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Psychiatric syndromes of interest to dermatologists.
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Endogenous event-related potentials in obsessive character.
Fifteen healthy subjects with obsessive character (OC) and 15 control subjects were tested for endogenous event-related potentials using the auditory odd ball paradigm. A difference was found in the peak amplitude of the P200 component in response to both stimuli; the subjects with OC had smaller amplitudes than the controls, and the mean amplitude for the 120 to 200 ms latency range was smaller (negative shift) for the OC subjects. In the OC subjects, NA appears to be markedly induced to both rare and frequent stimuli; moreover, the OC subjects may show excessive reactions to selective attention as well as to the process of pattern recognition.
The prevalence of obsessive-compulsive disorder in Japan: a study of students using the Maudsley Obsessional-Compulsive Inventory and DSM-III-R.
The prevalence of obsessive-compulsive disorder (OCD) was measured in 424 Japanese students using a Japanese version of the Maudsley Obsession-Compulsive Inventory (MOCI-J). Six students (1.7%) of 350 interviewed students were diagnosed as OCD according to DSM-III-R. When the cut-off point of the MOCI-J was 12, the sensitivity was 100% and the specificity was 96%. Our results suggest that individuals with OCD are not rare among the young Japanese population and that the MOCI-J is a useful tool for screening OCD.
Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase.
Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.
Impulse control disorders in patients with obsessive-compulsive disorder.
The purpose of the present paper was to identify the rate of prevalence of impulse control disorders (ICD) in patients with obsessive-compulsive disorder (OCD) and to compare patients with OCD with and without ICD with regard to sociodemographic, clinical and prognostic characteristics. Forty-five patients with OCD were assessed by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn, DSM-IV) plus additional modules for the assessment of ICD and examined using the Yale-Brown Obsessive-Compulsive Scale, the Clinical Global Impression, the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Global Assessment of Functioning. These patients were treated with serotonin re-uptake inhibitors (SRI) and followed for a variable period of time. Individuals with ICD (here defined as including not only the impulse control disorders not elsewhere classified of the DSM-IV, but also other disorders in which impulse control is a prominent feature such as alcohol and drug dependence, paraphilias and bulimia nervosa/binge eating disorder) were compared to those without ICD using the Mann-Whitney U-test and the Pearson's goodness of fit chi2 test. Sixteen patients with OCD (35.5%) displayed comorbid ICD. Patients with ICD were characterized by a significantly earlier age at OCD onset (P=0.04), a more insidious appearance of OCD symptoms (P=0.04), a higher rate of comorbid anxiety disorders (P=0.03), a greater number (P=0.02) and severity of compulsive symptoms (P=0.04), an increased rate of counting compulsions (P=0.02), and a higher number of required SRI trials (P=0.01). When OCD is found in association with ICD, the clinical picture is characterized by a greater severity of the obsessive-compulsive symptoms at presentation and by the requirement of a greater number of therapeutic attempts during follow up.
To be born was the death of him: a clinical study of a self that might have been but never got born.
In this paper, using a pluralistic perspective on the psyche, I consider theoretical formulations concerned with the development of the self in relation to the environment. This includes discussion about how the infant interacts with its maternal environment before birth and how observation of the foetus in the womb and infant research have important implications affecting our understanding of adult psychopathology. I briefly look at the object-related nature of religious experience and the concept of the development of a representation of God. Furthermore, I explore the object-related nature of the Laius myth as the deeper realm and the homo-erotic component in the Oedipal conflict, with emphasis on the link between oracular literalism and literalizing obsessionality. Finally, I show how all of these elements manifested in the course of my work with a very disturbed male patient in whom the transferential relationship uncovered a psychopathic pocket; and how my life was put in danger when his defences took the form of an impulse to kill: he became murderous.
Personality and experience in an encounter-group.
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Character and defense: relationships between oral, obsessive and hysterical character traits and defense mechanisms.
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Childhood obsessive-compulsive disorder: a prospective follow-up study.
Twenty-five of 27 patients (93%) who had participated in a study of severe primary obsessive-compulsive disorder with onset in childhood or adolescence, were seen 2-7 yrs after initial examination (mean, 4.4 yrs). They were compared to a group of normal controls matched for age, sex and IQ and followed up for the same period. Continued psychopathology was striking for the patients, with only seven (28%), three males and four females, receiving no psychiatric diagnosis at follow-up. Seventeen subjects (68%) still had obsessive-compulsive disorder, 12 patients (48%) had another psychiatric disorder, most commonly anxiety and/or depression; neither initial response to clomipramine or any other baseline variable predicted outcome.
Clinical note: childhood neurotic disorders with a sexual content need not imply child sexual abuse.
Two cases are described of childhood obsessional states in which the content of the symptomatology led parents and professionals to suspect child sexual abuse. Following assessment it was felt, on the balance of probabilities, unlikely that child sexual abuse had occurred in either case. Both children had previously engaged in "sex play" with peers. Maternal attitudes to sexuality were felt to have influenced their daughters' views about sexual behaviour and to have contributed to the children's guilt feelings. Response to appropriate treatment was rapid and has been sustained in the short-term. The importance of avoiding lengthy and possibly damaging assessment procedures in such cases is discussed.
