[Obsessive disorders and ritualizations in the psychotic patient].
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Ceremonial Behavior↗
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Behavioral avoidance test for childhood obsessive-compulsive disorder: a home-based observation.
Obsessive-compulsive disorder (OCD) is one of the most debilitating of the anxiety disorders. As our knowledge about this childhood condition continues to grow, there is a need for controlled treatment-outcome trials with precise assessments that are sensitive to treatment change, to guide the development of effective interventions. To evaluate the efficacy of a treatment protocol, it is necessary to have reliable and sensitive measures of OCD symptoms, including measures of obsessions, compulsions, and related levels of distress and avoidance. Whilst structured diagnostic interviews, semistructured clinical interviews, and self-report measures have been widely used in the assessment of childhood OCD, related levels of behavioral distress and avoidance have not been measured in treatment-outcome trials. This study investigated the sensitivity of a behavioral avoidance test (BAT), conducted in the home environment, in assessing treatment-outcome effects for children and adolescents with OCD following a 14-week cognitive-behavioral therapy (CBT) family intervention, in comparison to children in an 8-week "waitlist" control group. The results of the current study strongly support the sensitivity of a standardized BAT in assessing treatment-related changes in children and adolescents with OCD. Implications and future directions for research are discussed.
Adolescent↗
[Cognitive therapy in patients with obsessive ruminations].
The article stands out the elevate amount of patients with obsessive-compulsive disorder who only or mainly present obsessive ruminations. Firstly, the basic concepts of behavioral model of obsessive-compulsive disorder are enunciated. In the second place, the limitations of behavioural treatment for patient with obsessive ruminations are discussed. Then, the general characteristics of cognitive model of compulsive-obsessive dysfunction are formulated. Finally, steps of cognitive treatment for patient with obsessive ruminations are outlined.
Cognitive Behavioral Therapy↗
Consumer & family information: obsessive-compulsive disorder.
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Behavior Therapy↗
Family treatment of an obsessive-compulsive child: a case report.
This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.
Adult↗
Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy.
BACKGROUND: The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictors of clinical outcome. METHOD: Sixty outpatients meeting DSM-II-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prolonged pharmacologic therapy with an SRI. RESULTS: Thirty-seven patients (61.7%) completed an adequate behavioral treatment. At long-term assessment, 22 patients (36.7%) exhibited a global Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a final reduction in Y-BOCS global score of less than 35% and were considered nonresponders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no significant differences in either Y-BOCS global or obsessions subscale scores between those who did and those who did not undergo behavioral therapy were detected. Obsessions of sexual/religious content were the unique factor related to a poorer long-term outcome. CONCLUSION: A substantial number of OCD patients showed persistent disabling symptoms at the long-term follow-up in spite of combined pharmacologic and behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions predicted poorer long-term outcome, whereas short-term response to SRI treatment failed to achieve predictive value in the long-term course of OCD.
Adolescent↗
Obsessive thoughts: the problem of therapy.
Eleven patients with obsessive thoughts were treated in two pilot studies. In the first of these patients were given thought-stopping, and this was contrasted with relaxation therapy. In the second study patients were treated by a technique described here as 'satiation', and this was followed by thought-stopping and finally a course of amitriptyline. The overall results were poor, but one type of obsessive thought responded well to satiation.
Amitriptyline↗
Integrating play therapy in the treatment of children with obsessive-compulsive disorder.
While behavioral and psychopharmacological approaches are the most effective interventions for treating obsessive-compulsive disorder (OCD), psychodynamically oriented play therapy can enhance the treatment of children with this disorder. Play therapy techniques are useful in addressing treatment resistance, feelings of shame around OCD symptoms, negative self-concept, and issues of psychosocial adjustment. A case study illustrates this integrated approach to treatment.
Child, Preschool↗
Cognitive behavioral therapy versus psychosurgery for refractory obsessive-compulsive disorder.
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Clomipramine↗
Behavior therapy for the treatment of obsessive-compulsive disorder: theory and practice.
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Behavior Therapy↗
Perceived criticism predicts severity of anxiety symptoms after behavioral treatment in patients with obsessive-compulsive disorder and panic disorder with agoraphobia.
In prospective research, psychiatric patients' perceived criticism (PC) from family members has been linked to higher rates of relapse and worse treatment outcome. Researchers have disagreed about whether PC contributes to poor treatment outcomes or whether it merely reflects the severity of a patient's disturbance. In this study, structural equation modeling was used to conduct a cross-lagged panel analysis of the relationship between PC and anxiety symptom severity assessed before and after treatment in anxiety-disordered patients. PC was found to be unrelated to concurrent symptom severity. Furthermore, pretreatment PC significantly predicted posttreatment symptom severity over and above the effect of pretreatment symptom severity, whereas pretreatment symptom severity failed to significantly predict posttreatment PC. Thus, these results are consistent with (although not proof of) the hypothesis that PC detracts from patients' ability to respond to treatment, and inconsistent with the hypothesis that PC is a reflection of a patient's symptom severity.
