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PubMed2003

Frontotemporal dementia.

In this case study, we describe the symptoms, neuropsychological testing, and brain pathology of a man with frontotemporal dementia (FTD). FTD most often presents with either a change in personality or behavior, such as social withdrawal, increased gregariousness, disinhibition, or obsessive behaviors; or with impairment of language function. Memory difficulties are common, but usually are less prominent than these other symptoms in the early stages of the disease. Frequently, psychiatric diagnoses are initially the primary consideration. Cases may be either familial or sporadic. In this familial case, an autopsy was ultimately performed and revealed findings characteristic of FTD, with grossly evident focal brain degeneration in the frontal and temporal regions, microscopic signs of gliosis, and cellular abnormalities of the intracellular microtubule-associated protein tau.

Age of Onset↗
PubMed1995

Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa.

OBJECTIVE: It is well recognized that patients with anorexia nervosa have perfectionistic and obsessive behaviors. This study investigated whether such behaviors persist after recovery. METHOD: Twenty subjects who had recovered from anorexia nervosa were recruited for the study. They had been at normal weight and their menses had been regular for more than a year. These subjects were compared with 16 healthy women with the use of the Eating Disorder Inventory, the Frost Multidimensional Perfectionism Scale, and the Yale-Brown Obsessive Compulsive Scale. RESULTS: The recovered anorexic patients had significantly higher scores than the comparison women on the measures of perfectionism on the Eating Disorder Inventory and on overall perfectionism on the Frost scale. Moreover, the recovered patients had higher scores on the Yale-Brown scale, with target symptoms suggesting that many had specific concerns with symmetry and exactness. CONCLUSIONS: Certain characteristics of anorexia nervosa, such as a need for order and precision, persist after good outcome and recovery, raising the question of whether these behaviors are traits that contribute to the pathogenesis of this illness.

Adult↗
PubMed2006

A model linking biology, behavior and psychiatric diagnoses in perpetrators of domestic violence.

Research indicates that perpetrators of domestic violence have abnormalities in central serotonin and testosterone metabolism, an increased sensitivity to anxiogenic stimuli, and an impaired neuro-connection between their cortex and the amygdala. Clinical evaluations show that perpetrators of domestic violence also have a distinguishing set of behaviors and diagnoses related to anxiety, depression, intermittent explosive disorder, and borderline personality disorder. In this paper we propose a model to understand how the biological abnormalities can potentially explain the behaviors and diagnoses exhibited by the perpetrators. Changes in the perpetrator's neurotransmitters lead to a heightened sensitivity to environmental stimuli, anxiety, and conditioned fear. Lack of cortical input to the amygdala impairs the perpetrator's ability to extinguish anxiety and/or conditioned fear and gives rise to either innate behaviors (e.g., fight, flight, and shut down) or learned fear avoidant behaviors designed to avoid anxiety (e.g., alcohol consumption, self-injurious acts, and obsessive behaviors). Linking conditioned fear and fear avoidance to the behaviors and psychiatric diagnoses will serve to change the way the medical community perceives and treats perpetrators of domestic violence.

Behavior↗
PubMed1994

Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗
PubMedDate not supplied

L-tryptophan in neuropsychiatric disorders: a review.

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.

Dopamine↗
PubMed2002

[Compulsive repetition of movements in a case of progressive supranuclear palsy].

