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PubMed2006

Effects of acamprosate on sleep during alcohol withdrawal: A double-blind placebo-controlled polysomnographic study in alcohol-dependent subjects.

BACKGROUND: Sleep disturbances are frequently encountered in alcohol-dependent patients. Drugs improving sleep during abstinence from alcohol may play an important role in the recovery process. METHODS: In the present study, the effects of acamprosate, a drug successfully used in maintaining abstinence following alcohol withdrawal, were assessed by polysomnographic recordings. A parallel double-blind placebo-controlled study was conducted in 24 male DSM-IV alcohol-dependent subjects aged 35.9+/-1.2 years. Treatments (2 tablets of 333 mg acamprosate vs placebo t.i.d.) were initiated 8 days before alcohol withdrawal and continued during the 15 days following alcohol withdrawal. Polysomnographic assessments were recorded during acute withdrawal (the first 2 nights following withdrawal) and during postwithdrawal abstinence (the last 2 nights of the trial). RESULTS: Results show that, compared with placebo, acamprosate decreased wake time after sleep onset and increased stage 3 and REM sleep latency (all treatment effects with a p < 0.05 significance). Withdrawal effects themselves were also demonstrated as sleep efficiency (p < 0.01) and total sleep time (p < 0.05) were lower in abstinence nights versus withdrawal nights, whereas no significant treatment x withdrawal effect could be evidenced. Acamprosate was well tolerated during the entire course of the study. CONCLUSIONS: The present study shows that acamprosate ameliorates both sleep continuity and sleep architecture parameters classically described as disturbed in alcohol-dependent patients. From a clinical perspective, it suggests that an 8-day acamprosate prewithdrawal treatment is well tolerated and can attenuate the sleep disturbances engendered by alcohol withdrawal in alcohol-dependent subjects.

Acamprosate↗
PubMed1977

Studies of endocrine activity, plasma tryptophan and catecholamine excretion on psychosurgical patients.

The Geoffrey Knight Psychosurgical Unit admits patients on a regular basis and thus offers special opportunities for studying severely ill psychiatric cases, all having one particular treatment under relatively controlled conditions. The opportunity has been taken to repeat various metabolic studies previously reported to be abnormal in some psychiatric illnesses. In the present investigation several measures of endocrinological activity were studied, as was plasma tryptophan, both free and bound. None of these data confirmed reports of abnormalities and neither did the values found at operation help to predict clinical outcome 1 year later, which was another possibility. Urinary catecholamines were also measured and 2 weeks after operation. Male patients, regardless of diagnosis, showed a mean increase in adrenaline output after operation compared with the pre-operative value and this was significantly different from the females, who showed a small mean decrease. The depressed patients showed a significant reduction in noradrenaline excretion after operation compared with before operation and this trend was enhanced in those of good outcome at 1 year, the difference from those who responded poorly being significant. It could be that the ventromedial lesion that is produced alters noradrenaline metabolism or autonomic activity in depression and this possibility merits further study.

Adult↗
PubMed1984

Effects of four treatment methods on social phobic patients not suitable for insight-oriented psychotherapy.

Forty-two social phobic men and women, rated unsuitable for insight-oriented psychotherapy, received one of four randomly assigned types of treatment for 3 months. All patients received basal therapy (B) in the form of standardized information, self-exposure instructions, and anxiolytic medication. One group received this treatment only, with monthly appointments. The others, in addition, received either therapist-directed prolonged exposure in vivo, in some cases supplemented with exposure in imagination (PE), dynamically oriented supportive therapy (ST) or relaxation therapy (R). There was a 9 months' follow-up period. The phobia variables were more improved in the PE and ST groups than in the R and B groups at the termination of treatment. Although improvement had deteriorated somewhat in the PE group during follow-up, the improvement in target phobia was better than in the other groups. There were almost no improvements in the R and B groups. ST and PE groups also showed improved social function while the global rating showed most improvement in the PE group. The B group was not improved at all and the R group only showed a short-lived drop in muscular tension.

Adolescent↗
PubMed1990

Hostility, hopelessness and deliberate self-harm: a prospective follow-up study.

Sixty-one consecutive patients who presented following an episode of deliberate self-harm (DSH) were assessed on a number of variables, including measures of hopelessness and hostility. Attempts were made to follow all of the patients. Those who were known to have had a further episode of DSH had significantly higher levels of hopelessness and intropunitive hostility after the index episode than those who did not repeat. The question of vulnerability to DSH is discussed as well as the possibility of using measures of hopelessness and intropunitive hostility to identify those at greater risk of repetition.

Adolescent↗
PubMed1991

Platelet imipramine binding and serotonin uptake in obsessive-compulsive patients.

Platelet imipramine binding was measured in 16 drug-free nondepressed patients (aged 20-61 years, mean +/- SD 35 +/- 8) suffering from obsessive-compulsive disorder (OCD) and in 16 sex-, race- and age-matched healthy controls. Imipramine binding capacity and affinity were not different in the 2 groups. Platelet serotonin (5-HT) uptake capacity, Vmax, was also measured in 15 of these patients and their matched controls. Vmax was significantly higher in the patients (309 +/- 149 pmol/10(9) cells/min) than in the controls (181 +/- 110). An increase in platelet 5-HT uptake supports the involvement of 5-HT in OCD and may suggest that a hyperactive serotonergic system is present in this disorder.

Adult↗
PubMed1991

Dimensional approach to obsessive-compulsive disorder in childhood and adolescence.

Based on a review of the charts of child and adolescent psychiatric patients, a group of patients with obsessive-compulsive symptoms and a control group were identified. Obsessive-compulsive symptoms described in the charts were classified according to form using the checklist of Khanna et al. By use of latent trait models, a 6-item obsessive-compulsive rating scale was established revealing a dimensional rather than a categorical distribution of obsessive-compulsive symptoms. The correlation with other clinical features was investigated.

