Compulsive behavior in generalized anxiety disorder and obsessive-compulsive disorder.
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Adult↗
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Prader-Willi syndrome as a neurogenetic model for psychosis and obsessive-compulsive disorder: A review of clinical, behavioral, and biological insights.
Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder classically defined by hyperphagia and obesity. However, its profound psychiatric phenotype offers a unique genetic framework for understanding major mental illnesses. This review positions PWS as a potentially informative biological model for psychosis and obsessive-compulsive disorder (OCD), bridging the gap between 15q11-q13 imprinting defects and neural circuit dysfunction. We synthesize evidence demonstrating that psychosis in PWS is not a uniform trait but is disproportionately linked to the maternal uniparental disomy (mUPD) subtype. This genotype-phenotype correlation suggests that overexpression of maternally imprinted genes and loss of paternal expression disrupt cortical excitatory-inhibitory balance, resembling the "schizophrenia-bipolar" genomic architecture. Furthermore, synthesized evidence characterizes the repetitive, ritualistic behaviors in PWS not merely as behavioral challenges, but as a developmentally arrested OCD-spectrum phenotype driven by distinct serotonergic-oxytocinergic imbalances and hypothalamic-limbic dysconnectivity. Mechanistic insights from preclinical models of MAGEL2, SNORD116, and NDN deficiency are integrated with clinical findings to highlight shared neurobiological substrates. Finally, we outline a roadmap for precision psychiatry in PWS, emphasizing the necessity of pharmacogenomics in antipsychotic management and the potential of targeted circuit-based therapeutics. By deconstructing the psychiatric comorbidities of PWS, we provide a framework for translating genomic architecture into mechanistic understanding and targeted treatment for complex neuropsychiatric disorders.
15q11-q13↗
A psychodynamic clinician's foray into cognitive-behavioral therapy utilizing exposure-response prevention for obsessive-compulsive disorder.
Research suggests that, by itself or as an adjunct to pharmacotherapy, cognitive-behavioral therapy (CBT) involving exposure with response prevention (ERP) is an effective treatment for Obsessive-Compulsive Disorder (OCD). However, there is a shortage of clinicians trained in this form of therapy. Although many psychodynamic clinicians treat individuals with OCD using traditional therapy that may assist them with their relationships, there is little evidence that such treatment is effective in ameliorating the OCD symptoms. As there is a clear need for more clinicians trained in CBT for OCD, it may be possible for practitioners trained in psychodynamic or other modalities to learn ERP. Such cross-theoretical training involves a number of challenges. These include the therapist's own anxiety about ERP, understanding resistance, and reconsidering therapeutic boundaries. The first author describes his experiences as a psychodynamically-trained psychologist venturing into ERP in an attempt to demonstrate that although there are barriers they are not insurmountable.
Adult↗
An interactive computer-administered self-assessment and self-help program for behavior therapy.
Behavior therapy for obsessive-compulsive disorder (OCD) is extremely effective and usually conveys lasting benefits. Unfortunately, behavior therapy is not widely available and is usually quite costly in the few settings where it can be obtained. The essential features of effective behavior therapy are identifying triggers of obsessions, rituals, and discomfort; designing personalized exposure and ritual prevention (E & RP) goals; and encouraging and monitoring E & RP sessions of sufficient frequency and duration for habituation to occur. A computer program (BT STEPS) was designed to assist OCD sufferers in carrying out self-assessment and self-help behavior therapy. The program has nine clinical steps, 12 computer-controlled interactive voice response (IVR) telephone calls (some used repeatedly), and more than 1000 digitized voice files that depend on the progress that patients report during calls. BT STEPS has been studied in two trials at three sites with a total of 65 patients. In both trials, patients who experienced behavior therapy had substantial reductions in OCD severity as assessed by the Yale-Brown Obsessive Compulsive Scale. Approximately two thirds of those who participated in two or more E & RP sessions were much or very much improved. Patients liked using the program, and 71% thought their lives improved as a result. BT STEPS makes behavior therapy for OCD patients potentially available to anyone with a touch-tone telephone. It is intended for use under the supervision of a clinician and can be used in conjunction with pharmacotherapy.