Adolescent↗
Psychological impact of infertility: identifying issues and needs.
During interviews, married couples experiencing infertility reported emotional reactions such as sadness, depression, anger, confusion, desperation, hurt, embarrassment, and humiliation. Behavioral reactions to infertility included disorganization, distractability, exhaustion, moodiness and obsessive thoughts and behaviors. Participants also described multiple sources of stress and utilized a variety of coping strategies. Implications for social work clinical and research practitioners are discussed.
Adaptation, Psychological↗
A genetic basis for obsessive grooming.
Excessive grooming behaviors, cleansing rituals, and self-mutilation are important features of a range of neuropsychiatric diseases including obsessive compulsive (OC)-spectrum disorders. In this issue of Neuron, Greer and Capecchi (2002) report that Hoxb8 mutant mice exhibit this behavioral phenotype. These Hoxb8 mutants will be valuable in exploring the genetics and pathophysiology of OC-spectrum disorders as well as strategies for their treatment.
Animals↗
Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: an open trial of a new protocol-driven treatment package.
OBJECTIVE: The authors present an open trial of cognitive-behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder. METHOD: The authors developed a treatment manual explicitly designed to facilitate (1) patient and parental compliance, (2) exportability, and (3) empirical evaluation. Successive versions of the manual were used to treat 15 consecutive child and adolescent patients with obsessive-compulsive disorder, most of whom were also treated with medications. RESULTS: Statistical analyses showed a significant benefit for treatment immediately posttreatment and at follow-up. Nine patients experienced at least a 50% reduction in symptoms on the Yale-Brown Obsessive-Compulsive Scale at posttreatment; 6 were asymptomatic on the National Institute of Mental Health Global Obsessive-Compulsive Scale. No patients relapsed at follow-up intervals as long as 18 months. Booster behavioral treatment allowed medication discontinuation in 6 patients. No patient refused treatment; 2 discontinued prematurely. CONCLUSIONS: Cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, appears to be a safe, acceptable, and effective treatment for obsessive-compulsive disorder in children and adolescents.
Adolescent↗
Using obsessions as reinforcers with and without mild reductive procedures to decrease inappropriate behaviors of children with autism.
We assessed the effectiveness of using the obsessions of children with autism to reduce their inappropriate behaviors. Baseline consisted of a traditional differential reinforcement of other behaviors (DRO) in which food reinforcers were provided contingent upon a period of nonoccurrence of the inappropriate behaviors. Then, three treatment conditions were assessed using a multielement design. One condition provided objects of obsession as reinforcers for periods of nonoccurrence of the inappropriate behaviors. A second condition also provided the obsessions as reinforcers, but in conjunction with mild reductive procedures (verbal "no", time-out). A final condition used the food reinforcers of baseline, but with mild reductive procedures. Results indicated that all three treatment conditions were more effective than the traditional food DRO of baseline. The most effective condition was the obsessions plus mild reductive procedures. Results are discussed in terms of recommendations for effective treatment planning.
Autistic Disorder↗
The effect of fluvoxamine and behavior therapy on children and adolescents with obsessive-compulsive disorder.
OBJECTIVE: The efficacy of medications, consisting of serotonin partial and specific reuptake blockers, and behavior therapy, consisting of exposure and response prevention in addition to social skills training, cognitive therapy, and habit reversal, in the treatment of obsessive-compulsive disorder are well documented. The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy. METHODS: Ten children/adolescents who had not previously responded to behavior therapy were randomly assigned to two groups: fluvoxamine alone or fluvoxamine with behavior therapy. All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year. RESULTS: Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable, the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). According to the other measurements-National Institute of Mental Health-Global Obses-sive-Compulsive Scale, Clinical Global Impression-Improvement (assessing level of im-provement from week to week), and Clinical Global Impression-Severity of Illness Scale (as-sessing how ill the patient is from week to week)-improvement was not as evident. According to the CY-BOCS, those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication. At two-year follow-up, all patients continued to improve, with those in the combined approach improving more than those in the medication-alone group. CONCLUSIONS: Future studies should determine the specific effect of each treatment group, combined and singularly. Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed. The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy, according to the CY-BOCS.
Adolescent↗
Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.
BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.
Adult↗
Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.
OBJECTIVE: This study tracked the individual criteria of four DSM-IV personality disorders-borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years. METHOD: This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. CONCLUSIONS: These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V.
Adolescent↗