professional help.

Adult↗