Clomipramine in obsessive-compulsive disorder: a review.
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Behavior Therapy↗
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[Obsessive-compulsive disorders and structural cerebral alterations. Description of 3 cases].
Obsessive-compulsive spectrum disorders have emerged as a differentiated entity, characterized with intrusive and obsessive thoughts or repetitive behaviors whose major syndrome would be the classical obsessive-compulsive disorder. In order to spread this concept among neurologists, we present three cases that can be considered as obsessive-compulsive spectrum disorders, in which structural cerebral lesions co-exist. Obsessive-compulsive spectrum disorders share with obsessive-compulsive disorder several clinical and neurobiological characteristics as well as their therapeutic response. Nevertheless, obsessive-compulsive spectrum disorders have a lesser positive familial history incidence and a later start than obsessive-compulsive disorder. Recent neurobiological studies using functional and structural neuroimaging in patients with obsessive-compulsive disorder together with neuropsychological studies reveal the existence of defects in the following neural circuits: frontal-orbital-basal ganglia-thalamus-cortical and their limbic connections. In a similar manner as it occurs with obsessive-compulsive disorder, research on obsessive-compulsive spectrum disorders will provide the pathophysiological basis of the obsessive-compulsive disorder in the dysfunctionality of the previously mentioned neurological circuits.
Adult↗
Cognitive-behavioural approach to understanding obsessional thinking.
BACKGROUND: Obsessional ruminations (obsessions without any accompanying overt compulsive behaviour) were previously considered especially difficult to treat. METHOD: Cognitive-behavioural theory regarding obsessional problems is discussed. Strategies for therapy developed on the basis of this theory are reviewed. RESULTS: The cognitive-behavioural theory of obsessive-compulsive disorder proposes that obsessional problems occur as a consequence of the particular meaning or significance which patients attach to the occurrence and/or content of intrusive thoughts. When intrusions are interpreted (appraised) as indicating increased personal responsibility, this results in both distress and the occurrence of neutralising behaviour. Cognitive-behavioural treatment seeks to change responsibility beliefs and appraisals, and thereby reduce distress and eliminate neutralising responses which usually occur as covert neutralising (mental rituals). Evidence is emerging for the success of therapy developed on this theoretical basis. CONCLUSIONS: Recent developments in the psychological conceptualisation of obsessional ruminations have improved the prospects for successful therapy.
Anxiety Disorders↗
Behavioral effects of naloxone infusion in obsessive-compulsive disorder.
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Adult↗
Autogenous/reactive obsessions and their relationship with OCD symptoms and schizotypal personality features.
This study was conducted to examine the autogenous-reactive model of obsessions [Behav. Res. Ther. 41 (2003) 11-29]. A large number of college students (n=932) were administered a questionnaire battery assessing obsessional intrusions, schizotypal personality features, depressive symptoms, general anxiety and OCD symptoms. Hierarchical regression analyses revealed that autogenous obsessions were more strongly associated with schizotypal personality features than with OCD symptoms, general anxiety, or depression, whereas the relationship between reactive obsessions and schizotypal personality features was negligible. Moreover, autogenous obsessions were more strongly associated with covert OCD symptoms, whereas reactive obsessions were more strongly associated with overt OCD symptoms. These findings suggest that autogenous obsessions are more strongly associated with cognitive features (e.g., anomalous perception, obsessing), whereas reactive obsessions are more strongly associated with overt behavioral features (e.g., checking, washing, ordering). Theoretical and clinical implications are discussed.
Adult↗
[The dialectic of the obsessionality and the dissociativity: toward a psychopathology of binge-eating].
Binge-eating is one of the most paradoxical phenomena in the symptomatology of anorexia nervosa and bulimia nervosa. The patients seem to be struggling to control their eating behaviors as strictly as possible, and at the same time, they repeat chaotic patterns of binge-eating. The author investigated the descriptive psychopathology of binge-eating in this paper. The author recognized the impulsive nature of binge-eating at first, and compared it with the clinical features of so-called impulse control disorders, such as kleptomania, trichotillomania, and so on. According to the literature review, most impulse control disorders tended to show high coincidence with eating disorders. The mode of the coincidence and the alternation of the symptoms suggested the common psychopathologies between eating disorders and impulse control disorders. The author then inquired into their common psychopathologies, and revealed characteristic features which could be formulated as dissociative. The study of the concept of dissociation proved that this formulation was not only valid, but also useful in understanding eating disorders clinically and theoretically. Binge-eating could be regarded as a manifestation of dissociative pathology. The author inquired further into the psychopathologies of eating disorders and impulse control disorders, and revealed obsessional features in these disorders. Though some investigators regarded the symptoms of eating disorders as compulsive behaviors and considered that eating disorders were variants of obsessive-compulsive disorder, the author pointed out some descriptive differences between them. Nevertheless, the obsessionality formed an important basis of the psychopathology of binge-eating. Finally, the author discussed the relationship between the obsessionality and the dissociativity in eating disorders. These two features were reciprocal factors in mental activity, and were forming dialectical dynamism in general psychological functioning. In anorexia nervosa and bulimia nervosa, the opposition between two factors was morbidly rigid and their sublation could not occur. Though the obsessional and the dissociative features of binge-eating were opposite phenomena, it was important to comprehend them as an incorporated psychopathology. The conceptualization of the dialectic of the obsessionality and the dissociativity could also be useful in understanding other psychopathological phenomena such as addiction and splitting.
