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PubMed2003

Obsessive-compulsive disorder after traumatic brain injury.

Traumatic brain injury ( TBI) neuropsychiatric sequelae are a significant cause of morbidity in TBI victims. Among the recognized sequelae are anxiety, obsessions, compulsions and obsessive-compulsive disorder (OCD). This review addresses the emergence of OCD and OCD symptoms after TBI with an emphasis on neural circuits that underlie OCD symptom expression that may be affected by the injury. Current studies suggest that post-TBI emergent psychopathology, including OCD, is influenced by underlying sub-clinical diathesis, brain injury lesions sites, environmental stressors and the rehabilitation process. Pre-morbid status can be obtained by structured psychiatric interviews, and TBI brain lesions can be defined with advanced neuroimaging techniques. This information along with the management of family and environmental stressors and the enhanced clinical identification of symptoms of anxiety and OCD can be used in the rehabilitation process to improve prognosis after TBI.

Anxiety↗
PubMedDate not supplied

Pharmacological management of obsessive-compulsive disorder: a review for clinicians.

Obsessive-compulsive disorder (OCD) has been treated pharmacologically with drugs that enhance availability of the neurotransmitter serotonin. This review summarizes the available literature on the pharmacological treatments of OCD. Numerous randomized controlled trials have attested to the efficacy of serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a coherent model of serotonin dysfunction in OCD has not been established. Meta-analyses of randomized controlled trials have found better results with clomipramine than with other SRIs, but comparative studies have so far not replicated this finding. Aspects of the methodology in these studies that might explain this discrepancy are considered. Tolerability, side effects, dosing, and safety during pregnancy of the SRIs are discussed. Treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs are reviewed. Finally, the available interventions for refractory OCD are considered.

Antipsychotic Agents↗
PubMed2007

On keeping (intrusive) thoughts to one's self: testing a cognitive model of auditory hallucinations.

BACKGROUND: Previous studies have linked intrusive cognitions (hallucinations and obsessions) with inhibitory dysregulation. Combined deficits in intentional inhibition and context memory have been proposed to explain the intrusive nature and perceived nonself origin of auditory hallucinations (Waters et al., 2006). This study tested the prediction, from this model, that individuals with obsessive-compulsive disorder (OCD), who do not mistake the origin of their intrusive thoughts, will show a deficit of intentional inhibition but intact contextual memory. METHOD: The performance of 14 individuals with OCD and 24 healthy controls was compared on two measures of intentional cognitive inhibition and on a context memory task.Results. Participants with OCD were significantly impaired on both measures of inhibition but were not significantly different from controls in any condition of the context memory task. CONCLUSIONS: The predictions were confirmed. Individuals with OCD, like schizophrenia patients with auditory hallucinations, showed impaired intentional inhibition. This impairment might be responsible for the intrusive thoughts reported in both disorders, and might also partially account for the high rates of comorbidity of OCD and schizophrenia. Finally, intact context memory abilities in OCD may contribute to an efficient memory system, and may differentiate this group from those with hallucinations.

Adult↗
PubMed2004

Task switching and backward inhibition in obsessive-compulsive disorder.

The presumed involvement of the prefrontal cortex in the pathogenesis of obsessive-compulsive disorder (OCD) has fueled growing interest in cognitive paradigms with a putative sensitivity to this brain region. Measures of inhibition and executive functioning are thought to be promising in this regard. To our knowledge, this is the first study that has investigated task switching in OCD captures an important aspect of a paradigm that executive control, namely the preparation for an upcoming task. It was speculated that task switching costs would be enhanced in OCD patients, reflecting a fundamental deficit to quickly control the stream of thoughts. In addition, the paradigm allowed the measurement of backward inhibition, that is the time costs afforded for the re-engagement of a previously irrelevant task. A sample of 40 OCD patients, 20 psychiatric controls with anxiety disorders other than OCD as well as 20 healthy controls was investigated. Contrary to expectation, task switching costs were not elevated in OCD patients. Although anxiety control patients failed to display robust backward inhibition, group comparisons did not reach significance. Implications for future research are discussed.

Adult↗
PubMed2003

Localized functional neurochemical marker abnormalities in dorsolateral prefrontal cortex in pediatric obsessive-compulsive disorder.