A 51-year-old right-handed man with an 8-year history of progressive supranuclear palsy developed a peculiar behavior including compulsive repetition of movements. At the age of 47, it was noted that he continuously scratched his trunk with the right hand. He also scratched his thighs until his trousers were torn. On the scalp, posterior neck and forearms, patches of skin were scraped away and the bleeding wounds were scratched over and over again. Although he perceived pain, he could not terminate the strange scratching movement. He could not stop his eating action even after the bowl became empty. He could not leave the bathroom because he continued to wipe the anus after defecation. Yet the patient was not demented. Psychometric assessments including Wechsler adult intelligence scale revised, meaningful and meaningless syllables memory test. Raven's color matrix test, Wisconsin card sorting test (Keio version), and modified Stroop test were within the normal range. When requested to write a letter or a figure, he was always successful, however, he endlessly wrote the same letter or figure until he was told to stop. Although he repeated the behavior and could not terminate the action by himself, he immediately stopped the action on verbal command. When another task was given during the repetitive action, he responded quickly and successfully. His strange behavior was compulsive because he wanted to cease it, but it was not compulsive-obsessive behavior because he did not feel anxiety or pain when his repetitive action was stopped. It was different from stereotypy because he repeated not only meaningless movements but also meaningful complex actions. Unlike perseveration, he changed his activity immediately and successfully when a new task was given. Magnetic resonance imaging findings were remarkable only for mild atrophy of the midbrain tegmentum. Single photon emission computed tomography with ethyl cysteinate dimer demonstrated hypoperfusion in the frontal lobes and the left thalamus. A thalamofrontal disconnection or dysfunction is suggested as the mechanism underlying the compulsive repetifim of moving its based on the SPECT findings in this patient.

Compulsive Behavior↗
PubMed2001

Adolescent Obsessive-Compulsive Drinking Scale: an assessment tool for problem drinking.

Alcoholism has been studied in adults and found to share obsessive-compulsive characteristics. The Yale-Brown Obsessive Compulsive Scale (YBOC) was used to quantify the measurements of this disorder. This study adapted the YBOC for use with adolescents/young adults in an attempt to measure the "craving" expressed as obsessive and compulsive phenomenon. The primary findings show that the obsessive compulsive dimensions of alcohol cravings, as described in adult populations, also exist in adolescent/young adults. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed utilizing idioms and language typical for the 17-20 age group. Various quantitative evaluations proved that the Interference and Irresistibility sub-scales were the primary dimensions causing the obsessive behavior. This study begins to address this aspect of adolescent substance abuse utilizing a tool that is easy to administer. Because of the ease of use, although not a diagnostic instrument, the A-OCDS may be useful for identifying problem drinking in adolescents as well as detecting impairment in function related to drinking.

Adolescent↗
PubMed2006

Autogenous and reactive obsessions: further evidence for a two-factor model of obsessions.

Obsessive-compulsive disorder is a highly disabling anxiety disorder, characterized by occurrence of intrusive and unwanted thoughts (obsessions), which lead to performance of repetitive compulsions and/or rituals in order to reduce distress. Recently, it has been proposed that obsessions may be divided into two categories, termed autogenous and reactive obsessions [Lee, H.-J., & Kwon, S.-M. (2003). Two different types of obsessions: autogenous obsessions and reactive obsessions. Behavior Research and Therapy, 41, 11-29]. In this study, we aimed to further validate this subtyping of obsessions, and to investigate the cognitive and emotional correlates of the subtypes. Evidence was found for the division, using a confirmatory factor analysis in an analogue sample (N=372). It was found that frequency of reactive obsessions related more strongly to distress caused by overt OC symptoms (e.g., washing, checking), whereas frequency of autogenous obsessions related to distress from impulses of harm. Compared to autogenous obsessions, frequency of reactive obsessions correlated more strongly with all OC-related beliefs. Few differences were found between autogenous and reactive obsessions with respect to depression, anxiety, and view about self (self-ambivalence, self-esteem). It is suggested that existing OC-belief measures are more relevant to reactive obsessions. Implications for theory and treatment are discussed.

Adolescent↗
PubMed2005

Paraneoplastic chorea with leukoencephalopathy presenting with obsessive-compulsive and behavioral disorder.

Chorea is a rare manifestation of paraneoplastic disease and is associated with CV2/CRMP-5 antibodies. Obsessive-compulsive disorder and large-scale white matter abnormalities on MRI have not been previously reported in association with these antibodies. We report on a case of CV2 paraneoplastic syndrome with obsessive-compulsive behavior preceding the motor manifestations of chorea with associated leukoencephalopathy on MRI. The literature on paraneoplastic chorea is reviewed.

Aged↗
PubMed1987

A controlled study of Tourette syndrome. IV. Obsessions, compulsions, and schizoid behaviors.

