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PubMed1975

Self-mutilation, obsessionality and narcissism.

A controlled study of the clinical and biographical features of 22 female repeated self-cutters is described. The results of the assessment of these patients, using the Middlesex Hospital Questionnaire and the Obsessive-Compulsive section of the Tavistock Inventory, is presented. The marked obsessionality of these patients is emphasized and the possible implications of these findings for treatment is discussed.

Adolescent↗
PubMed1977

Obsessional cognition: performance on two numerical tasks.

It is argued that obsessional indecision reflects a formal cognitive characteristic, and should therefore be detectable in slower performance of insignificant, neutral tasks. The obsessional will not be handicapped in structured tasks requiring concentration and a deductive approach, but he will be slower in less structured tasks requiring a predominantly inductive approach. Results from two neutral (numerical) tasks support the predictions.

Cognition↗
PubMed1986

Delineating social phobia.

The natural history--including psychiatric symptoms, precipitating factors, onset and course of illness, and personality characteristics--of 47 social phobics, 80 agoraphobics, and 72 simple phobics was examined. The social phobia group differed from the agoraphobia group by having a lower mean age, fewer females and married members, and a higher educational and occupational status. They were less fearful generally, less obsessive, and less likely to follow a fluctuating or phasic course. There was overlap between the two groups with regard to main phobias, and they were similar with regard to adjacent symptomatology. Both the social and agoraphobia groups differed in similar and significant ways from simple phobics.

Adult↗
PubMed1987

Familial aspects of obsessive-compulsive neurosis.

The first-degree relatives of 50 obsessive-compulsive patients and those of matched controls completed the General Health Questionnaire (GHQ) and the Leyton Obsessional Inventory (LOI). Relatives who were identified as possible 'cases' by their high GHQ scores, or by their own or informant relatives' reports, were interviewed using the Schedule for Affective Disorders and Schizophrenia. Index relatives had a significantly higher lifetime prevalence of mental illness (36%) than had those of controls (17%), due mainly to an excess of depressive and neurotic disorders. However, only one relative from each group was diagnosed as having definite obsessive-compulsive neurosis. In addition, the LOI scores were similar for the index and control relatives.

Adolescent↗
PubMed1989

A follow-up of adolescents with obsessive-compulsive disorder.

Twenty-six patients seen at a regional adolescent psychiatry unit between 1974 and 1979 with a discharge diagnosis of obsessive-compulsive disorder were followed up after an average of ten years. Of 24 subjects traced, outcome information was obtained from 20. At the point of follow-up, ten patients remained psychiatrically ill, six having persisting obsessive-compulsive symptoms. Poor outcome was associated with a family history of psychiatric illness and lack of response to therapy at initial contact. All patients who were asymptomatic at discharge had remained well.

Adolescent↗
PubMed1990

Marital adjustment and obsessive-compulsive disorder.

Fifty obsessive-compulsives were treated by behavioural therapy (self-exposure in vivo and response prevention) either with their partner directly involved in all aspects of treatment or without their partner. The two treatment formats were equally effective. Although a substantial number of obsessive-compulsives were found to have marital problems, behavioural treatment directed at the obsessive-compulsive disorder resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner.

Adaptation, Psychological↗
PubMed1990

Asperger's syndrome: to be or not to be?

It has been questioned whether Asperger's syndrome (AS) is in fact a specific (high functioning) subgroup of autism, rather than a distinct entity. Thirteen AS patients were compared with 13 autistic patients and 13 developmentally disordered controls. While there was symptom overlap between AS and autism, patients could be separated into one or other group. However, current criteria are based on symptoms, and it is argued that studies of genetics and treatment response are needed to elucidate the relationship between these developmental disorders.

Adolescent↗
PubMed1991

Adoption and eating disorders: a high-risk group?

Between 1975 and 1985, 3.8% of patients referred to the Maudsley Hospital with anorexia and bulimia were adoptees. This exceeds the rate of adoption (1.5%) in the general population matched for year of birth. The 18 adoptees with eating disorders had significantly more associated behavioural disturbance and lower academic achievement than the 18 matched controls, and different precipitating factors.