Behavior Therapy↗
Using the health belief model for bulimia prevention.
The author discusses application of the Health Belief Model to bulimia prevention (reduction of bulimic-like behaviors of food obsessions, bingeing, and various forms of purging). She considers the individual's beliefs about bulimia and bulimic-like behaviors as a means of predicting the likelihood of behavior change to prevent clinically diagnosable bulimia, includes a description of each Health Belief Model component, and offers implications for further research.
Attitude to Health↗
Early parental preoccupations and behaviors and their possible relationship to the symptoms of obsessive-compulsive disorder.
This study focuses on early parental preoccupations and behaviors (EPPB) surrounding the birth of a new family member. An interview instrument was developed to assess EPPB at eight months prepartum and two weeks and three months postpartum. Measures with adequate psychometric and conceptual properties were used to assess the overall level of parental preoccupations and associated actions as well as three content domains: caregiving (CARE), relationship building (RELATIONSHIP), and anxious intrusive thoughts associated with harm avoidant behaviors (AITHAB). The hypothesis that preoccupations and behaviors would peak for both parents close to the birth of the child was confirmed. Measures of EPPB were distinguished from symptoms of depression and generalized anxiety. Consistent with our a priori hypothesis the content and character of the AITHAB was found to resemble the symptoms of obsessive-compulsive disorder (OCD). The study findings suggest the potential adaptive significance of EPPB and the possible evolutionary origins of OCD.
Adult↗
Gilles de la Tourette's syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: which symptoms discriminate?
Stereotyped repetitive behaviors occur in Gilles de la Tourette's Syndrome (GTS) and obsessive-compulsive disorder (OCD). The present study was undertaken to compare the distribution of obsessive-compulsive and Tourette-related impulsive behaviors in GTS with (+) OCD, GTS without (-) OCD, tic-free OCD, and control subjects. Fourteen GTS + OCD, 18 GTS-OCD, 21 OCD-tic, and 29 control subjects were evaluated using a semistructured interview designed to assess GTS and OCD-related repetitive behaviors. Each reported item was evaluated on the presence of anxiety and goal-directedness. This information was subsequently used to define whether the repetitive behavior was an (anxiety-related) obsession or compulsion, or a (non-anxiety-related) OC-like behavior, impulsion. GTS + OCD subjects reported more overall Tourette-related impulsions than OCD-tic subjects, i.e., more mental play, echophenomena, and touching behaviors but similar frequencies of typical obsessive-compulsive behaviors. Further, GTS + OCD subjects exhibited more overall repetitive behaviors than GTS-OCD subjects, i.e., more Tourette-related impulsions as well as more obsessive-compulsive behaviors. The distribution of symptoms is similar in GTS with and without OCD, and differs from tic-free OCD. These differences suggest that GTS with OCD constitutes a form of GTS, not of OCD, although the possibility that GTS + OCD patients constitute a subgroup distinct from GTS and from OCD can not be excluded by this phenomenological study. Specific non-anxiety-related impulsions seem to discriminate between GTS and OCD-tic individuals. These impulsions possibly reflect differences in underlying mechanisms between GTS and OCD-tics.
Adult↗
Cognitive-behavioral therapy for children who have obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a relatively chronic and impairing disorder in children and adolescents. Whereas childhood OCD was largely ignored in the past, major advances in the identification and treatment over the past 20 years have led to a significant upsurge in the prevalence of youngsters seeking treatment for this problem. The present article describes the use of exposure-based cognitive-behavioral therapy (CBT) for the treatment of childhood OCD. Although the phenomenology of OCD is largely consistent across the age span, traditional adult CBT approaches have been modified for use with children and adolescents in order to address those developmental differences that do exist. The case example describes the use of CBT for a child who has OCD and highlights these developmental considerations, including age-appropriate techniques to address family involvement in the disorder and the impact of symptoms on the psychosocial functioning of the patient.