To determine the frequency of obsessive, compulsive, and schizoid behaviors in Tourette syndrome (TS), we prospectively questioned 246 patients with TS, 17 with attention-deficit disorder (ADD), 15 with ADD due to a TS gene, and 47 random controls. The comparative frequency of obsessive, compulsive, and repetitive behaviors--such as obsessive unpleasant thoughts, obsessive silly thoughts, echolalia, palilalia, touching things excessively, touching things a specific number of times, touching others excessively, sexual touching, biting or hurting oneself, head banging, rocking, mimicking others, counting things, and occasional or frequent public exhibitionism--were significantly more common in TS patients than in controls. The frequency of each of these was much higher for grade 3 (severe) TS. Most of these behaviors also occurred significantly more often in individuals with ADD or in individuals with ADD secondary to TS (ADD 2(0) TS). When these features were combined into an obsessive-compulsive score, 45.4% of TS patients had a score of 4-15, whereas 8.5% of controls had a score of 4 or 5. These results indicate that obsessive-compulsive behaviors are an integral part of the expression of the TS gene and can be inherited as an autosomal dominant trait. Schizoid symptoms, such as thinking that people were watching them or plotting against them, were significantly more common in TS patients than in controls. Auditory hallucinations of hearing voices were present in 14.6% of TS patients, compared with 2.1% of controls (P = .02). These symptoms were absent in ADD patients but present in ADD 2(0) TS patients. These voices were often blamed for telling them to do bad things and were frequently identified with the devil. None of the controls had a total schizoid behavior score greater than 3, whereas 10.9% of the TS patients had scores of 4-10 (P = .02). This frequency increased to 20.6% in the grade 3 TS patients. These quantitative results confirm our clinical impression that some TS patients have paranoid ideations, often feel that people are out to get them, and hear voices.

Adolescent↗
PubMed1993

Behavior therapy for obsessive compulsive disorder in the office-based practice.

The article provides guidance for the clinician in applying scientifically proven behavior therapy techniques for obsessive compulsive disorder. Rationale for considering behavior therapy for all patients with OCD is presented, along with guidelines for determining an adequate trial of this approach and for predicting if a particular patient is likely to benefit.

Ambulatory Care↗
PubMed2001

Personality change as defensive responses of patients evaluated for liver transplant.

Patients affected by endstage liver disease and awaiting liver transplant suffer very stressful conditions. The aim of this study was to evaluate the person ality and behavioral responses of a group of liver transplant candidates, 95 men (M age 50 yr.) and of a group of 18 normal men (M age 49 yr.). The 16 Personality Factor Questionnaire of Cattell, and the PSY Inventory for Behavioral Assessment were administered to assess personality and behavior. On the 16PF Questionnaire, patients had significantly different mean scores from normal subjects on Scale B- (low mental capacity), G (conformity), N (shrewdness), and Q1- (conservatism). They also showed a somewhat lower but not a statistically significant mean on Scale E (submissiveness). In addition, on the four second-order factors of the 16PF (Anxiety, Control, Pathemia, and Extraversion) patients had a significantly higher mean on Control. With respect to PSY Inventors factors, patients showed impairment in energy, sleep, sexual disturbances, and obsessive behaviors. It appears these patients with endstage liver disease, who were evaluated for liver transplant, showed psychological regressive functioning, i.e., high control and dependency on medical staff, submissiveness, which are interpretable as defensive responses to upcoming transplant.

Adult↗
PubMedDate not supplied

[A case of obsessive symptoms in Huntington's disease].

INTRODUCTION: Recently, some authors have postulated the existence of the so-called < >. This would include disorders that have the common point of the presence of repetitive thoughts and actions, which may either have a < > or < > nature. Certain neurological disorders with repetitive movements have also been grouped within this spectrum, including some forms of epilepsy, Parkinson's disease, Sydenham's Chorea or Huntington's disease. There is evidence that physiopathological connections may exist between some of these conditions. METHODS: A case of a patient with Huntington's Chorea with obsessive signs and symptoms is presented. The patient is a 50 year old male, diagnosed of Huntington's Chorea who is being treated with 25 mg/day of clozapine and 10 mg/day of clorazepate. The patient refused to eat certain foods for < >. He began to display other obsessive behaviors such as refusing to touch objects that might have been touched by others, and developed ritual checking methods. Treatment based on the administration of 40 mg/day of paroxetine was begun. With this treatment the compulsive symptoms have disappeared, as has the fear of choking. However, the choreic movements typical of his condition persist and the signs and symptoms associated with a process of dementia are becoming increasingly evident. CONCLUSIONS: It is concluded that the case described may well be a good example of obsessive spectrum, and that the underlying physio-pathology should be studied.

