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PubMed1991

[A study of psychopathology in phobia and obsessive-compulsive disorder: through the treatment of exposure and response prevention by transcutaneous electrical stimulation].

For the treatment of phobia and obsessive-compulsive disorder (OCD), we developed a method of exposure (in vivo or in imagination) and response prevention by transcutaneous electrical stimulation (TES), in which weak electrical stimuli (3-4V, about 5Hz) are applied to the palm ("Rokyu" in acupuncture treatment) or vertex ("Hyakue") of a patient tolerating dysphoria induced in a state of imagination or in real life. TES was very effective in about 80% of 32 patients treated (Seishin Igaku, 1989). Through the treatment of severe cases with TES, several new findings regarding the psychopathology and etiologic mechanism of phobia or OCD were recently obtained. 1) In relatively simple cases treated with TES, anxiety and fear were extinguished within a few minutes by simultaneous close-up normal thoughts. Antagonism may thus possibly be present between a self integration mechanism and pathological mental structure, and TES may discontinuously dysfunctions this antagonism in the manner of a changeover switch. In severe cases, anxiety and fear were not immediately abolished by TES, but strong resistance and fear appeared with increase in TES. Thus, multilevel pathological mental structure are possibly present in severe cases. Moreover, one obsessive-compulsive patient suddenly restored totally free senses after 10 months of TES treatment and stated that he had been found for 10 years by a rule demanding obsessive checking. A certain more decisive principle may then have been present in his pathological mental structure. Based on the above, the pathological mental structure in these phobia and OCD may be concluded to have been dissociated from the self integration mechanism, intensified as the mechanism dealing specifically with anxiety, and finally became resistant to self integration due to the simultaneous close-up of a decisive principle. As for the mechanism of TES action, the following change provides some indication: that is, when TES was applied to the patient under exposure in a state of imagination, strong anxiety was initially induced, and then disappeared after several minutes. This may indicate that TES activates not only a pathological mental structure but also normal mental structure. Thus, while TES may be elevating the energy of anxiety, filling the pathological mental structure, by exposure and response prevention, it is efficiently inducing this anxiety towards the self integration mechanism. 2) On the basis of the above concept, an attempt was made to explain the etiologic mechanism of phobia or OCD. In many cases, the disease is evoked by a trivial provoking trigger after persistent conflict and psychic fatigue.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[Biological bases of obsessive-compulsive disorder].

Obsessive Compulsive Disorder, combines several characteristics which suggest an organic etiopathology. The evidence relies on: genetic studies; the treatment response to drugs with serotonergic profile; the appearance of obsessive-compulsive disorder after cerebral nervous system damages; the existence of neurophysiological alterations; good response to neurosurgery and negative course evaluation. In spite of all, the studies of the biological bases of the Obsessive-compulsive Disorder are scarce, which perhaps can be explained due to its relatively low incidence. The present paper reviews all available studies in this area, those referred to family predisposition, dysfunctions of neurotransmission systems, specific biological markers or those common to depression and the most recent research (including new brain imaging techniques) on organic etiology of this disorder.

Biomarkers↗
PubMed1991

Six-year follow-up after exposure and clomipramine therapy for obsessive compulsive disorder.

To determine whether gains from exposure therapy are lasting in patients with chronic obsessive compulsive disorder, the authors followed up 34 (85%) of 40 such patients who had been treated 6 years earlier with exposure therapy for 3 or 6 weeks and with clomipramine or placebo for 36 weeks. Severity of obsessive compulsive disorder was assessed by rating the discomfort caused by the time devoted to four target rituals, the Behavioral Avoidance Test, and the Compulsion Checklist. Mood was assessed by the 17-item Hamilton Rating Scale for Depression, the Wakefield Self-Assessment Depression Inventory, and the Anxiety scale. In addition, the patients' general adjustment was assessed. The authors found that the group as a whole remained significantly improved on obsessive compulsive symptoms, work and social adjustment, and depression; however, the group returned to pretreatment levels (slight to moderate) of general anxiety. They found that neither clomipramine nor placebo affected long-term outcome and that the majority of patients who were taking clomipramine or other antidepressants at follow-up were no more improved that those who were not taking antidepressants. Better long-term outcome correlated with more exposure therapy (6 weeks of therapy vs. 3 weeks) and with better compliance with the exposure therapy homework. The best predictor of long-term outcome was improvement at the end of treatment. Subjects who had initially been most depressed were more likely to receive psychotropic medication during follow-up. Initial severity of illness did not preclude benefit from exposure therapy.

