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PubMed1999

Obsessive-compulsive disorder symptoms before and after recovery from bulimia nervosa.

OBJECTIVE: Obsessive-compulsive disorder (OCD) symptoms are common in people who are ill with bulimia nervosa. However, little is known about whether OCD symptoms persist after long-term recovery from bulimia. METHOD: Thirty-one female patients with bulimia nervosa, 29 women who had been recovered from bulimia for more than 1 year, and 19 healthy female comparison subjects completed the Yale-Brown Obsessive Compulsive Scale, which measures OCD-like symptoms. Items related to symptoms of core eating disorders were omitted from the Yale-Brown scale. RESULTS: The Yale-Brown scale scores of the women with bulimia (mean = 13.1, SD = 10.6) and those who had recovered from bulimia (mean = 7.9, SD = 7.0) were significantly higher than the scores of the normal comparison subjects (mean = 1.9, SD = 2.6). Women with bulimia and those who had recovered from bulimia had similar Yale-Brown scale scores and endorsed similar Yale-Brown scale target symptoms, such as obsessions related to symmetry and exactness. CONCLUSIONS: OCD symptoms persist after recovery from bulimia. Moreover, the types of OCD symptoms experienced by bulimia patients do not vary dramatically with improvement in bulimic symptoms. Persistent OCD symptoms after recovery from bulimia raise the possibility that these behaviors are trait-related and contribute to the pathogenesis of bulimia.

Adult↗
PubMed2006

Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania.

OBJECTIVE: Problems with inhibiting certain pathological behaviors are integral to obsessive-compulsive disorder (OCD), trichotillomania, and other putative obsessive-compulsive spectrum disorders. The authors assessed and compared motor inhibition and cognitive flexibility in OCD and trichotillomania for the first time, to their knowledge. METHOD: The Stop-Signal Task and the Intradimensiona/Extradimensional Shift Task were administered to 20 patients with OCD, 17 patients with trichotillomania, and 20 healthy comparison subjects. RESULTS: Both OCD and trichotillomania showed impaired inhibition of motor responses. For trichotillomania, the deficit was worse than for OCD, and the degree of the deficit correlated significantly with symptom severity. Only patients with OCD showed deficits in cognitive flexibility. CONCLUSIONS: Impaired inhibition of motor responses (impulsivity) was found in OCD and trichotillomania, whereas cognitive inflexibility (thought to contribute to compulsivity) was limited to OCD. This assessment will advance the characterization and classification of obsessive-compulsive spectrum disorders and aid the development of novel treatments.

Adult↗
PubMed2003

Obsessive-compulsive disorder in adolescent schizophrenia patients.

OBJECTIVE: The co-occurrence of obsessive-compulsive disorder (OCD) in adult patients with schizophrenia has been increasingly recognized. However, the rate of OCD comorbidity in adolescent schizophrenia patients has yet to be systematically evaluated. METHOD: The rate of DSM-IV OCD was evaluated in 50 adolescent inpatients with schizophrenia or schizoaffective disorder. The severity of schizophrenia and OCD symptoms was assessed with the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Thirteen schizophrenia patients (26.0%) also met the DSM-IV criteria for OCD. This subgroup scored significantly higher on the SANS subscale for affective flattening or blunting. The total SANS score positively correlated with the total Yale-Brown Obsessive Compulsive Scale score. CONCLUSIONS: A substantial proportion of adolescent schizophrenia inpatients have concomitant OCD. A prospective study is needed to evaluate the clinical course, response to treatment, and prognosis for this complex disorder.

Adolescent↗
PubMed2001

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings.

The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.

Adolescent↗
PubMed1999

Are musical obsessions a temporal lobe phenomenon?

Obsessive musical tunes have been described in some cases of obsessive-compulsive disorder (OCD). The authors present 2 cases of patients with musical obsessions, including findings from functional brain imaging. Both patients, 1 with idiopathic OCD and 1 with symptoms secondary to head trauma, demonstrated decreased blood flow in temporal lobes. This finding is consistent with previous literature on musical and auditory hallucinations.

