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PubMed1994

Obsessive compulsive spectrum disorder.

A wide range of psychiatric and medical disorders have been hypothesized to be related to obsessive compulsive disorder (OCD) and thus, together, to form a family of disorders known as obsessive compulsive (or OCD) spectrum disorder. The grouping of these conditions is based on their phenomenological similarities with OCD (i.e., obsessive thinking and/or compulsive behaviors), as well as their having courses of illness, comorbidity and family history patterns, biological abnormalities, and treatment responses similar to OCD. Proposed OCD spectrum disorders have included body dysmorphic disorder, hypochondriasis, anorexia nervosa, trichotillomania, and some forms of delusional disorder, among others. However, conditions with impulsive features have also been hypothesized to belong to this family, including impulse control disorders in general, paraphilias and nonparaphilic sexual addictions, bulimia nervosa and binge eating disorder, and Tourette's disorder. We review the evidence supporting the grouping of these conditions into an OCD spectrum disorder family. We conclude that these disorders are different in some ways from OCD, but that they also have many similarities with OCD, and may therefore be related to one another and to OCD. In addition, we hypothesize that some of the differences among them may be explained in part by variation along a dimension of compulsivity versus impulsivity. Finally, because most of these conditions appear to be related to mood disorder, we hypothesize that the OCD spectrum disorder family may belong to the larger family of affective spectrum disorder.

Comorbidity↗
PubMed1994

The epidemiology and differential diagnosis of obsessive compulsive disorder.

Originally considered a rare disorder, obsessive compulsive disorder (OCD) has been shown to be quite common with a 1% point prevalence in many cultures. Comorbidity with other psychiatric disorders is common, with a lifetime history of major depression present in two thirds of OCD patients. This disorder also coexists with a number of other Axis I disorders including panic disorder, social phobia, eating disorders, and Tourette's disorder. Data collected on phenomenological subtypes have shown that most OC patients have multiple obsessions and compulsions. Another model for subtyping OC symptoms categorizes core features that underlie obsessions and compulsions. These core features such as abnormal risk assessment or incompleteness may be useful in identifying homogeneous subgroups that have distinct treatment responses. The presence of compulsions is helpful in distinguishing this disorder from other anxiety disorders as well as depression. The differential diagnosis of OCD is presented.

Adult↗
PubMed1994

Refractory obsessive compulsive disorder and ECT.

The authors review their experience with electroconvulsive therapy (ECT) in 32 patients meeting DSM-IIIR criteria for obsessive compulsive disorder. All patients had received extensive behavioral and cognitive therapy and pharmacotherapy prior to the initiation of ECT without apparent benefit. Following ECT, most subjects showed considerable improvement in obsessive compulsive symptoms and remained improved up to 1 year after therapy. Some patients also showed short-term improvements on several measures of depression. The change in obsessive compulsive symptoms, however, appeared to be independent of changes in measures of depression.

Depressive Disorder↗
PubMed1993

Obsessive-compulsive disorder: efficacy of specific treatments as assessed by controlled trials.

There is overwhelming evidence that specific pharmacologic agents are effective in lessening symptoms of OCD in many patients. In addition, considerable evidence indicates that the behavioral techniques of exposure and response prevention are effective. Although complete cure occurs infrequently, the combination of both pharmacotherapy and behavioral treatment optimizes the individual patient's potential for recovery and the majority of patients can now expect to lead relatively normal lives, to work, and to function well in families and in social situations. There is no controlled, and almost no anecdotal evidence, to suggest that traditional psychodynamic psychotherapy or psychoanalysis are effective in treating the symptoms of OCD. However, wise clinicians frequently use psychotherapy as an adjunct to more specific treatments to help deal with other problems that the patient might have. Even though many patients became vigorously opposed to psychodynamic treatments and psychoanalysis after experiencing such treatments for years without any improvement in their obsessions and compulsions, they are now realizing that psychotherapy may have a place in the treatment plan for many patients who, after responding to medication and behavior therapy, need to explore the deeply rooted thought patterns that developed in response to obsessive-compulsive behaviors and to work to free themselves from these patterns. For example, it may no longer be adaptive for the patient to attempt to control others, or to set up a restricted or extremely regimented environment. Even trying to distinguish a "normal" thought or worry from an obsession may require the help of a therapist. There may well be a place for psychodynamic therapies for some patients (often with onset of OCD in childhood) who are left with developmental scars after their OCD is well-treated. Although controlled evidence is lacking, there may well be a role for neurosurgical procedures in the management of very severely-ill OCD patients who have failed to respond to more conventional treatments. With the development of new technologies, controlled trials may now be feasible.

Clinical Trials as Topic↗
PubMed1993

Obsessive compulsive disorder with psychotic features.