Obsessive-compulsive disorder in childhood and adolescence: a clinical study.
The clinical records of 72 children and adolescents aged 5-18 with a diagnosis of OCD were examined. Mean age of onset was 11 years. Repeating, cleaning and checking were the most common compulsions. Twenty percent of subjects showed obsessions unrelated to compulsions. In 53% of cases stress situations preceded the disorder. Seventy-seven percent of subjects suffered some other psychiatric disorder, lifetime or current, particularly anxiety and affective disorders. The majority (57%) had some first-degree relative with a psychiatric diagnosis. Family conflicts, social withdrawal and poor school performance were also common features.
Normative and pathological obsessive-compulsive behavior and ideation in childhood: a question of timing.
This study was designed to test whether obsessive-compulsive behavior declines over development. A cross-sectional design was used on a large community sample of children. Children in grades four, six, and eight (N = 1083), 8 to 14 years of age, were administered the Maudsley Obsessive Compulsive Inventory (MOCI) and the Spielberger State Trait Anxiety Scales. Whereas the mean MOCI score was significantly lower in the eighth grade than in the sixth and fourth, there was an elevation of children with very high MOCI scores in the eighth grade. Obsessive ideas and compulsive behaviors that were common for fourth-grade children were present in only a minority of children in the eighth grade, and were associated with high levels of anxiety. No gender differences were observed for overall obsessive-compulsive behavior, but checking behavior was higher in boys, and cleaning behavior in girls. State anxiety was higher in girls than in boys, and was also higher in older than in younger children.
The Obsessive Compulsive Scale of the Child Behavior Checklist predicts obsessive-compulsive disorder: a receiver operating characteristic curve analysis.
BACKGROUND: The purpose of this study was to determine a score on the Obsessive Compulsive Scale (OCS) from the Child Behavior Checklist (CBCL) to screen for obsessive compulsive disorder (OCD) in children and to rigorously test the specificity and sensitivity of a single cutpoint. METHODS: A receiver operating characteristic (ROC) curve analysis was applied to data from 61 patients with clinically determined OCD, 64 clinical controls and 73 general population controls to determine the best sum score on the CBCL-OCS to predict confirmed OCD in children. Using the ROC-determined cutoff, this score was applied to a national sample of CBCL data from 2460 singleton children ages 4-18 and to 20,016 children ages 7-18 from three large general population twin samples to determine the estimated prevalence in the general population. RESULTS: Using a CBCL-OCS score of 5 demonstrated an area under the curve (AUC) of .88 with high sensitivity (92%) and moderate specificity (67%) compared to clinical controls. Compared to the general population controls, the AUC was .96 with high sensitivity (92%) and specificity (89%). In the twin samples, the number of participants with CBCL-OCS scores above this cutpoint was 2.3-7.1%. CONCLUSIONS: These findings suggest that the OCS of the CBCL may provide a highly effective way to screen for childhood OCD, and that the prevalence of childhood OCD may have been underestimated, thus prompting the need for further research into screening children for this condition.
Observations on the relation of migraine and epilepsy. An electroencephalographic, psychological and clinical study using oral tyramine.
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Obsessive and compulsive characteristics of alcohol abuse and dependence: quantification by a newly developed questionnaire.
The purpose of the this study was to develop an instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in subjects who abuse or are dependent on alcohol, and to quantify the extent to which drinking-related thought and behavior in these subjects resemble the obsessions and compulsions seen in obsessive-compulsive disorder (OCD). To achieve these goals, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was modified to reflect obsessionality and compulsivity specifically related to heavy drinking rather than to obsessions and compulsions generally. The modified Y-BOCS (Y-BOCS-hd) was administered to 62 subjects satisfying DSM-III-R criteria for alcohol abuse or alcohol dependence and 62 matched normal controls. The data showed that the Y-BOCS-hd is a sensitive and specific instrument for measuring the obsessive and compulsive characteristics of drinking-related thought and behavior in alcohol-abusing and alcohol-dependent populations, and that there are specific and quantifiable similarities between these characteristics and the obsessions and compulsions of OCD. The data also indicated that the Y-BOCS-hd may be a useful screening instrument for the presence of alcohol abuse and dependence.
Psychometric properties and validity of the obsessive-compulsive drinking scale.
Abstinent alcoholics' self-reports of distressing alcohol-associated thoughts and compulsions to drink were evaluated by the Obsessive-Compulsive Drinking Scale (OCDS). Exploratory and confirmatory factor analyses on separate subject samples revealed that subjects' OCDS responses were best described by four correlated dimensions: alcohol obsessions, alcohol consumption, automaticity, and interference due to drinking. The validity of this four-factor solution was supported by the pattern of associations with drinking and coping style measures. In particular, alcohol obsessions were positively associated with alcohol dependence and use of passive/ avoidant coping. Automaticity was positively associated with the intensity and salience of drinking, and inversely associated with use of active/approach coping, as well as abstinence duration. The obsession and automaticity subscales of the OCDS may be useful in evaluating cognitive-motivational processes associated with recovery from alcoholism.