Antidepressive Agents, Tricyclic↗
PubMed1990

Treatment of obsessive compulsive disorder: psychotherapies, drugs, and other somatic treatment.

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.

Antidepressive Agents↗
PubMed1990

Clinical predictors of treatment response in obsessive compulsive disorder: exploratory analyses from multicenter trials of clomipramine.

Two multicenter, double-blind trials were conducted in adults with DSM-III (American Psychiatric Association 1980) defined Obsessive Compulsive Disorder (OCD), comparing clomipramine (Anafranil, CMI) up to 300 mg daily with placebo. Of 519 patients evaluated, 260 received CMI for up to 10 weeks. More than half of the CMI treated patients were significantly improved, approximately 30 percent were minimally improved, and 15 percent showed no improvement after CMI treatment. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess treatment effects and attempts were made to correlate change in Y-BOCS score from baseline with a number of baseline characteristics, including age, sex, duration of OCD, baseline Y-BOCS score, baseline Hamilton Rating Scale for Depression (HAM-D) score, presence or absence of secondary depression, and predominance of obsessions or compulsions. Pearson and/or Spearman correlations failed to reveal any statistically significant correlations between outcome and any of the baseline characteristics studied. While the differences were not statistically significant, it did appear that male patients and patients with a longer duration of illness may be less likely to respond to CMI treatment; however, the overall conclusion from this analysis is that none of the variables studied is a reliable predictor of responses to treatment with CMI.

Adult↗
PubMedDate not supplied

[Psychoanalytic and clinical prospects of obsessive disorders].

Is there a possible meeting-point between the psychoanalytical views of obsessive neurosis and the purely descriptive approach to symptoms, i.e. the biological, cognitive or behavioral explanations of symptoms? Obviously, it is impossible to dream of a general consensus since the processes concerned by the various therapeutic methods are not alike. What would be, for a behavior specialist, the value of discussing the reality of the primitive scene so dear to psychoanalysts? What would be, for a psychoanalyst, the value of discussing the comparative merits of the several conditioning methods? A confrontation is possible only in those fields that are common to all the parties. In this report two of these have been selected: the debate on the genesis of obsessive disorders (are they psychogenetic or organogenetic?) and the clinical study. Today's psychoanalysis discuss the first subject only sparingly, but Freud has given it much thought and it is surprising to find out to what extent his thought is in agreement with the current trends. As to the second subject, there is obviously a possibility for confrontation of the various views, since, regarding obsessive disorders, psychoanalysis provides a psychopathological model suitable for clinical practice and allowing the synthesis of the various manifestations to be made and the behavioral dynamics to be understood. I shall try to show how this model can be used profitably, even if one is ignorant of, or not familiar with, psychoanalytical metapsychology.

Freudian Theory↗
PubMedDate not supplied

[Psychotherapy in patients with obsessive-compulsive disorder].