BACKGROUND: The purpose of this study was to systematically identify and characterize the demographic and clinical features of patients with obsessive compulsive disorder (OCD) and psychotic symptoms. METHODS: From a total of 475 patients with DSM-III-R OCD evaluated and/or treated in an outpatient OCD clinic, 67 patients (14%) were identified as having psychotic symptoms in addition to OCD. Psychotic symptoms were defined as hallucinations, delusions, and/or thought disorder. Clinical and demographic data on these probands were collected from semistructured interviews and compared with data collected on the nonpsychotic OCD probands. RESULTS: We identified 27 (6%) of 475 probands with DSM-III-R OCD whose only psychotic symptom was lack of insight and high conviction about the reasonableness of the obsessions ("OCD without insight"). The remainder of the patients with psychotic symptoms and OCD met criteria for distinct DSM-III-R psychotic disorders as well as OCD: 18 probands (4%) had OCD and schizophrenia, 8 probands (2%) had OCD and delusional disorder. Fourteen patients (3%) met criteria for both OCD and schizotypal personality disorder. Compared with the OCD patients without psychosis, probands with OCD and psychotic features were more likely to be male, be single, have a deteriorative course, and have had their first professional contact at a younger age. The data suggest that these differences were largely due to those patients with OCD and schizophrenia-spectrum disorders and not those probands whose only psychotic symptom was complete conviction and lack of insight about their obsessions. CONCLUSION: There appears to be considerable heterogeneity in the clinical features of OCD patients who also have psychotic symptoms. The implications of these findings for understanding delusional states and for diagnostic classification are discussed.

Adult↗
PubMed1993

Family study of obsessive-compulsive disorder in a Mexican population.

Twenty seven obsessive-compulsive disorder (OCD) patients were studied at the Instituto Mexicano de Psiquiatría in Mexico City. This is the first sample of OCD patients studied in Latin America. There was a significant sex ratio difference and a significant difference in the type of obsessions and compulsions displayed by males and females. Co-morbidity data demonstrated a high frequency of obsessive-compulsive personality disorders, depression, sexual abuse, suicidal attempts and neurological damage. Approximately one third of OCD cases demonstrated a positive family history. There was a higher than expected frequency of first degree relatives affected with OCD. In addition, this study may support the hypothesis that OCD and tics are genetically related.

Adolescent↗
PubMed1993

[Obsessive compulsive disorders].

Obsessive compulsive disorders (OCD) are a nosographic entity. Their biological rating in serotonergic pathways and the efficacy of serotonergic antidepressants allows for developing a clinical and biological models of OCD. J. Guyotat, one of the first in 1959 to observe the favorable effects of antidepressants on OCD, presents their history. Epidemiological surveys conducted since 1980 have shown that the prevalence of OCD was underestimated until then. The prevalence is 2 to 3% in the adult population, with more women affected. The disorder develops early in childhood and adolescence. Loss of time is an important criteria for OCD but, according to M. Bourgeois, who reviewed the symptoms precisely, this does not warrant identifying a separate "primary obsessive slowness" syndrome. According to M. Bouvard, the prognosis of the disorder, in contrast to that for rituals observed in children between 3 and 5 years of age, is poor, with a risk of chronicity and social disturbances. The prevalence of OCD in children and adolescents is 0.8% and remains stable. The comorbidity, in particular with tics, is discussed. The favorable effects of fluoxetine are reported. J.M. Chignon reviews the concept of comorbidity, developed in internal medicine, and explains that it could be rigorously applied to psychiatry only starting with the DSM III-R. The comorbidity of OCD with other psychiatric diseases is highly variable: it is reviewed for personality disorders (0 to 55%), schizophrenia (4%), substance abuse (10%) and especially depression: one third of patients with OCD will develop a major depressive episode. Based on a clinical case report, M. Faruch leads us from symptoms to behavior therapy. The symptom must be considered for itself, whether it is part or not of the obsessive neurosis. It is legitimate to use antidepressants in combination with behavior therapy.

Adolescent↗
PubMed1993

Symptoms and physiologic manifestations in obsessive compulsive patients before and after treatment with clomipramine.