BACKGROUND: Neurobiological abnormalities in the prefrontal cortex have been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Although OCD commonly arises during childhood and adolescence, to our knowledge, no prior study has examined prefrontal cortex neurochemistry in pediatric patients with OCD. METHODS: A multislice spectroscopic imaging sequence with validated phantom replacement methodology was used to measure N-acetyl-aspartate (NAA), a putative neuronal marker; choline compounds (Cho); and creatine/phosphocreatine (Cr) in right and left dorsolateral prefrontal cortex (DLPFC) of 15 treatment-naïve OCD patients, 8-15 years of age, and 15 case-matched healthy comparison subjects. RESULTS: A significant increase (21% higher) in NAA was observed in left but not right DLPFC in OCD patients versus control subjects. No significant differences in Cho or Cr were observed between groups in left or right DLPFC. CONCLUSIONS: These results provide new evidence of localized functional neurochemical marker alterations in left DLPFC in pediatric OCD. Increased left DLPFC NAA may represent neuronal hypertrophy or hyperplasia, glial hypoplasia, and/or abnormal pruning of neural brain elements in DLPFC.

Adolescent↗
PubMed2005

Elevated thyroid indices in children and adolescents with obsessive-compulsive disorder: effects of clomipramine treatment.

OBJECTIVE: To examine the basal thyroid function in pediatric Obsessive Compulsive Disorder (OCD) versus controls, and to explore the relation between baseline thyroid measures and response to clomipramine treatment, and the effects of treatment on thyroid hormones. METHODS: Sixteen children and adolescents with DSM-III-R OCE and 13 control children and adolescents without psychiatric illness were compared on basal measures of thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). For the OCD subjects, samples were compared pre- and post- 4 weeks of treatment with clomipramine. Response of OCD symptoms was measured by the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS: OCD subjects demonstrated subtle but significant elevations of TSH, T3, and T4 pre-treatment compared to controls. Clomipramine treatment was associated with significant decreases in TSH and T3 concentrations. Pre-treatment TSH and T4 concentrations correlated with reductions in CY-BOCS following 8 weeks of clomipramine. CONCLUSION: Elevated thyroid function at baseline may be a biomarker of OCD improvement, and may reflect aspects of the underlying pathophysiology of OCD.

Adolescent↗
PubMed1989

Childhood obsessive compulsive disorder: a two-year prospective follow-up of a community sample.

A 2-year prospective follow-up of a community-based sample of adolescents previously diagnosed as having obsessive compulsive disorder (OCD) or "obsessive compulsive spectrum" disorder and a control sample was completed by clinicians experienced with OCD but blind to prior diagnosis. An initial diagnosis of OCD or "other psychiatric disorder with OC features" was most likely to predict a diagnosis of OCD at follow-up. Subclinical OCD at baseline did not strongly predict continuing psychopathology. A prior diagnosis of obsessive-compulsive personality predicted continued obsessive-compulsive symptoms but its relationship to OCD remains obscure.

Adolescent↗
PubMed1990

Childhood rituals: normal development or obsessive-compulsive symptoms?

The symptoms of obsessive compulsive disorder (OCD) have been viewed as extreme variants of normal developmental rituals and superstitiousness; however, difference in timing, content, and severity argue against this continuum. In a systematic comparison of 38 children with severe primary OCD and 22 matched normal controls, parents were interviewed about their child's early developmental rituals and current superstitions. Children were asked about superstitious beliefs. Children with OCD did not differ significantly from controls in number or type of superstitions. However, parents of the OCD children reported significantly more "marked" patterns of early ritualistic behavior than did parents of normal controls. When behaviors resembling primary OCD symptoms were excluded, other rituals did not differ leaving open the possibility that such behaviors were early manifestations of the disorder. Only a prospective study can determine whether these results reflect preclinical OCD or are an artifact of biased recall.

Adolescent↗
PubMed1995

Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors.

OBJECTIVE: To report descriptive epidemiological information on obsessive-compulsive disorder (OCD) in an unselected birth cohort of 930 males and females, aged 18 years. METHOD: An epidermiological study of the prevalence of self-reported OCD at age 18, and a longitudinal analysis of the prospective predictors of OCD. RESULTS: Using the Diagnostic Interview Schedule, the authors found a 1-year prevalence rate of 4%, with a male-female ratio of 0.7:1. The majority of OCD cases met criteria for a comorbid disorder, most commonly depression (62%), social phobia (38%), and substance dependence (alcohol 24%, marijuana 19%). CONCLUSIONS: Data collected on the sample from birth to age 18 years indicated that many childhood risk factors theorized in the literature did not predict OCD in this sample. However, a history of depression and substance use were prospective risk factors for OCD.

Adolescent↗
PubMed1996

Obsessive-compulsive disorder in children and adolescents: a review of the past 10 years.