Adult↗
PubMed2003

Item-by-item factor analysis of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist.

Clinical subtypes of obsessive-compulsive disorder may have differing pathophysiological mechanisms and treatment outcomes. The subtypes identified by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist, clustered by clinical consensus, have never been subject to statistical validation. A factor analysis using a sample of 160 patients with OCD was conducted to determine whether factor analytically derived categories are identical to extant clinically determined categories. Our analysis revealed that the contamination subtype of the Y-BOCS Symptom Checklist contains two distinct subgroups: one relating to discomfort and the other to fear of harm. If replicated on a larger scale, the finding of new subtype groupings would have important implications for future research in obsessive-compulsive disorder.

Adolescent↗
PubMed1997

Impaired neuropsychological functioning in Tourette's syndrome subjects with co-occurring obsessive-compulsive and attention deficit symptoms.

This study examined neuropsychological performance by 92 children with Tourette's syndrome (TS) grouped by the presence or absence of obsessive-compulsive and/or attention deficit symptoms. The identified groups did not differ with respect to age, education, age at onset of TS symptoms, or medication use. After statistical control for complex motor symptoms, impaired performance on measures of achievement and executive functioning was correlated with obsessive and obsessive/attention symptoms, but not with attention symptoms alone. The presence of both obsessive and attention symptoms identified children with impairment across several tasks. Clinical and functional implications are discussed.

Adolescent↗
PubMed1992

Obsessive-compulsive disorder.

Obsessive-compulsive disorder is a well-defined clinical syndrome that has been difficult to treat with standard psychotherapies and medications. Data accumulated over the last decade have demonstrated that the disorder is relatively common and frequently coexists with phobia, depression, and alcohol abuse. The authors review current studies of the spectrum of obsessive-compulsive disorder and related disorders that respond to the new serotonergic antidepressants and behavioral therapy. Differential diagnosis, epidemiology and comorbidity, etiology, evaluation, and psychologic and pharmacologic treatments are discussed. Most patients with obsessive-compulsive disorder require long-term treatment with drugs, but behavioral therapy has also been used successfully. Serotonin reuptake inhibitors used in the treatment of depression have been found effective; clomipramine has produced the best results in large-scale tests. The fact that serotonin reuptake inhibitors are effective as both antidepressants and antiobsessional agents suggests common biological factors in disorders that respond to these drugs.

Antidepressive Agents↗
PubMed2002

Symptoms of obsessive-compulsive disorder in a sample of Iranian patients.

BACKGROUND: Characteristic features of the obsessive-compulsive disorder (OCD) occur with remarkable consistency in different cultural settings. The content of symptoms, however, seems to vary across cultures. AIMS: To examine the content of symptoms in a sample of OCD patients from Iran. METHODS: In a sample of 135 patients recruited from three treatment settings the prevalence of symptoms with different contents were ranked and compared across genders. RESULTS: Doubts and indecisiveness were the most common obsessions and washing the most common compulsion for the whole sample. Fears of impurity and contamination, obsessive thoughts about self-impurity and washing compulsions were more common in women, whereas blasphemous thoughts and orderliness compulsions were more common in men. CONCLUSIONS: With minor differences, the pattern of symptoms with various contents in this sample was similar to that in Western settings.

Adult↗
PubMed2001

A family study of juvenile obsessive-compulsive disorder.