BACKGROUND: Anxiety and hyperarousal constitute important aspects of obsessive compulsive disorder (OCD). This study examined the effects of clomipramine on symptoms, arousal-related physiologic states, and stress reactions in OCD patients. METHOD: Twenty-five OCD patients were randomly assigned to a clomipramine or placebo group and were assessed for 10 weeks using a double-blind parallel design. They were assessed clinically with the Yale-Brown Obsessive Compulsive Scale, the National Institute of Mental Health Global Obsessive-Compulsive Scale, the patient- and investigator-rated Global Improvement Scales, and the Hamilton Rating Scale for Depression. Prior to treatment, and again during the last day of medication, physiologic states (heart rate, respiration, skin conductance, blood pressure, and EMG) were measured at rest and during both nonspecific (psychomotor tasks) and pathology-specific (visualization) stressors. RESULTS: Patients taking clomipramine, but not those taking placebo, improved significantly on all clinical measures. With the exception of heart rate, treatment did not affect resting physiologic states. Heart rate increased in patients taking clomipramine and decreased in patients taking placebo. Autonomic reactivity to nonspecific and to pathology-specific stressors was attenuated by clomipramine, but not by placebo. CONCLUSION: Clinical improvement on clomipramine treatment was independent of the physiologic state of the patients and was not associated with autonomic down-regulation. The attenuation of autonomic reactivity to stressors appears not to be pathology-specific but may reflect either a direct pharmacologic effect of clomipramine on the autonomic nervous system or a heightened indifference to psychological stressors in general.

Adult↗
PubMedDate not supplied

[Cognition disorders in obsessive disorder].

The authors present a critical overview of the multiple studies of cognitive functions of patients with obsessive compulsive disorder. First are mentioned some correlations between neurological diseases and obsessive compulsive disorder. Then, the authors analyse the results obtained by the patients in WAIS, in the tactual perception memory test, in visual memory and orientation and in verbal memory. Verbal behaviour, performances in sensory perception tests, motor performances, attention and, lastly, troubles in information processing are reviewed. With these results, the authors try to develop the relevant theories about the mechanisms in obsessive compulsive disorder: dysfunction of the dominant hemisphere and abnormality of the serotoninergic system.

Cognition Disorders↗
PubMed1996

Obsessive-compulsive and spectrum disorders: overview and quality of life issues.

Although obsessive-compulsive disorder (OCD) is among the most common of all psychiatric disorders, the diagnosis is frequently overlooked unless specific screening questions are asked by the treating physician. The obsessive thinking and compulsive behaviours that primarily characterize OCD can be found in other obsessive-compulsive "spectrum" disorders as well. These disorders affect a sizable percentage of the U.S. population and have thus become an increasing public health problem. Preliminary results from our comprehensive survey of OCD sufferers found significant impairments in quality of life and substantial costs associated with the morbidity and treatment of OCD. This is of particular interest to the primary care practitioner since these patients often present initially to primary care physicians, and early diagnosis and appropriate treatment can substantially improve outcome.

Adolescent↗
PubMed1996

Obsessive-compulsive spectrum disorders in primary care: the possibilities and the pitfalls.

Although the serotonin selective reuptake inhibitors make the treatment of obsessive-compulsive spectrum disorders possible for primary care physicians, numerous obstacles to successful treatment in the primary care setting remain. Given the absence of studies of primary care patients in primary care settings, the generalizability of results from patients with obsessive-compulsive spectrum disorders in psychiatric settings is uncertain. The primary care physician must combat resistance and refusal by patients to accept psychiatric intervention. In addition, the primary care physician faces recognition problems--not only are patients reluctant to disclose such problems, but primary care physicians lack validated screening tools. The development of a new computerized compulsive-impulsive spectrum scale should assist primary care physicians in diagnosing and treating obsessive-compulsive spectrum disorders, which may occur at a rate of 10% in the primary care setting.

Diagnosis, Computer-Assisted↗
PubMed1996

Treatment of obsessive-compulsive disorder with fluvoxamine: a multicentre, double-blind, placebo-controlled trial.

One hundred and sixty patients with a primary diagnosis of obsessive-compulsive disorder were enrolled in a multicentre, randomized, double-blind, placebo-controlled study of fluvoxamine. After a placebo washout phase, patients were randomized to treatment with placebo or fluvoxamine (100-300 mg/day) for 10 weeks. Seventy-eight patients in each group were evaluable for efficacy. Fluvoxamine was significantly more effective than placebo as assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive (NIMH-OC) scale and the Global Improvement item of the Clinical Global Impression (CGI) scale. The percentage of patients classified as "responders" (much or very much improved according to the Global Improvement item) was also significantly higher in the fluvoxamine group from Week 6 onwards, with 33.3% of fluvoxamine-treated patients and 9.0% of those given placebo classified as "responders" at endpoint. The "responders" to fluvoxamine experienced a substantial clinical benefit as reflected in decreases in their Y-BOCS and NIMH-OC scores. Fluvoxamine was well tolerated with the majority of adverse events considered mild or moderate.