OBJECTIVE: To review the literature on pediatric obsessive-compulsive disorder (OCD) from the perspective of information relevant to American Board of Psychiatry and Neurology recertification in child and adolescent psychiatry. METHOD: The clinical and research literatures were systematically searched or articles that address the diagnosis and treatment of pediatric OCD. RESULTS: Drawing from the literature and their own clinical experience, the authors note that (1) OCD is a common neuropsychiatric disorder; (2) comorbidity is common, especially with tic, attention-deficit, anxiety, and affective disorders; (3) OCD following group A beta-hemolytic streptococcal infection may define an autoimmune sub-grouping calling for immunomodulatory treatments; and (4) OCD-specific cognitive-behavioral psychotherapy and pharmacotherapy with a serotonin reuptake inhibitor define the psychotherapeutic and pharmacotherapeutic treatments of choice, respectively. CONCLUSION: Child psychiatrists should be familiar with the differential diagnosis and treatment of OCD.

Adolescent↗
PubMed1996

Comorbidity of juvenile obsessive-compulsive disorder with disruptive behavior disorders.

OBJECTIVE: To examine the full spectrum of psychiatric comorbidity in juvenile obsessive-compulsive disorder (OCD) in a naturalistic manner when no exclusionary criteria are used for sample selection. METHOD: Consecutive referrals to a specialized pediatric OCD clinic were evaluated by means of structured diagnostic interviews and rating scales. No exclusionary criteria were used for sample selection. Findings were compared with those of previously published reports of juvenile OCD. RESULTS: Compared with previous studies, our sample of juveniles with OCD had high rates of comorbidity not only with tic, mood, and anxiety disorders but also with disruptive behavior disorders. CONCLUSIONS: Our findings indicate that in the naturalistic setting, juvenile OCD is heavily comorbid with both internalizing and externalizing disorders. The presence of such a complex comorbid state has important clinical and research implications and stresses the relevance of limiting exclusionary criteria in studies of juvenile OCD.

Adolescent↗
PubMed1996

Platelet serotonin transporter in children and adolescents with obsessive-compulsive disorder or Tourette's syndrome.

UNLABELLED: Previous studies of serotonin transporter protein (5HTPR) indexed in platelets by 3H-imipramine demonstrate reduction in children with comorbid obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). OBJECTIVE: To use the 5HTPR selective ligand 3H-paroxetine and homogeneous diagnostic groups to reevaluate these findings. METHOD: Platelet Kinetic binding parameters were evaluated using standard techniques from medication-free child and adolescent patients with OCD (n = 18), with TS (n = 10), and normal controls (n = 19). RESULTS: Baseline binding capacity (Bmax) was significantly reduced in patients with OCD (1,342 +/- 952 fmol/mg; protein p < .01) compared with normal controls (2,486 +/- 1309 fmol/mg) and TS patients (2,420 +/- 1,069 fmol/mg; p < .05). Among OCD patients who were subsequently treated on an open-label basis with selective serotonin reuptake inhibitor (SSRI), Bmax values at baseline differentiated between responders (1,718 +/- 1,041 fmol/mg) and nonresponders (802 +/- 713 fmol/mg protein; p < .05). Response to SSRI was greatest in patients with a positive family history of OCD. Among responders (n = 10), baseline Yale-Brown Obsessive Compulsive Scale and Bmax were positively correlated (r = .76, p = .01), as was Clinical Global Impression (r = .67, p = .03). CONCLUSIONS: Platelet 5HTPR capacity (Bmax) is reduced in children and adolescents with OCD, but not in those with TS. 5HTPR may be an indirect measure of basal serotonergic tone.

1-Naphthylamine↗
PubMed1999

Paroxetine open-label treatment of pediatric outpatients with obsessive-compulsive disorder.

OBJECTIVE: Paroxetine is a selective serotonin reuptake inhibitor with demonstrated efficacy in treating obsessive-compulsive disorder (OCD) in adults. This study evaluates the safety and effectiveness of paroxetine in pediatric OCD patients. METHOD: In a 12-week, open-label trial of paroxetine, 20 OCD outpatients, aged 8 to 17 years, were treated for OCD with daily doses ranging from 10 to 60 mg. Target symptoms were rated at regular intervals with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Children's Global Assessment Scale, the Clinical Global Impression Scale, the Hamilton Anxiety Rating Scale, and the Yale Global Tic Severity Scale. RESULTS: Paroxetine proved relatively safe in this brief trial with a small sample and appeared to be effective in patients with OCD; mean CY-BOCS scores decreased significantly (z = 3.49, p = .0005) from 30.6 +/- 3.5 to 21.6 +/- 6.8 on medication. The most common side effects (n > or = 2) were hyperactivity/behavioral activation, headache, insomnia, nausea, and anxiety. Paroxetine did not have to be discontinued in any of the patients because of side effects; the most serious side effects included hyperactivity/behavioral activation in 3 younger patients (< 10 years) necessitating dosage reduction but not discontinuation. CONCLUSIONS: Preliminary evidence suggests that short-term treatment of pediatric OCD outpatients with paroxetine may be relatively safe and effective.

Adolescent↗
PubMed2002

Attention-deficit/hyperactivity disorder in children and adolescents with obsessive-compulsive disorder: fact or artifact?