Adult↗
Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial.
This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy (CBT) in pediatric patients with obsessive-compulsive disorder (OCD) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT. Sixteen OCD outpatients, 8-17 years of age, were treated in a 12-week open trial with manualized CBT. Target symptoms were rated at two-week intervals with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH Global), the Clinical Global Impression Scale (CGI), and the Hamilton Anxiety Rating Scale (Ham-A). Statistical analyses showed a significant benefit for treatment. Ten patients experienced at least a 50% reduction in symptoms on the CY-BOCS; seven were asymptomatic on the NIMH Global. These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD. Further, the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy. These results must be considered preliminary, given the small sample size and open administration of treatment.
Adolescent↗
[Cognitive therapy in obsessive-compulsive disorders].
Cognitive approach is presented both at a theoretical and clinical level. It enlarges and enriches the classical behavioral approach of obsessive-compulsive disorders. To date, controlled studies are too few to fully assert its value. Further investigations are justified to ascertain whether cognitive therapy has a value as such, or enhances the effects of more classical pharmacological and/or behavioral treatments.
Cognitive Behavioral Therapy↗
Tourette syndrome: recent advances.
Clinical and genetic studies have allowed the limits of Tourette syndrome to be broadened. There is now strong evidence that chronic motor tics and Tourette syndrome are different manifestations of an autosomal dominant gene with high penetrance. A genetic link with obsessive-compulsive disorder also appears to have been established. Up to 10% of cases of Tourette syndrome may be nongenetic phenocopies, however. There is also an association between Tourette syndrome and attention deficit hyperactivity disorder. This complicates therapy, as psychostimulant drugs may precipitate or exacerbate tics in some individuals. A high proportion of patients with Tourette syndrome also has neuropsychological deficits and learning disabilities. The pathophysiology is incompletely understood. The best supported hypothesis is that there is dopamine receptor supersensitivity, although there are strong suggestions of abnormalities in serotonin metabolism. The possibility of abnormalities in neuropeptide systems is being explored. Treatment of tics relies primarily on neuroleptics with dopamine receptor blocking activity. Clonidine may be useful in some patients, especially those with behavior problems. Obsessive-compulsive symptoms can be treated using appropriate pharmacologic agents. The treatment of attention deficit disorder in patients with tics should begin with behavioral strategies. Clonidine can be tried as the first-line drug, and psychostimulants should be used only if necessary and with great caution. In rare instances it may be necessary to combine a psychostimulant and a neuroleptic.
Child↗
Behavioral Aspects of Frontal Lobe Epilepsy.
There is growing interest in disorders of behavior, personality, and mood associated with focal epilepsies, though the neuropsychological and behavioral or psychiatric aspects of epilepsy have usually been treated separately. The causes of behavioral disorders in patients with focal epilepsies are multifactorial, though the positive effects of seizure control on behavior suggest that state dependency is a major contributing factor. Patients with temporal lobe epilepsy manifest depression, anxiety, neuroticism, and social limitations, as well as impaired memory. By contrast, studies of cognitive function in patients with frontal lobe epilepsy show executive dysfunctions in response selection/initiation and inhibition, as well as cognitive impairment, hyperactivity, conscientiousness, obsession, and addictive behaviors.
Journal Article↗
Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder.