The present paper is a study of the role of psychotherapy in the treatment of obsessive-compulsive disorders (OCD). It also includes an attempt to integrate several paradigms in order to obtain the best possible approach in helping each patient on an individual basis. The aim of this psychotherapy may limit itself to simple verifications in the pharmacotherapeutic follow-up, or it may be as ambitious as an attempt to modify the character structure of the individual. In the process of the latter case, one expects the defensive aim of symptoms to be no longer relevant, insofar as the patient successfully solves the conflicts that caused the symptoms. We can only use tags or labels to bear witness of the efficiency of such ambitious use of psychotherapy, and even these tags or labels seem to be concerned with compulsive personality rather than with OCD proper. At each end of the range of aims (encouraging the follow-up of pharmacotherapeutic or behavioral treatments vs character modification), the therapist is inevitably confronted with a multitude of features frequently present in the obsessive patient. Because it is a disorder which invades and influences the patient's feelings, thoughts, behavior and relationships with other people, the obsessive patient's mind is a constant prey to special problems at every meeting with his therapist, whether they be related to the administration of drugs or to a behavioral therapy regime. Obviously, such problems will multiply if one initiates systematic psychotherapy in such patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

New findings in obsessive-compulsive disorder.

During the past several years, impressive progress has been achieved in the field of obsessive-compulsive disorder (OCD). Improved diagnosis and treatment of this disorder has brought about renewed interest and optimism. Newer biological findings as well as drug treatment of obsessive-compulsive disorder are summarized here. A brief clinical description of obsessive-compulsive disorder is also included.

Brain↗
PubMed1988

Mood-related obsessive-compulsive symptoms in a patient with bipolar affective disorder.

The authors present a case of coexisting obsessive-compulsive disorder (OCD) and bipolar affective disorder in which the obsessive-compulsive symptoms disappeared during episodes of mania and reappeared during periods of depression. Although patients with coexisting bipolar disorder and OCD are relatively rare, careful study of those patients may increase our understanding of the complex relationship between obsessive-compulsive symptoms and mood. Abnormalities in serotonergic neurotransmission have been postulated in both affective disorders and OCD and may provide important clues to the pathophysiology of OCD.

Bipolar Disorder↗
PubMed1986

An open clinical trial of fluoxetine in the treatment of obsessive-compulsive disorder.

In a 9-week open label study, seven outpatients with obsessive-compulsive disorder were treated with fluoxetine, a selective inhibitor of neuronal reuptake of serotonin. After a 7-day placebo washout period, patients were given a dose of 40 mg/day, which was gradually increased to a maximum of 80 mg/day. A significant improvement was found in the symptomatology of patients as measured on the obsessive-compulsive subscale of the Comprehensive Psychopathological Rating Scale (p less than 0.001) and the Clinical Global Impression of severity of illness (p less than 0.01). These findings support the hypothesis that serotonergic antidepressants may be useful in the treatment of obsessive-compulsive disorder and underline the need to carry out double-blind clinical trials to confirm these results.

Adult↗
PubMed1985

Obsessive-compulsive disorder.

Obsessive-compulsive disorder is a heterogeneous cluster of syndromes that share aspects of both anxiety and affective disorders. Obsessive-compulsive disorder is epidemiologically and phenomenologically distinct from the compulsive character. Although both genetic and neuropsychological data suggest some biologic basis to obsessive-compulsive disorder, there is still insufficient information in both of these areas. Treatment with clomipramine, a tricyclic antidepressant, has proved useful for obsessional patients either as an adjunct to behavior therapy or as a primary treatment for patients who are not amenable to behavioral interventions.

Antidepressive Agents, Tricyclic↗
PubMed1985

[Various features of the favorable dynamics of obsessive fears with onset in childhood].

Peculiarities of the formation of the syndrome of obsessive fears originating in childhood and showing a favourable outcome are considered. Thirty-eight subjects (aged 17-24 years) taken off the psychiatric registry in connection with recovery were examined. A comparative analysis of 2 groups of patients with different clinical manifestations and age at the disease onset allowed the identification of conditions contributing to a favourable time course of obsessive fears. The author outlines the optimum therapeutic measures compensating neurotic disorders in children and adolescents with obsessive fears.

Adolescent↗
PubMed1995

Risperidone addition in fluvoxamine-refractory obsessive-compulsive disorder: three cases.