OBJECTIVES: To determine whether juvenile obsessive-compulsive disorder (OCD) is familial and whether the rate of Tourette syndrome (TS) and tic disorders is higher among relatives of patients with OCD than among relatives of controls subjects. METHOD: We assessed first-degree relatives of 35 juvenile OCD probands (aged 16 years or less) and 34 matched, psychiatrically unaffected control subjects, using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) (unpublished), a Questionnaire for tic disorders, the Children's Version of Leyton's Obsessional Inventory (CV-LOI), and the Children's Version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Similarly, we assessed adult relatives, using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Leyton's Obsessional Inventory (LOI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and a Questionnaire for tic disorders. The diagnoses were determined by consensus, using DSM-III-R criteria. We calculated age-corrected morbid risk, using Weinberg's method. RESULTS: The morbid risk for OCD among the relatives of OCD probands was 4.96%, while none of the relatives of unaffected control subjects had OCD. We did not diagnose TS in any of the relatives of either OCD probands or control subjects. We diagnosed chronic motor tic disorders in only 1 of the relatives of OCD probands, while none of the relatives of control subjects had any tic disorder. CONCLUSION: Most juvenile cases of OCD are nonfamilial and unrelated to tic disorders, while only a few are familial. There is a need to re-examine the issue of familiality in cases of OCD, as well as its relation to TS, using larger community samples to better understand the hypotheses of familial transmission and comorbidity with tic disorders.

Adolescent↗
PubMed2001

Obsessive--compulsive disorder and psychosis.

OBJECTIVE: To study the phenomenology, treatment, course, and outcome of patients with comorbid obsessive-compulsive disorder (OCD) and psychotic features. METHOD: A retrospective chart analysis was conducted on 15 patients with OCD with psychotic features. Data were collected regarding patient demographics, psychiatric diagnosis, duration of illness, treatment details, and clinically determined outcome over time. RESULTS: Obsessive doubts, washing, and checking compulsions were the most commonly seen obsessive-compulsive (OC) symptoms. Of the patients, 53% had first-rank symptoms, and 77% showed significant improvement on treatment with a combination of antipsychotic and antiobsessional drugs. CONCLUSIONS: The observed improvement on treatment with a combination of antiobsessional and antipsychotic drugs supports the use of combination treatment in patients who have both OC and psychotic symptoms.

Adult↗
PubMed2005

Obsessive-compulsive symptoms and positive, negative, and depressive symptoms in patients with recent-onset schizophrenic disorders.

OBJECTIVES: To study the relation between obsessive-compulsive symptoms (OCS) and positive, negative, and depressive symptoms in patients with recent-onset schizophrenic disorders. METHODS: We undertook a prospective study of 113 consecutively hospitalized patients with recent-onset schizophrenia or related disorders diagnosed according to DSM-IV criteria. We compared 3 subgroups: one without comorbid OCS, one with OCS not fulfilling DSM-IV criteria for obsessive-compulsive disorder (OCD), and one with comorbid OCD diagnosed according to DSM-IV criteria. We assessed OCS severity at admission and 6 weeks thereafter with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Positive and Negative Syndrome Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS) were independently administered. RESULTS: At admission, patients with schizophrenic disorders and OCD had higher mean MADRS scores than both other groups; patients with OCS not fulfilling DSM-IV criteria for OCD had lower mean PANSS negative subscale scores than both other groups. After 6 weeks, there were no significant between-group differences, and OCS severity remained constant. CONCLUSIONS: Acute patients with recent-onset schizophrenia and OCD have more severe depressive symptoms but do differ in negative symptoms, compared with patients without comorbid OCD. Mild OCS may be related to less severe negative symptoms. During regular inpatient treatment, OCS severity remains constant

Acute Disease↗
PubMed1991

Fluoxetine treatment of obsessive-compulsive disorder.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

Adult↗
PubMed1996

[Utilization of thought stopping in the treatment of obsessive- compulsive disorder in a 9 year old girl].

