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PubMed2004

[Tic disorders and arousal dysfunction: clinical evaluation of 49 children and adolescents].

AIM: Tourette Syndrome (TS) shows a significant comorbidity with obsessive-compulsive disorders, behavioral problems (i.e. attention-deficit/hyperactivity disorders) and sleep disturbances. Several studies showed that sleep problems are common in TS patients affecting 12% to 62% of patients. Aim of this study was to evaluate the relationships between tics, sleep disorders and behavioral disturbances. METHODS: Fourty-nine consecutive children and adolescents with tics have been studied by the following procedure: a) the Yale Global Tic Severity Scale (YGTSS) was administered in order to establish the severity of tics; b) the Child Behavior Checklist (CBCL) was used to evaluate behavioural disturbances; c) the Sleep Disturbance Scale for Children (SDSC) was filled out in order to assess the presence of sleep disorders. An age-matched control group was used for comparison. RESULTS: All patients (either TS or non-TS) showed a higher prevalence of sleep disturbances versus the control group. Sleep-wake transition disorders (SWTD) were the most frequent sleep disturbances found in our sample, followed by disorders of initiating and maintaining sleep (DIMS). These latter sleep disturbances were highly correlated with the severity of tics. Internalization problems, anxiety/depression and attention and thinking problems were very frequent in our sample. Correlation analysis showed a positive relationship between internalization problems and DIMS and also between aggressive behaviour and respiratory disturbances during sleep (RDS). CONCLUSION: The results obtained seem to confirm the literature reports on the strict relationship between tics and sleep disturbances, mainly SWTD, and further support the hypothesis of a dysfunction of arousal mechanism in TS.

Adolescent↗
PubMed1991

[Psychiatric and neuropsychological symptoms in children with arachnoid cysts--a case report].

Arachnoid cysts (AC) are intracranial, extracerebral cysts. They can produce a wide variety of neurological symptoms, but they can also be asymptomatic or produce psychological or psychiatric symptoms. First, a short overview of the clinical manifestations of AC is given. There is an astonishing lack of literature dealing with psychological problems in children with AC. The case of a 12-year-old boy with a large left temporofrontal AC without increased intracranial pressure is presented. The psychiatric symptoms, which had begun only a few months earlier, included lack of interest, attention deficit, difficulties in contact and communication, severe outbursts of aggression and obsessive-compulsive, inhibited behavior. The main neuropsychological finding was slow and hesitant expression of thoughts despite an intelligence level in the upper normal range. The findings and course are described in detail. They are discussed as signs of an organic psychosyndrome due to the AC.

Affective Symptoms↗
PubMed2002

A comparison of purging and non-purging eating disorder patients in comorbid personality disorders and psychopathology.

OBJECTIVE: We evaluated the significance of purging behavior in the diagnosis of eating disorders through an objective assessment of eating disorder psychopathology including personality disorders. METHODS: Subjects were 42 consecutive outpatients with eating disorders who visited the Outpatient Psychiatric Clinic at Tokai University Hospital (Kanagawa, Japan). Diagnosis of eating and personality disorders was established using the modified Structured Clinical Interviews for DSM-III-R and DSM-III-R-Axis II. Eating disorder symptoms and psychopathology were assessed with the Eating Disorder Examination, Eating Disorder Inventory 2, Beck Depression Inventory, and Leyton Obsessional Inventory Results were compared between purgers and non-purgers. RESULTS: Purgers had severe borderline or avoidant personality disorder, mixed personality disorder, eating attitude, depressive symptoms, and obsessive symptoms. CONCLUSION: Purging behavior in eating disorder patients is associated with personality disorders, depression, and obsessive symptoms. Assessment of this behavior is critical in the diagnosis and treatment of eating disorders.

Adult↗
PubMed2000

Symptom provocation alters behavioral ratings and brain electrical activity in obsessive-compulsive disorder: a preliminary study.