Adolescent↗
PubMed1992

Clomipramine versus phenelzine in obsessive-compulsive disorder. A controlled clinical trial.

A double-blind clinical trial of clomipramine versus phenelzine was carried out on 30 patients suffering from DSM-III obsessive-compulsive disorder. The study period was 12 weeks, and the maximum doses used (from the fifth week on) were 225 mg/day for clomipramine (14 patients) and 75 mg/day for phenelzine (12 patients); four patients dropped out. Obsessive symptoms improved significantly in both drug groups, but there was no significant difference between groups. Depressive symptoms improved before obsessive ones.

Adult↗
PubMed1994

Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients.

The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.

Adult↗
PubMed1996

Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences.

BACKGROUND: Demographic data, family history, psychopathological features, comorbidity and course of obsessive-compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature. METHOD: Two hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview. RESULTS: We found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders. CONCLUSIONS: Pathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.

Adult↗
PubMed1996

Comparisons among the Yale-Brown Obsessive-Compulsive Scale, compulsion checklist, and other measures of obsessive-compulsive disorder.

BACKGROUND: The Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Compulsion Checklist (CC) were compared with one another and with five other measures to assess their place in measuring the outcome of obsessive-compulsive disorder (OCD). METHOD: Data came from a randomised trial of 46 patients with OCD who completed eight Weeks of treatment by exposure and response prevention. Using a structured modelling analysis, the YBOCS and the CC were compared with a latent factor derived from five other variables (Target Rituals, Target Obsession, Clinical Global Impression, Avoidance, Disability) of baseline severity and change after treatment, and also directly with those variables. RESULTS: Both the YBOCS and the CC were accurate and sensitive measures of OCD. The YBOCS related slightly more than did the CC to the latent factor and to Disability directly. The YBOCS related slightly more to Disability than it did to other measures. Inter-assessor and self kappa assessor reliability was high. CONCLUSIONS: The 10-Item YBOCS plus the 4-item Disability scale are a simple and efficient way to measure important aspects of OCD in clinical practice.

Behavior Therapy↗
PubMed2004

Cingulotomy for psychiatric disease: microelectrode guidance, a callosal reference system for documenting lesion location, and clinical results.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI)- and microelectrode recording-guided cingulotomy for patients with psychiatric disorders and to develop a new method of mapping lesion location in anterior cingulate cortex that takes into account the significant interindividual variability in callosal morphometry. METHODS: MRI and microelectrode recording were used to guide placement of radiofrequency lesions in patients with obsessive-compulsive disorder (n = 21) or affective disorders (n = 5). Postoperative improvement was evaluated with the Yale-Brown Obsessive-Compulsive Scale in 15 of the 21 obsessive-compulsive disorder patients studied. From the postoperative MRI scans, we developed a coordinate system for position in the anterior cingulate cortex. The callosal line passes from the most anterior point of the corpus callosum (c = 0) to the most posterior (c = 100). We reconstructed the lesions onto a sagittal map from the Talairach and Tournoux atlas using the distance along the callosal line and the distance above the upper surface of the corpus callosum. RESULTS: The location of neuronal activity distinguished gray and white matter and was useful in delineating the upper and lower cortical banks of the cingulate gyrus, the cingulate bundle, and the corpus callosum. This information was used to place the lesions. Lesions typically were 6 to 8 mm in diameter on T2-weighted MRI scans. The inferior margins were along the corpus callosum from c = 16 to c = 38. Four of 15 patients with obsessive-compulsive disorder had a documented decrease of more than 35% on the Yale-Brown Obsessive-Compulsive Scale, but only one patient had a sustained benefit for more than 1 year. CONCLUSION: Microelectrode recording is useful for lesion placement. Our system for reporting location in anterior cingulate cortex normalizes for differences in callosal morphometry. These techniques may aid future study.

Adult↗