Humans↗
PubMedDate not supplied

Personality disorders do not influence the results of cognitive and behavior therapy for obsessive compulsive disorder.

This study examined whether categorical or dimensional personality disorder variables affected treatment outcome in a sample of 52 patients with obsessive compulsive disorder who followed a standardized cognitive behavior therapy program. Treatment consisted of 12 weekly sessions and was completed by 43 patients. The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was taken before the start of treatment by an independent rater. The treatment outcome measures included questionnaires and a Behavioral Assessment Test. Measurements were taken before and after treatment, and at 1 and 6 month follow-up tests. After the first follow-up test, further treatment was provided if clinically indicated. Neither categorical, nor dimensional personality disorder variables affected treatment outcome significantly. The inclusion of drop-outs in the analyses, did not change these results. Therefore, patients with obsessive compulsive disorder and concomitant personality disorder pathology should not be excluded from cognitive or behavior therapy for their obsessive compulsive complaints. Attributing therapy failure to concomitant Axis II pathology should be approached with caution.

Adolescent↗
PubMedDate not supplied

Pseudo-knuckle pads: an unusual cutaneous sign of obsessive-compulsive disorder in an adolescent patient.

Knuckle pads are discrete benign cutaneous lesions overlying the extensor surfaces of the fingers and hand joints and are unrelated to trauma, whereas pseudo-knuckle pads may be considered as a form of callosity that appears after repeated trauma. This type of knuckle pad has been described in children with obsessive behavior as "chewing pads" and in adults as occupational disorder. Cases of pachydermodactyly, benign fibromatosis of the fingers, have been described as the unusual forms of knuckle pads that usually affect young adult males. We believe that pseudo-knuckle pads, chewing pads or pachydermodactyly are terms which have been used to decribe the same clinical situation reported in different patients. Here we describe a 12-year-old male patient with pseudo-knuckle pads along the metacarpophalangeal joints developed secondary to repeated trauma reflecting obsessive-compulsive disorder characterized by a tic-like habit. He received fluvaksamine 25 mg/day. The lesions started to disappear after three months of therapy. The recognition of pseudo-knuckle pads by dermatologists and pediatricians is very important in adolescent patients because these lesions may be clues for diagnosis of serious psychiatric problems. The collaboration of a dermatologist or pediatrician with a psychiatrist is essential in the follow-up of these patients.

Callosities↗
PubMed2004

The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive-compulsive disorder.

Mounting evidence concerning obsessive-compulsive disorders points to abnormal functioning of the orbitofrontal cortices. First, patients with obsessive-compulsive disorder (OCD) perform poorly on tasks that rely on response suppression/motor inhibition functions mediated by the orbitofrontal cortex relative to both normal and clinical controls. Second, patients with OCD exhibit functional hyperactivity in lateral orbitofrontal and related structures corresponding with symptom severity. In this article, we compare these neurocognitive correlates of OCD with the executive and neural underpinnings of "compulsive-like" behaviors that are common in normal childhood. We discuss the phenomenology and natural history of normative compulsive-like behaviors as well as the behavioral, emotional, and cognitive continuities between typical and pathological obsessive-compulsive behaviors. We then examine associations between children's executive performance deficits and their observed compulsive-like characteristics. We relate these patterns to executive deficits shown by adults with OCD. Finally, we speculate on the developmental neurobiology of children's compulsive-like behaviors, with particular attention to orbitofrontal functions including behavioral and emotional regulation, and we suggest similarities and differences with the neurobiology of OCD. In making these comparisons, we hope to open a dialogue between researchers who study underlying brain pathologies associated with OCD and those who explore the neurocognitive bases of normal development.

Adolescent↗