OBJECTIVE: To clarify whether the symptoms of inattention and distractibility commonly seen in children and adolescents with obsessive-compulsive disorder (OCD) represent true comorbidity with attention-deficit/hyperactivity disorder (ADHD) or a manifestation of obsessional anxiety. METHOD: Phenotypic features and functional correlates of ADHD-like symptoms were examined in youths with and without OCD from a large sample of pediatric psychiatry patients consecutively referred since 1997. RESULTS: The number, frequency, and types of core ADHD symptoms as well as ADHD-associated functional indices were identical in all youths with DSM-IV-diagnosed ADHD irrespective of the presence or absence of comorbid OCD. CONCLUSION: These findings suggest that when ADHD-like symptoms are seen in youths with OCD, they reflect a true comorbid state of OCD plus ADHD and that the ADHD syndrome may be independent of OCD in comorbid youths.

Adolescent↗
PubMed2004

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial.

OBJECTIVE: To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD). METHOD: This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components. RESULTS: By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up. CONCLUSIONS: Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.

Adolescent↗
PubMed2001

Clinical predictors of drug response in obsessive-compulsive disorder.

The aim of this study was to evaluate which clinical variables might influence the antiobsessional response to proserotonergic drugs in a sample of patients with obsessive-compulsive disorder (OCD). One hundred fifty-nine patients with DSM-IV OCD underwent a 12-week standardized treatment with fluvoxamine, clomipramine, citalopram, or paroxetine. According to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35%, patients were divided into two groups. Ninety patients (56.6%) responded to treatment and 69 (43.4%) did not. Responders had a significantly higher frequency of positive family history for OCD (FH-OCD) in their first-degree relatives, whereas nonresponders had an earlier onset and a higher frequency of "poor insight" subtype and somatic obsessions. The predictive value of all these variables was tested by a stepwise logistic regression analysis that confirmed poor insight and FH-OCD to be the best predictors of poor and good drug treatment response, respectively. These preliminary findings need additional investigations toward a better definition of the genetic and biological heterogeneity of patients with OCD, and they underlie the importance of collecting the insight score and family history for psychiatric disorders in the pretreatment assessment.

Adolescent↗
PubMed1992

Sertraline in the treatment of obsessive compulsive disorder: two double-blind, placebo-controlled studies.

Sertraline is a non-tricyclic, potent and selective serotonin reuptake inhibitor (SSRI) which is currently approved for the treatment of depression in several countries, including the UK and the USA. The role of serotonin in the aetiology of obsessive compulsive disorder (OCD) has been established through considerable indirect evidence. The strongest evidence comes from the fact that drugs known to be SSRIs have been found to be useful in the pharmacotherapy of OCD. Two double-blind, placebo-controlled studies, including a total of 412 patients, were undertaken to evaluate the efficacy and safety of sertraline in OCD. The first of these studies of a flexible dosing design showed that sertraline, given for eight weeks in daily dosages of 50-200 mg, was a safe and effective treatment for OCD, and superior to placebo. The second study of a fixed dose design and 12 weeks duration confirmed the efficacy and safety of sertraline in OCD at fixed dosages of 50, 100, or 200 mg/day and demonstrated that further improvement in OCD symptoms can be achieved through continued treatment with sertraline. A comparison between the results of these two studies and similar studies with clomipramine shows that, while both drugs have significant therapeutic efficacy, their side-effect profiles may be markedly distinct.

1-Naphthylamine↗
PubMed1995

Meta-analysis of pharmacotherapy trials for obsessive-compulsive disorder.

Since the discovery that clomipramine was effective in the treatment of obsessive-compulsive disorder (OCD), trials of several different medications for OCD have been published. The question of which agent, if any, is the medication of choice in OCD is of real clinical concern. Published clinical trials were collected using computerized search on MedLine and PsychLit. Trials that met predetermined criteria were included in a meta-analysis. Analyses of variance were used to compare the specific effect sizes of different medications in OCD. In placebo-controlled trials, serotonin reuptake inhibitor (SRI) type had a significant effect on medication effect size, with clomipramine more effective than fluoxetine. Although this finding did not alter when trials were restricted to those with large numbers of subjects (n > 50), the analysis was based on a very limited number of studies. The fact that so few placebo-controlled studies have been done in OCD compromises the findings of this meta-analysis. It would be premature to extrapolate the results to clinical practice, where clomipramine and certain selective SRIs are currently and justifiably used as first-line agents. Nevertheless, the current study supports previous work suggesting that increased serotonergic specificity is not necessarily correlated with greater efficacy in the treatment of OCD. Further head-to-head comparison studies are necessary to confirm or refute this preliminary impression.

Analysis of Variance↗