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PubMed2006

Deconstructing obsessive-compulsive disorder: a multidimensional perspective.

PURPOSE OF REVIEW: The aim of this article is to critically summarize the most promising attempts to split obsessive-compulsive disorder into subgroups based on clinical characteristics (i.e. age of onset, presence of comorbid tics, positive family history) and symptom theme, with particular emphasis on the latter. RECENT FINDINGS: Attempts to split obsessive-compulsive disorder into mutually exclusive sub-groups based on clinical characteristics have been useful but not exempt of problems. The complex clinical presentation of the condition can be reduced to a few consistent, temporally stable symptom dimensions that can coexist in any given individual. Researchers have begun to investigate the genetics and neural mechanisms of these symptom dimensions and to develop specific assessment and treatment protocols for each particular problem. SUMMARY: The multidimensional model of obsessive-compulsive disorder proposes a middle ground between the 'lumping' and 'splitting' perspectives. The disorder can be better understood as a spectrum of multiple potentially overlapping syndromes. The most fruitful research strategy will be to examine the common and specific etiological factors implicated in each symptom dimension.

Brain↗
PubMed2004

Clinical management of obsessive-compulsive-bipolar comorbidity: a case series.

OBJECTIVE: To assess the clinical characteristics and the optimal treatment of obsessive compulsive symptoms in patients with familial background, current or past symptoms consistent with a bipolar spectrum diagnosis. METHODS: Longitudinal clinical observation of seven cases with obsessive-compulsive-bipolar comorbidity. RESULTS: In the cases presented that met the DSM-IV-TR criteria for obsessive compulsive disorder (OCD), the concurrent symptoms and the clinical course pointed to a different principal diagnosis and suggested therapeutic strategies different from those currently recommended in OCD. Clear-cut onset of symptoms, high prevalence of mood disorders in relatives, revaluation of their history, switch into mania induced by antidepressants, and clinical follow-up suggested a hierarchical priority of bipolar diagnosis. CONCLUSIONS: The presence of the aforementioned atypical symptoms should alert the physician about the possibility of bipolar comorbidity in OCD patients. If the suspicion is confirmed, bipolar diagnosis should have priority, at least from a therapeutic point of view. The first choice in treatment should be with mood stabilizers or second generation antipsychotics. Mood stabilization should be achieved as a first objective.

Adult↗
PubMed1990

Direct modification of obsessive thinking with messages.

We treated 2 patients with obsessive-compulsive disorders for years using messages, and their symptoms had improved. We provided the messages that utterly disproved the core reason of their fears, and suggested the patients to repeat, listen or read these messages whenever the obsessive thinking occurred. We supposed that the therapeutic intervention we proposed here have the following benefits: 1. This could dispel the patients' fears and correct the contents of obsessive thinking. 2. This could avoid involving others around and remove the disadvantages following the involvement. We discussed the mechanism of this intervention on the basis of the learning theory.

Adult↗
PubMed2005

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.

Adult↗
PubMed2005

Obsessive-compulsive symptoms in schizophrenia: prevalance and clinical correlates.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive-compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) were evaluated by the structured and clinical interview for axis-1 DSM-IV disorders-patient edition (SCID-P), the Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y-BOCS total score > or =7) also met the DSM-IV criteria for OCD. The total score on Y-BOCS was significantly correlated with total score on PANSS, Positive-PANSS score, General-PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.

Adult↗
PubMed2006

Group A beta hemolytic streptococcal infections and obsessive-compulsive symptoms in a Turkish pediatric population.

The purpose of the present study was to evaluate obsessive-compulsive disease (OCD) in Turkish Children who had group A beta hemolytic streptococcal (GABHS) infections and those who had not. Thirty-one children and adolescents (the study group) were compared with 28 children and adolescents. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores were rated between study group and control group. The mean score, obsession and compulsion scores of CY-BOCS in the study group were significantly higher than they were in the control group (P < 0.05). The GABHS infections should be assessed in the etiology of OCD in children. Considering GABHS infections may help the treatment of OCD.

Adolescent↗
PubMed2006

Successful treatment for obsessive-compulsive disorder with addition of low-dose risperidone to fluvoxamine: implications for plasma levels of catecholamine metabolites and serum brain-derived neurotrophic factor levels.