BACKGROUND: Forty percent to 60% of patients with obsessive-compulsive disorder (OCD) remain unimproved after adequate treatment with serotonin uptake inhibitors (SUIs). The addition of low-dose haloperidol and pimozide to ongoing SUI treatment has been shown to be effective in up to 65% of SUI-refractory OCD patients, particularly in those with comorbid chronic tic disorder. Because OCD patients typically require prolonged pharmacotherapy, they are subject to the development of tardive dyskinesia during neuroleptic treatment. Risperidone is a highly potent and selective serotonin2 and dopamine2 receptor antagonist with a side effect profile that appears to be much more tolerable and safer than that of typical neuroleptics. METHOD: We report our experience with three OCD patients who were unimproved after a minimum of 12 weeks of treatment with the potent and selective SUI fluvoxamine, in whom we added risperidone in an open-label manner. RESULTS: All three patients showed significant improvement in their obsessive-compulsive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after risperidone 1 mg/day was added to ongoing fluvoxamine (250-300 mg/day). Within 4 weeks of adding risperidone, the three patients' Y-BOCS scores had decreased by 65%, 56%, and 43%, respectively. Other than mild or moderate sedation, no side effects were observed. CONCLUSION: These results suggest that risperidone addition to ongoing SUIs may be an effective treatment strategy for refractory OCD.

Adult↗
PubMed1995

[Ambulatory behavior therapy in obsessive-compulsive disorders].

The term Obsessive Compulsive Disorder (OCD) is a label for a variety of syndromes with changing symptom configurations and different intraindividual as well as interactional functions. They are among the most difficult to treat psychiatric disorders. Heterogeneous variables affecting personal development in family, school, and peer-group, as well as genetic or brain organic variables contribute to the development of obsessions and compulsions. In more than 50% of patients with OCD we find one or more of the following disturbances before the outbreak of the disorder: low self-esteem; social deficits; increased anxiety level with increased, latent aggressiveness; striving for 100% security. Behaviour therapy today is the "treatment of choice" for OCD--both in respect of direct symptom reduction as well as the treatment of "causes", co-morbidity and risk factors. Additionally to the use of highly standardised "symptom techniques" individualized, multimodal treatment is necessary in the more severely disturbed patients. Long-term follow-up results show 50-80% success--probably depending on variations in the study samples regarding the type of obsessions and compulsions, the degree of developmental deficits before the occurrence of OCD, actual co-morbidity, and professional as well as private life conditions. Whether and to what degree additional psychotropic medication can enhance the efficacy of behaviour therapy, and whether the high relapse rates of 70% after discontinuation of previously successful drug treatment can be reduced by concomitant or subsequent behaviour therapy, cannot be safely concluded from the currently available studies. Are the non-responders in each of these treatments the responders of the non-responders in the alternative treatment mode?

Ambulatory Care↗
PubMed1995

Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both?

Over the past century, body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, has been hypothesized to be related to obsessive-compulsive disorder (OCD). More recently, BDD has also been hypothesized to be a form of affective spectrum disorder. Affective spectrum disorder refers to a family of disorders postulated to have a common pathophysiologic abnormality. This grouping of disorders has been identified on the basis of their response to pharmacologic treatments and is supported by comorbidity and family studies. Available data suggest that BDD should be considered a candidate form of affective spectrum disorder--a disorder that may eventually be demonstrated to belong to this family of disorders. Available data also strongly support the hypothesis that BDD is an obsessive-compulsive spectrum disorder. Because OCD itself has been hypothesized to be an affective spectrum disorder, BDD may be more narrowly conceptualized as an obsessive-compulsive spectrum disorder and more broadly as a candidate form of affective spectrum disorder.

Adolescent↗
PubMedDate not supplied

[Progress and therapeutic response in the obsessive-compulsive disorder].