OBJECTIVE: To compare the effectiveness of group cognitive-behavioral therapy (GCBT) and of sertraline in treatment-naïve children and adolescents with obsessive-compulsive disorder. METHOD: Between 2000 and 2002, 40 subjects between 9 and 17 years old were randomized to receive GCBT (n = 20) or sertraline (n = 20). GCBT consisted of a manual-based 12-week cognitive-behavioral protocol adapted for groups, and treatment with sertraline involved medication intake for 12 weeks. Subjects were assessed before, during, and after treatment (at 1, 3, 6, and 9 months after treatment conclusion). Primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale. Repeated-measures analyses of variance were done. RESULTS: Both GCBT and sertraline conditions had significant improvement in obsessive-compulsive disorder symptoms as measured by the Children's Yale-Brown Obsessive-Compulsive Scale after 12 weeks of treatment. After the 9-month follow-up period, subjects in the GCBT condition had a significantly lower rate of symptom relapse than those in the sertraline group. CONCLUSIONS: The treatment with GCBT may be effective in decreasing obsessive-compulsive symptoms in childhood obsessive-compulsive disorder and should be considered as an alternative to either individual cognitive-behavioral therapy or a medication, such as sertraline. Results support the effectiveness and the maintenance of gains of GCBT in the treatment of youngsters with obsessive-compulsive disorder.
Adolescent↗
Compulsive checking behavior of quinpirole-sensitized rats as an animal model of Obsessive-Compulsive Disorder(OCD): form and control.
BACKGROUND: A previous report showed that the open field behavior of rats sensitized to the dopamine agonist quinpirole satisfies 5 performance criteria for compulsive checking behavior. In an effort to extend the parallel between the drug-induced phenomenon and human obsessive-compulsive disorder (OCD), the present study investigated whether the checking behavior of quinpirole rats is subject to interruption, which is an attribute characteristic of OCD compulsions. For this purpose, the rat's home-cage was placed into the open field at the beginning or the middle of a 2-hr test. RESULTS: Introduction of the home-cage reduced checking behavior, as rats stayed inside the cage. After 40 min, checking resurfaced, as quinpirole rats exited the home-cage often. An unfamiliar cage had no such effects on quinpirole rats or saline controls. CONCLUSIONS: Checking behavior induced by quinpirole is not irrepressible but can be suspended. Results strengthen the quinpirole preparation as an animal model of OCD compulsive checking.
Animals↗
Disabling obsessive thoughts responsive to antidepressants.
The authors report four patients with disabling obsessive thoughts who responded in dramatic fashion to antidepressant medication. None met criteria for major depression. This response is discussed in light of the current literature on obsessive-compulsive disorder.
Adolescent↗
Clinical evidence of genomic imprinting in Tourette's syndrome.
Recent genetic studies of Tourette's syndrome (TS) have suggested a sex-specific expression of TS behaviors but not a sex-associated difference in their transmission. In a retrospective study designed to assess the influence of gender of the affected parent on childhood TS phenotype, we compared unmedicated TS subjects with patrilineal (n = 25) or matrilineal (n = 25) inheritance of TS, as determined by family history methodology, with respect to demographic variables, temporal profile of tic evolution, and clinical ratings of tics and associated behaviors, particularly obsessive-compulsive symptoms and attention deficit hyperactivity disorder (ADHD). Maternal transmission of TS was characterized by trends toward greater motor tic complexity and more frequent noninterfering rituals (p < 0.05); paternal transmission was associated with increased vocal tic frequency (p = 0.01), an earlier onset of vocal tics relative to motor tics (p < 0.01), and more prominent ADHD behaviors, including motor restlessness (p < 0.01). These findings are consistent with genomic imprinting in TS. Confirmation of this phenomenon promises not only to advance understanding concerning the genetic link between TS and ADHD but may also help to explain the apparent fit of competing models of genetic transmission in TS.
Adolescent↗
Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study.
Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands. Hoarding in relatives was associated with indecision in probands, independently of proband hoarding status. The findings suggest that hoarding behavior may help differentiate a distinct clinical subgroup of people with OCD and may aggregate in some OCD families. Indecision may be a risk factor for hoarding in these families.
Adolescent↗
Obsessive-compulsive disorder: recognition across medical settings, and treatments from behavior therapy to neurosurgery.
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Behavior Therapy↗
Obsessive compulsive disorder.
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Behavior Therapy↗
Toward a new nosology of obsessive compulsive disorder.
Obsessive compulsive disorder (OCD) is receiving increasing attention in the clinical research literature. This review briefly summarizes data concerning diagnosis, phenomenology, and epidemiology of OCD and examines other disorders that closely resemble OCD. In addition, the nosological and treatment implications of these data are discussed. We find that OCD is characterized by a focal anxiety point(s) reflected in obsessions and by behavioral or cognitive compulsions. The appearance of these characteristics in other disorders suggests some relation between them and, consequently, the treatment of these disorders may be enhanced by conceptualizing them as OCD "variants".
Anxiety Disorders↗