Adolescent↗
Behavioral and magnetic resonance spectroscopic studies in the rat hyperserotonemic model of autism.
Autism is classified as a pervasive developmental disorder, with several cardinal features including sensory disturbances, obsessive-compulsive-like behavior, lack of bonding to caregivers and motor disturbances. To date, there is a lack of an animal model of the disease. The current work is aimed at producing such a model by treating developing rat pups with a serotonergic agonist, 5-methoxytryptamine (5-MT; 1 mg/kg) during development (from gestational age 12 days to postnatal day 20), thus mimicking one of the hallmark neurochemical features of the illness-increases in the neurotransmitter, serotonin. Animals were then tested in behavioral paradigms that may resemble the human illness. Treated rat pups were found to be overreactive to auditory or tactile sensory stimuli, to display changes in the negative geotaxic test of motor development, to show lack of separation-induced vocalizations when their dam was removed and to show decreased alternation in the spontaneous alternation task. As well, the animals showed metabolic abnormalities in the brain using in vivo proton magnetic resonance spectroscopy, which are consistent with those observed in autistic children. In summary, the model we are proposing shows some of the behavioral and metabolic features of autism, as well as being produced through alteration of a neurochemical system known to be altered in autism.
5-Methoxytryptamine↗
Effects of suppressing neutral and obsession-like thoughts in normal subjects: beyond frequency.
Recent cognitive-behavioral theories on obsessive-compulsive disorder (OCD) show that deliberate attempts to suppress intrusive and undesirable thoughts lie at the genesis of clinical obsessions. In this paper the results of an experimental study on the suppression of neutral and obsession-like thoughts in normal subjects are presented. Eighty-seven university students performed in three experimental periods: (1) base-line monitoring, (2) experimental instruction, and (3) monitoring. For each of these periods, the frequency of the occurrence of a "white bear" thought or a personally relevant intrusive thought was registered. Half of the subjects received instructions to suppress the target-thought in period 2, and the other half were instructed to only monitor the target-thought in each of the experimental periods. Several measures were also obtained before and after the experiment: annoyance caused by the intrusion, suppression effort, subjective success, and evaluative appraisals of the target-thought. The results showed neither immediate nor delayed frequency increases of the target thought. However, evidence was found that deliberate thought suppression efforts, regardless of their content, had greater negative consequences than did non suppression. These results are discussed in relation to the recent cognitive proposals about OCD.
Adult↗
Conditional-associative learning in eating disorders: a comparison with OCD.
The acquisition of conditional associations using neutral and individually threatening verbal stimuli was assessed in 16 females with anorexia nervosa (AN), obsessive-compulsive disorder (OCD), bulimia nervosa and normal controls, respectively. Groups did not differ in terms of age, sex, intelligence, depression, verbal memory and verbal fluency measures. Patients and controls were widely comparable on tests assessing neuropsychological functioning. In the conditional-associative learning (CAL)-task only anorectic and OCD-patients displayed an impaired performance with neutral material but not with individually threatening material. Such a deficit was not evident in bulimics or in normal controls. These findings support the assumptions from functional neuroimaging investigations in AN and OCD and provide evidence that obsessive and compulsive behavior could have its origin within common neurobiological dysfunctions. The CAL possibly serves as a functional correlate of a neurophysiological dysfunction in obsessive-compulsive spectrum disorders.
Adolescent↗
Behavioral therapy in children and adolescents with obsessive-compulsive disorder: a pilot study.