The purpose of the present work was to analyze the outcome of patients diagnosed of Obsessive Compulsive Disorder (OCD) after Hospital discharge from our Unit, focusing on therapeutical efficacy immediately after discharge and in the follow up, searching for good evolution predictors. We have studied 42 patients (26 females and 16 males) diagnosed of OCD according to ICD-9 diagnostic criteria, all patients were hospitalized during a seven years period 1981 and 1988. Therapeutical response was evaluated through a (1-4 punctuation) of a Clinical Global Impression Scale considering the changes from the moment the patient was hospitalized, the day of discharge and in the follow up (mean 4.1 years). 73.8% and 71.4% were considered as treatment "responders" the day discharged and in the follow up respectively. Through a multiple logistic regression, treatment with serotonergic drugs and insidious onset of the illness were identified as short-term treatment response predictors, while the absence of a previous obsessive personality was a long-term therapeutical response predictor. Our results show the efficacy of serotonergic drugs and the tact that the presence of a previous obsessive personality could have a prognostic value in OCD.

Adolescent↗
PubMedDate not supplied

[Obsessive-compulsive disorder in the child and adolescent: developmental aspects and therapeutic strategies].

The obsessive-compulsive disorder has only recently been recognized as a specific pathological entity in children, despite the fact that the first descriptions of pediatric manifestations date back to the beginning of this century (P. Janet, 1903) with further reports having been published regularly since that time. The first assessment of the complete epidemiologic, clinical and functional repercussions of the obsessive-compulsive disorder was reported by the Pediatric Psychiatric Group of the NIMH (Pr Judith Rapoport); of their various publications, one is well known in France: The Child who Couldn't Stop Washing (17). Among possible reasons for this delayed recognition are the special conditions for diagnosis and the frequent underestimation of its importance by the family, and sometimes by doctors. This underassessment could be due to confusion between the normal developmental rituals which are frequently seen between the ages of 3 and 5 years, and which do not cause any particular handicaps, and a more severe symptomatology which interferes with normal academic and social adaptation, presenting a substantially worse long-term prognosis. Having recognized the disorder, questions have arisen as to its possible linkage with the form seen in adults. There are numerous convergent argument suggesting a certain long-term persistence of this disorder throughout development and later life: 1) the relative stability of the incidence and prevalence of the disorder; 2) phenomenologic and developmental similarities; 3) most recently, comparable efficacy of treatments for pediatric and adult obsessive-compulsive disorder, whether by the behavioral modification approaches or by pharmacologic treatment, notably with the serotonin re-uptake inhibitors (clomipramine, fluoxetine, fluvoxamine).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Childhood movement disorders and obsessive compulsive disorder.

Recent investigations of childhood-onset obsessive compulsive disorder (OCD) and pediatric movement disorders such as tics, Tourette's syndrome (TS), and Sydenham's chorea suggest that these disorders may be related. Although comorbid obsessive-compulsive symptoms have long been recognized in individuals with TS, more recent studies have demonstrated that tics and TS are surprisingly common in children with primary OCD, and further, that the two disorders seem to have a common genetic vulnerability. Obsessive-compulsive symptoms are also manifest in Sydenham's chorea, a neurologic variant of rheumatic fever in which antistreptococcal antibodies are thought to cross-react with neuronal tissue, particularly within the basal ganglia, and cause inflammatory changes resulting in neuropsychiatric symptomatology. The frequent comorbidity of OCD and Sydenham's chorea and similar postulates of basal ganglia dysfunction for both disorders suggest that Sydenham's chorea may serve as a medical model for OCD. Of note, however, is that the medications (e.g., neuroleptics) that are effective in treating this and other movement disorders are distinctly different from those that are efficacious for OCD (e.g., serotonin reuptake blockers). Examinations of the similarities and differences among these various neuropsychiatric conditions may lead to greater understanding of the pathophysiology of OCD and offer further insights into the etiology and treatment of this troubling disorder.

Antipsychotic Agents↗