The authors report on the successful treatment of obsessive-compulsive disorder (OCD) in three patients with the addition of risperidone to ongoing fluvoxamine treatment. Plasma homovanillic acid (HVA), but not 3-methoxy-4-hydroxyphenylglycol (MHPG) levels decreased after risperidone administration, and plasma levels of fluvoxamine did not change. In addition, serum brain-derived neurotrophic factor (BDNF) levels were not altered after the recovery from obsessive-compulsive symptoms, indicating that serum BDNF levels might not predict the patient's response to risperidone treatment. Taken together, a combination treatment of risperdone and fluvoxamine might improve obsessive-compulsive symptoms. In short, fluvoxamine enhances the activity of the serotonergic system by inhibiting serotonin transporters, and risperidone decreases that of the dopaminergic system by blocking D2 receptors.

Adult↗
PubMed2006

Clinical predictors of response to pharmacotherapy with selective serotonin reuptake inhibitors in obsessive-compulsive disorder.

The objective of this study was to investigate the clinical predictors of response to treatment with selective serotonin reuptake inhibitors (SSRI) in a sample of patients with obsessive-compulsive disorder (OCD). A total of 55 patients diagnosed as OCD according to revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders criteria underwent a 12-week standardized SSRI treatment. According to 'treatment response', defined as at least a 35% drop in the Yale-Brown Obsessive-Compulsive Scale total score, OCD patients were divided into two groups. A total of 32 (58.2%) patients who responded to treatment and 23 (41.8%) who did not, were compared in terms of sociodemographic and clinical characteristics. The authors' findings demonstrated that the severity of obsession-compulsions and disability in work, social and family lives at the beginning of treatment were significantly higher in OCD patients who did not respond to treatment in comparison to those who did. Linear regression analysis, however, revealed that Sheehan Disability Scale-work score at baseline was a predictor of response to SSRI treatment. The higher levels of disability at the beginning of treatment in patients with OCD are associated with a poorer response to SSRI.

Adolescent↗
PubMed1985

An investigation of two self-report measures of obsessional phenomena in obsessive-compulsive adolescents: research note.

A number of studies have recently demonstrated the clinical utility of objective self-report inventories in the assessment of obsessive-compulsive disorders in adults. To date, the usefulness of these instruments has not been demonstrated with obsessive-compulsive adolescents. In the present study the Leyton Obsessional Inventory and the Maudsley Obsessional-Compulsive Inventory were administered to 11 obsessive-compulsive adolescents and a group of 10 anxious non-obsessional patients. The obsessional adolescents scored significantly higher than the controls on the Maudsley total score and checking factors alone. Possible explanations of the results are discussed.

Adolescent↗
PubMed1996

Obsessions and compulsions in Prader-Willi syndrome.

This study examines the nature, severity and correlates of non-food obsessions and compulsions in 91 people with Prader-Willi syndrome (PWS) aged 5-47 years (mean age = 19 years). Prominent symptoms, seen in 37-58% of the sample, included hoarding; ordering and arranging; concerns with symmetry and exactness; rewriting; and needs to tell, know or ask. A remarkably high proportion of participants had moderate to severe symptom severity ratings; 64% showed symptom-related distress, and 80% showed symptom-related adaptive impairment. The study also compared obsessive-compulsive symptoms in 43 adults with PWS to age- and sex-matched non-retarded adults with obsessive-compulsive disorder (OCD). The PWS and OCD groups showed similar levels of symptom severity and numbers of compulsions; they also showed more areas of symptom similarity than difference. Increased risks of OCD in persons with PWS are strongly indicated. Implications are discussed for pharmacotherapy, behavioral therapy and family support.

Adolescent↗
PubMed1995

Familial paroxysmal kinesigenic choreo-athetosis in a child with visual hallucinations and obsessive-compulsive behaviour.

A teenage male is described, in whom Tourette Syndrome was suspected, which was later replaced by attacks of paroxysmal kinesigenic choreo-athetosis. He also exhibited bizarre, episodic perceptual distortions of his visual environment and manifestations of an obsessive-compulsive disorder. Carbamazepine treatment not only completely eliminated the recurring attacks of his choreo-athetosis but also, contrary to expectations, the visual disturbances and even the symptoms of his obsessive-compulsive disorder. Obsessive compulsive disorder should be searched for by direct questioning in all patients with basal ganglia disorders.

Adolescent↗
PubMed1996

Autonomic activity in relation to cerebrospinal fluid neurochemistry in obsessive and disruptive children and adolescents.