OBJECTIVE: To use a pharmacobehavioural approach employing modified techniques of exposure, prevention of the response, and thought stopping in the treatment of obsessive-compulsive disorder in a 9-year-old girl. METHODS: The diagnosis of obsessive-compulsive disorder (OCD) was made based on the DSM-IV criteria. The patient was seen over 15 sessions, during which clomipramine was introduced and modified techniques of exposure, prevention of the response, and thought stopping were successively used. Follow-up extended over more than 18 months after the end of the therapy. RESULTS: The patient learned and used the behavioural techniques easily, and we observed a rapid, complete, and sustained disappearance of the obsessive-compulsive symptomatology. CONCLUSIONS: Use of a pharmacobehavioural approach in treating OCD in young children remains limited. Techniques used with adults and slightly modified to adapt them for children are, in our view, an avenue of treatment worth exploring.

Child↗
PubMed1997

Behaviour therapy for obsessive-compulsive disorder: a decade of progress.

OBJECTIVE: To review the last decade of behaviour therapy research in obsessive-compulsive disorder (OCD). METHOD: The most salient research was analyzed. RESULTS: Many studies confirmed that exposure and ritual prevention (ERP) effectively reduced compulsive rituals and obsessive thoughts in most patients in all age groups, although a minority of the patients did not complete treatment. Gains persisted to follow-up 2 to 6 years later in several countries. Improvement after ERP generalized to obsessive-compulsive beliefs, mood, work, and social adjustment, and was accompanied by reduction in cerebral blood flow in the right caudate nucleus. Teaching patients how to prevent relapse seems to reduce the risk of recurrence. ERP yields slightly more improvement than does appropriate antidepressant medication and is followed by far less relapse after treatment has stopped, so ERP may be more cost-effective in the long term. Antidepressant medication is a useful adjunct to ERP when OCD is accompanied by comorbid depression. The therapist now tends to teach patients how to carry out self-exposure and self-imposed ritual prevention, rather than to impose ERP on them. Self-help manuals help patients to do this, and computer aids to allow patients to learn how to do ERP at home have been valuable in pilot studies. Cognitive therapy without ERP was as useful as ERP. CONCLUSION: ERP is of lasting value for OCD. Long-term cost-effectiveness comparisons are needed of self-administered ERP versus cognitive therapy and versus medication. Studies are also needed of brief psychological treatment for depression comorbid with OCD.

Adult↗
PubMed1999

Obsessive-compulsive spectrum disorders: effective treatment with paroxetine.

OBJECTIVE: To examine whether, like pure obsessive-compulsive disorder, obsessive-compulsive spectrum disorders are treatable with a selective serotonin reuptake inhibitor (SSRI). METHOD: Case histories of patients prescribed paroxetine for compulsive collecting, skin-picking, and trichotillomania were reviewed. RESULTS: All patients were successfully treated with paroxetine. CONCLUSIONS: Obsessive-compulsive spectrum disorders may share a serotonin-related dysfunction, and SSRIs may prove effective in their treatment.

Adult↗
PubMed2002

Hypoplasia of the corpus callosum and obsessive-compulsive symptoms.

Abnormalities in the corpus callosum, which connects the cerebral hemispheres, have been implicated in the pathogenesis of obsessive-compulsive disorder. This is a report of two cases of obsessive-compulsive disorder associated with hypoplasia of the corpus callosum. These data provide further support for corpus callosum-mediated dysfunction in obsessive-compulsive disorder.

Adolescent↗
PubMed2003

Obsessive-compulsive disorder in Bali: the cultural shaping of a neuropsychiatric disorder.

Many psychiatric researchers believe that the clinical picture of obsessive-compulsive disorder (OCD) shows little variability cross-culturally. This study examined the symptomatology and illness experience of 19 patients suffering from OCD in Bali, Indonesia. Patients were assessed using a semi-structured clinical interview. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was utilized for gauging symptomatology and severity of symptoms. A sub-sample of patients was interviewed using person-centered ethnographic techniques. Balinese culture strongly shaped symptomatic expression. The most common obsessional themes emphasized patients' obsessional need to know information about their social network, such as the identity and status of passers-by. Somatic obsessions and religious themes around witchcraft and spirits were also prominent. Psychiatric, indigenous and anthropological perspectives are contrasted to highlight the power and limitations of each to explain OCD.

Adult↗