Despite advances in pharmacotherapy for obsessive-compulsive disorder (OCD), medication treatments are not always effective. This pilot project examined the feasibility of a structured behavioral therapy program in the treatment of children and adolescents with OCD. Ten subjects with a primary diagnosis of OCD were invited to participate in the treatment program. Seven youngsters, 5 boys and 2 girls (age range 10.8-15.8, mean 13.0 years), participated and were treated for a mean of 14 sessions. These 7 subjects showed a broad range of OCD severity, as measured by the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS score range 12-29). Five subjects were also receiving antiobsessional medication (dose was not changed during the trial), and 2 subjects were treated without medication. All 7 youngsters showed a clinically significant reduction in the CYBOCS score at treatment endpoint (mean change 61%, range 30%-90%, effect size 2.04, p < 0.05), and the therapeutic gains were stable for at least 3 months after treatment. One of 5 children who had been receiving concurrent antiobsessional medication was able to tolerate a dose reduction following behavioral treatment. Two to three booster sessions within 6 months posttreatment were effective in preventing relapse in 4 of 6 subjects. The 3 children who declined behavioral treatment showed no improvement at 3-month and 6-month follow-up. Behavioral treatment appeared to be a useful adjunct to medication in children and adolescents with OCD. Further research could evaluate whether behavioral treatment would lower the dose requirements for children receiving antiobsessional medications. Randomized clinical trials are also needed to confirm the effectiveness of behavioral therapy alone or in combination with medication.
1-Naphthylamine↗
A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive-behavioral therapy.
BACKGROUND: Alexithymia as a predictor of treatment outcome in psychotherapy has often been discussed but rarely evaluated in prospective studies. The present study evaluated the absolute and relative stability of alexithymia in patients with obsessive-compulsive disorder (OCD), and the predictive value of alexithymia for the outcome of treatment. METHODS: We conducted a prospective study with 42 inpatients receiving intensive, multimodal cognitive-behavioral therapy (CBT). Patients were assessed for alexithymia at pre- and post-treatment with the 20-item Toronto Alexithymia Scale (TAS-20), for obsessive-compulsive symptoms and depression with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the 21-item Hamilton Depression Rating Scale (HDRS). RESULTS: OCD and comorbid depression showed a highly significant symptom-reduction from pre- to post-treatment while no absolute changes in the TAS-20 total scores and its factors 1 and 3 occurred. Only factor 2 scores decreased significantly, but with a smaller effect size than the effect sizes for the changes in Y-BOCS and HDRS. Alexithymia scores at pre-treatment correlated significantly with alexithymia scores at the end of treatment, indicating its relative stability. In the linear regression analyses, no variables were identified that predicted significantly the outcome of treatment. CONCLUSIONS: Our findings support the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon in obsessive-compulsive patients. Alexithymia scores do not predict response to multimodal CBT in OCD. It might be an effect of CBT that patients could at least partly regain or newly learn the capability to describe their feelings.
Adult↗
Cognitive and neurobiological findings in obsessive-compulsive disorder.
The behavioral disturbances seen in OCD patients likely are related to abnormalities in the frontal striatal systems, with complex involvement of other brain regions. This is suggested by data from various modalities. Executive deficits are seen on neuropsychological assessments, which may contribute to poor performance on tasks designed to test other domains. Studies of neurological illness in which obsessive and compulsive symptoms are seen with increased frequency and results of neuroimaging studies are also indicative of frontal-striatal dysfunction. Some neuroimaging studies specifically implicate the OFC, along with other regions such as the anterior cingulate cortex and caudate nucleus. Data from studies of neurological soft signs are less specific and suggest pathology that may be common to other psychiatric conditions, such as schizophrenia. Although data from these various modalities do not give clear guidance on treatment, future work may show usefulness of adding these assessments to a clinical evaluation,especially with respect to predicting treatment response in subtypes of OCD.
Brain↗
Behavioral characteristics of Prader-Willi syndrome in Korea: comparison with children with mental retardation and normal controls.