Electrodermal activity and heart rate were recorded during rest, simple tones, and a reaction time task in 43 male and female adolescents and children with obsessive compulsive disorder and 30 male adolescents and children with disruptive behavior disorders who had lumbar cerebrospinal fluid drawn during the same week. Partial correlations controlling for age and sex showed that in the obsessive group metabolites of serotonin and dopamine, but not of norepinephrine, were positively correlated with electrodermal responsivity, most consistently in the reaction time task. This result was not replicated in disruptive boys. Adrenocorticotropic hormone was positively related to electrodermal activity and heart rate throughout the session. The results for the obsessive adolescents suggest that nigrostriatal dopamine turnover and central serotonin turnover affect electrodermal activity, generally confirming and extending conclusions from pharmacological studies. Diagnosis may affect these relationships.

Adolescent↗
PubMed1997

Characteristics of open- and closed-loop smooth pursuit responses among obsessive-compulsive disorder, schizophrenia, and nonpsychiatric individuals.

Twenty obsessive-compulsive disorder patients and comparison samples of 20 schizophrenia and 20 nonpsychiatric individuals were presented with (a) a step-ramp task designed to measure smooth pursuit initiation and (b) a regular ramp task designed to measure steady-state tracking performance. Obsessive-compulsive disorder and non-psychiatric individuals had statistically similar pursuit reaction time and average eye accelerations during the open-loop interval. They also had similar closed-loop performance. Schizophrenia patients, however, had delayed pursuit reaction times and reduced eye acceleration during the last 60 ms of the open-loop interval. These findings suggest that brain regions supporting smooth pursuit performance are unimpaired among obsessive-compulsive disorder patients. Furthermore, the deficits found in the schizophrenia patients replicate and extend the results of previous smooth pursuit studies.

Adult↗
PubMed1991

Obsessive-compulsive disorders in the pediatric dermatology practice.

Childhood and adolescent obsessive-compulsive disorders are sometimes seen in dermatology practice. When present, OCD is most frequently manifested in younger patients as trichotillomania, onychotillomania, onychophagia, and acne excoriée. In addition to these disorders, obsessive hand washing, AIDS phobia, and other psychosomatic dermatoses characterized by obsessive-compulsive tendencies are seen in all age groups. It is important to define the nature of any underlying psychiatric disorder before beginning drug treatment of these patients. With the availability of new medications, most notably, clomipramine and fluoxetine, there is reason for optimism regarding the treatment of OCD. Whenever feasible, the dermatologist should not hesitate to involve a psychiatrist to help with diagnosis and treatment when the diagnosis of OCD is being considered.

Child↗
PubMed1978

Obsessive-compulsive neurosis, anancastic symptomatology and ABO blood types.

Determinations of ABO blood types was carried out in 38 patients with obsessive-compulsive neurosis, 48 schizophrenics with anancastic symptomatology, 31 depressives with anancastic symptomatology, 260 schizophrenics free of anancastic symptomatology and 65 depressives free of anancastic symptomatology. Results were compared with a representative sample of the general population. The findings of the present study provide evidence of an association between obsessive-compulsive neurosis and phenotype A, whilst a similar association between ABO blood types and anancastic symptomatology occurring in the course of psychotic disorders was not found. The significance of these findings is discussed with regard to current diagnostic and aetiological issues in obsessive-compulsive neurosis.

ABO Blood-Group System↗
PubMed1988

Total sleep deprivation in patients with obsessive-compulsive disorder.

Total sleep deprivation was performed in 16 patients with obsessive-compulsive disorder. Overall, no effect was observed on either mood or obsessive-compulsive behaviour. However, individual patients showed worsening, improvement or no change in obsessive-compulsive symptoms, independent of mood response, across the 3 days of sleep deprivation.

Adult↗
PubMed1994

Obsessions and compulsions in the community.

A total of 810 adults were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey. A semistructured examination, the Standard Psychiatric Examination, was used. The relationships between obsessions and compulsions and personal characteristics, childhood behaviors, family history, and other psychopathology were evaluated. The estimated prevalence of obsessions and compulsions in this population was 1.5%. Cases were significantly more likely to report having had childhood fears, learning disabilities and a family history of alcoholism and suicidal behavior. There were significant positive relationships between scores on compulsive, borderline and histrionic personality disorder scales and the probability of obsessions and compulsions. These exploratory analyses in an epidemiologic sample may identify factors of etiologic importance in this condition.

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↗