Adjustment Disorders↗
PubMed1993

Obsessive-compulsive disorder in children and adolescents. Self-reported obsessive-compulsive behaviour in pupils in Denmark.

A total of 1032 pupils in Denmark aged 11-17 years completed a survey form of the Leyton Obsessional Inventory - child version, consisting of 20 items. These pupils had higher scores for obsessional symptoms or traits than high school students in the United States, also when corrected for age differences, but the most frequently reported symptoms seemed to be the same: repetitive thoughts or words, having trouble making up one's mind and worrying about being clean enough. There was no significant sex difference in total score. From 0.5% to 5% reported considerable interference by each obsessional symptom, and 4.1% had a total interference score > 25, reflecting possible subclinical or clinical obsessive-compulsive disorder.

Adolescent↗
PubMed1996

Hypochondriacal fears and beliefs in obsessive-compulsive disorder.

The relationship of obsessions and compulsions with hypochondriasis is receiving increasing attention, but has not been substantiated by adequate research. The Illness Attitude Scales (IAS), which identify hypochondriacal patients, were administered to 30 patients with DSM-IV obsessive-compulsive disorder and 30 healthy control subjects matched for sociodemographic variables. All IAS scales were significantly higher in patients with obsessions and compulsions. However, there were no significant differences between patients and controls in the number of subjects whose symptom intensity exceeded a clinical threshold for hypochondriasis and disease phobia. Furthermore, hypochondriacal fears and beliefs were poorly correlated with obsessions and compulsions. The results suggest the presence of mild abnormal illness behaviour in patients with obsessive-compulsive disorder, unlike the situation in patients with panic disorder and depression.

Adolescent↗
PubMed1997

Citalopram in the treatment of obsessive-compulsive disorder: an open pilot study.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder, which often causes significant impairment of the affected individual's social, occupational or interpersonal functioning. Previous reports suggest that the disorder may be treated with the tricyclic antidepressant clomipramine, and also with the more recently introduced selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, sertraline and paroxetine. The present 24-week open pilot study was designed to examine the efficacy, appropriate dose range, side-effects and clinical usefulness of citalopram in OCD. A total of 29 OCD patients were included in the study, of whom 76% showed alleviation of symptoms as evaluated by various self- and observer-rated scales, such as the Yale-Brown Obsessive Compulsive Scale. In most cases the citalopram doses used were in most cases 40 or 60 mg daily, and the treatment was well tolerated. The most commonly experienced adverse events during the study were nausea, vomiting, increased dreaming and decreased sleep. Diminished sexual desire and orgasmic dysfunction were also reported. Despite having the limitations of an open study, our results suggest that citalopram may be effective in the treatment of obsessive-compulsive disorder.

Adult↗
PubMed2004

On phenomenology and classification of hoarding: a review.

OBJECTIVE: Hoarding is a behavioural abnormity characterized by the excessive collection of poorly usable objects. It is described mainly in association with obsessive-compulsive disorders (OCDs) and in geriatric populations. Yet the literature on the phenomenon is heterogeneous and the notion obviously lacks a consistent definition. This review attempts to describe the psychopathological and clinical spectrum of hoarding and may contribute to clarify its classification. METHOD: Systematic review and discussion of the literature on hoarding. RESULTS: Hoarding is a complex behavioural phenomenon associated with different mental disorders. The psychopathological structure is variously composed of elements of OCDs, impulse-control disorders, and ritualistic behaviour. Severe self-neglect is a possible consequence of hoarding. CONCLUSION: Without further specifications the term hoarding is of limited heuristic value and cannot guide therapeutic interventions satisfactorily. The condition needs to be evaluated carefully in every particular case in relation to the aforementioned psychopathological concepts.

Aged↗
PubMed2007

Impulsiveness in obsessive-compulsive disorder: results from a family study.

OBJECTIVE: Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.

Adult↗
PubMed1976

Styles of decision-making and probability appraisal in selected obsessional and phobic patients.

A questionnaire was administered to obsessional and phobic patients and normal subjects. The results of this survey confirmed the prediction that a sizeable proportion of phobic patients report irrational expectations associated with their most feared situations. A group of phobics who reported irrational expectations, a group of obsessionals who reported an abnormal degree of checking behaviour and a group of normal subjects, took part in a probabilistic inference task. Several predictions about the differential performance of these groups were fulfilled. (i) Deviations from the optimal model for individual responses were greatest in the obsessional group. (ii) When Neuroticism was partialled out, the three groups differed with respect to amount of evidence required prior to a decision, the obsessional group having the highest score on this variable. (iii) The phobic group were more likely than the other two groups to make irrational event predictions.

Age Factors↗
PubMed1992

Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behaviour therapy.

The efficacy of behavioural treatment of obsessive-compulsive disorder (OCD) has been well documented. However, severely depressed OCD patients showed fewer short- and long-term benefits than less depressed patients. The present study tested the hypothesis that reduction of depression by imipramine prior to behaviour therapy would enhance the effects of behavioural therapy on depressed OC patients. Thirty-eight patients were divided into highly and mildly depressed groups according to their scores on the Beck Depression Inventory; half of each group received imipramine and half received placebo for six weeks. All patients then received three weeks of daily behavioural treatment (exposure and response prevention) followed by 12 weekly sessions of supportive psychotherapy. Results indicated that although imipramine improved depressive symptoms in depressed patients, it did not affect OC symptoms. Behaviour therapy markedly reduced OC symptoms but, contrary to our hypothesis, imipramine did not potentiate the effects of behaviour therapy. No differences between highly depressed and mildly depressed patients on OC symptoms were found in their responses to behavioural or supportive therapy.

Adult↗