The purpose of this study was to examine the psychiatric characteristics of children with Prader-Willi syndrome in Korea, focusing particularly on their behavioral problems and obsessive-compulsive spectrum symptoms. Fourteen patients with Prader-Willi syndrome, together with their parents, underwent a psychiatric interview and parent questionnaire consisting of a Child Behavior Checklist. Twenty-four patients with mental retardation and 45 normal students were selected as control groups. Compared with the normal control group, the rates of inclusion in the clinical range and the mean scores with regard to social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems, and total problems profiles were significantly higher (P < .01) in the Prader-Willi syndrome group according to the results of the Child Behavior Checklist. Compared with the mental retardation group, there was a statistically significant (P < .05) difference in the delinquent behavior profile. Comparing selected Child Behavior Checklist items related to obsessive-compulsive spectrum symptoms, the Prader-Willi syndrome group showed significantly more (P < .05) compulsion, skin picking, and stealing than the mental retardation or normal control groups. These findings suggest that children with Prader-Willi syndrome in Korea have many behavioral problems, including obsessive-compulsive spectrum symptoms, needing proper psychiatric attention and treatment. This is the first study in Korea to evaluate the psychiatric and behavioral characteristics of children with Prader-Willi syndrome.
Adolescent↗
Comparison of obsessions and compulsions in patients with anorexia nervosa and obsessive compulsive disorder.
Patients with anorexia nervosa (n = 18) and patients with obsessive-compulsive disorder (OCD) (n = 16) had similar scores on the Yale-Brown Obsessive Compulsive Scale (19 + or - 9 vs. 22 + or - 6). This suggests that these disorders have similar magnitude of impairment from obsessions and compulsions; however, OCD patients endorsed a wide variety of obsessions and compulsions, whereas anorexics tended to endorse symptoms that were related to symmetry and order.
Adolescent↗
A maintenance program for obsessive-compulsive disorder using exposure with response prevention: 2-year follow-up.
Recent literature has emphasized the importance of instituting procedures for preventing relapse in obsessive-compulsive disorder (OCD). This study presents data documenting the effect of a maintenance program on the long term (2-year) adjustment of a group of patients with OCD treated with exposure and response prevention. Results indicate that patients maintained their gains for the 2-year follow-up period on measures of anxiety associated with avoidance (Behavioral Avoidance Tests), obsessions, compulsions, and anxiety. Further, patients were able to effectively manage situations defined as lapses (limited symptom return) effectively without additional therapist intervention. However, as in a previous report, treatment gains for depression were not well established. It is concluded that sessions prior to treatment termination which focus on relapse prevention methods focus on additional psychological symptoms aside from the acute disturbance of OCD.
Adult↗
Influence of age and tic disorders on obsessive-compulsive disorder in a pediatric sample.
BACKGROUND: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with emerging data suggesting that age of onset and/or the presence of tics may define clinically important subgroups. OBJECTIVE: This study set out to evaluate the impact of age and tic disorders on the symptom profile in a pediatric sample of patients with OCD ascertained from a specialty clinic. METHODS: Eighty children with OCD (50 boys, 30 girls) were assessed for symptom type, severity, age of onset, presence of a tic disorder, and functional status. Each child's most impairing obsessions and compulsions were identified and compared by age category (above and below the age of 11 years) and according to the presence or absence of a tic disorder. RESULTS: The mean age of the sample was 11.1 +/- 3.19 years (range 4-18 years). The most common obsessions reported were contamination and worries about harm. Common compulsions included washing and rituals to prevent harm. The only significant differences across age groups were the percentage of religious worries and slightly higher severity of obsessions in the adolescent age group (p < 0.05). The presence of tics was associated with increased frequency of repetitive behavior unrelated to harm avoidance (p < 0.05). Children without a history of tics were more likely to describe incidents of contamination, washing, and repetitive request for reassurance (p < 0.05 for each). CONCLUSION: In this convenient sample of clinically ascertained children, there were few phenotypic differences in children above or below the age of 11 years. Differences in the distribution of OCD symptoms according to the presence or absence of tics, which has been documented in adult samples, were evident in this sample.
Adolescent↗