Adult↗
PubMedDate not supplied

Tic-related vs. non-tic-related obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is a chronic condition characterized by an array of intrusive, upsetting thoughts and interfering, repetitive behaviors. Some forms of OCD may be etiologically related to Tourette's syndrome (TS). This cross-sectional study examines a range of obsessive compulsive (OC) symptoms which have been hypothesized to distinguish tic-related OCD from non-tic-related OCD. One hundred and seventy-seven patients with a primary DSM-IIIR diagnosis of OCD, aged 16 to 72, participated in the study. Patients with tic-related OCD (n = 56) reported more OC symptoms, including more aggressive, religious, and sexual obsessions as well as checking, counting, ordering, touching, and boarding compulsions than did patients with non-tic-related OCD (n = 121). Contrary to our expectation, these two groups of OCD patients did not differ with regard to the presence of "just right" phenomena or symptoms of psychasthenia. "Just right" phenomena and symptoms of psychasthenia, however, were both found to be associated with the current severity of OC symptoms.

Adult↗
PubMed1997

[Obsessive-compulsive disorders in children. A review based on recent research and clinical experiences].

This article describes obsessive-compulsive disorder in childhood through a review of some recent research topics and the author's own clinical experiences with the disorder. Among the topics discussed are diagnosis, differential diagnosis, phenomenological characteristics and treatment recommendation. The article concludes that although recent research on obsessive-compulsive disorders in children has lead to important advances in our understanding and treatment of the disorder, much remains to be addressed. Research on childhood obsessive-compulsive disorder in Norway seems to be non-existent, and the author calls attention to the need for empirical studies at Norwegian research institutions. These should include research on treatment preferences in Norwegian child psychiatry clinics.

Child↗
PubMed1997

Process characteristics of worry and obsessive intrusive thoughts.

One hundred and twenty-five university students were administered a battery of self-report measures to assess worry disposition and content, frequency of obsessive intrusive thoughts, and 10 conceptually derived appraisal dimensions of worry and obsessional intrusions. Process ratings indicated that the worrisome thoughts were considered more disturbing than the ego-dystonic intrusive thoughts. Worry was also distinguished by a focus on the possible consequences of negative events, whereas concern about the personal meaning of the thought was a unique process dimension for obsessive intrusive thoughts. Both content and process variables are important in differentiating worry and obsessive-like intrusive thoughts in a nonclinical population.

Adolescent↗
PubMed1998

Obsessive-compulsive disorder in children and adolescents.

Significant progress has occurred over the past 10 years in the understanding and treatment of obsessive-compulsive disorder. With the recognition that one half to one third of adults experience onset of the disorder in childhood and adolescence, early identification and treatment of the disorder become essential to reduce potential long-term ramifications. Models for etiopathogenesis suggest a neuropsychiatric disorder and are supported by identification of an immune-related subtype, association with other neurological diseases, brain-imaging studies, and peripheral blood findings. Pharmacological and behavioral treatments have been shown to have efficacy in reducing compulsive behaviors and obsessive thoughts. Although treatable, many children have only a partial response. Based on the current child and adolescent literature, an overview of childhood obsessive-compulsive disorder is presented.

Adolescent↗
PubMed1984

WAIS characteristics of non-pathological obsessive and hysteric styles.

Tested traditional clinical hypotheses about the cognitive functioning of individuals (N = 16) with an obsessive or an hysteric style in a non-pathological population using selected subtests of the WAIS. Individuals identified as having an obsessive style displayed the predicted patterns (Information and Vocabulary greater than Comprehension), while their hysteric counterparts displayed only a trend toward certain predicted patterns (Comprehension greater than Information and Vocabulary). Predicted between-group differences were significant. Higher base rates of obsessive features in a college population may account for the weaker trends within the hysteric group. Generally, the results appear to support the likelihood that nonpathological forms of the two styles display patterns of cognitive functioning similar to those of their more pathological counterparts.

Compulsive Personality Disorder↗
PubMed2006

Disentangling depressive personality disorder from avoidant, borderline, and obsessive-compulsive personality disorders.

Several studies have found that 3 personality disorders (PDs) tend to share moderate rates of comorbidity with depressive PD: avoidant, borderline, and obsessive-compulsive. This study sought to evaluate the diagnostic criteria of each disorder in an effort to understand where areas of overlap may occur and to modify criteria sets where reasonable to reduce any degree of overlap. One thousand two hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality Disorders. The highest degree of comorbidity was observed between avoidant PD and depressive PD. Logistic regression analyses indicated that 2 criteria-avoidant criterion 5 and depressive criterion 2-could be removed from the diagnostic criteria sets and reduce the rates of overlap by as much as 15%. A factor analysis of the criteria of all 4 PDs indicated that there is a common clustering of many of the symptoms of avoidant, borderline, depressive, and obsessive-compulsive PDs and that borderline symptoms tend to cluster together most consistently. Avoidant and obsessive-compulsive personality symptoms clustered in ways that may reflect a problem of how to engage with others, suggestive of an approach-avoidance conflict. Depressive PD symptoms clustered in a way suggestive of problems with anger that is directed toward oneself and others. The factor analysis results suggest that an organization of symptoms around themes of conflict may provide useful ways of understanding the personality patterns of these 4 disorders.

Adult↗