Regional brain activity was measured using quantitative electroencephalography (EEG) in six patients with obsessive-compulsive disorder (OCD) during live and imaginal exposure to feared contaminants. OCD symptoms increased significantly from baseline levels during live and imaginal exposures. However, live exposure provoked significantly more OCD symptoms than imaginal exposure. There was a significant change in the anterior-to-posterior scalp distribution of alpha power during live exposure. These preliminary results suggest that: (1) live exposure is more effective than imaginal exposure in altering behavioral and electrophysiological measures; and (2) live exposure is associated with regional EEG changes in OCD.

Adult↗
PubMed1986

Client-therapist cooperation in the treatment of compulsive handwashing behavior.

While success rates with obsessive-compulsive disorders have improved greatly, debate continues regarding the effective components of behavioral intervention. The present study uses techniques of a jointly designed behavioral contract, active modeling and response discrimination and delay to treat compulsive handwashing. The number of handwashings and time spent at each washing was reduced and the time between handwashings was increased. Obsessive-compulsive clients may respond more successfully to techniques that emphasize self-control, self-definition of appropriateness and client participation in treatment planning.

Behavior Therapy↗
PubMed1998

Psychopathological considerations on the relationship between bulimia and obsessive-compulsive disorder.

The relationship between eating disorders, impulse control disorders and obsessive-compulsive disorder as part of a so-called 'obsessive-compulsive spectrum' is discussed, with particular emphasis on the relationship between eating disorders (particularly bulimia) and obsessive-compulsive disorder. The empirical studies on comorbidity, personality and familiarity are briefly reviewed. Both similarities and differences found in personality, body image, mental rumination, fears, physical exercises, rituals, impulses (bulimic binging and obsessive impulses) and purging behaviors of these patients are discussed from a psychopathological point of view. In particular the importance of distinguishing between obsessive thoughts and prevalent (dominant) thoughts is underlined; the distinctions between repetitive weight controls, physical exercises and purging behaviors of eating disorder patients on the one hand and compulsions on the other, and the distinction between binge impulses and obsessive impulses, are also stressed.

Anorexia Nervosa↗
PubMed2000

Organicity in obsessive-compulsive disorder.

Though pharmacological and/or behavioral interventions have proven highly effective, 20 to 30% of the obsessive-compulsive disorder (OCD) population is treatment refractory. This study describes the OCD clinical profile that is correlated to organicity. Two groups of OCD patients were presented: an organic group and a control nonorganic group. The 9 organic patients exhibit an indifference to their illness, a lack of motivation, are nonanxious even during exposure exercises, are nondepressed, have rigid and concrete thinking, are treatment refractory, and have some type of organic impairment. The 10 nonorganic patients are also treatment refractory but do not exhibit the clinical profile correlated to the organic OCD patients. Furthermore, MRI results indicate that no organic impairment exists in this control group. All of these patients were tried on medication and behavior therapy to no avail. Reasons for lack of response in organic OCD patients, based on cerebral anatomical changes, are discussed.

Adult↗
PubMed1999

Cognitive-behavioral therapy as an adjunct to serotonin reuptake inhibitors in obsessive-compulsive disorder: an open trial.

BACKGROUND: We report the results of an open trial of cognitive-behavioral therapy (CBT) using exposure and ritual prevention as an adjunct to serotonin reuptake inhibitors (SRIs) in obsessive-compulsive disorder (OCD). We hypothesized that exposure and ritual prevention would significantly reduce OCD symptoms in patients who remained symptomatic despite an adequate trial of an SRI and enable patients to discontinue their medication. METHOD: OCD patients taking an adequate dose of an SRI > or = 12 weeks who remained symptomatic (i.e., a Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score > or = 16) were eligible. While taking a stable dose of an SRI, patients received 17 sessions of exposure and ritual prevention. For the intent-to-treat group, the paired t test was used to compare scores on the Y-BOCS, the National Institute of Mental Health (NIMH) Global OCD scale, the Clinical Global Impressions scale, and the Hamilton Rating Scale for Depression before and after exposure and ritual prevention. RESULTS: Six of 7 eligible patients entered the study, and 5 completed it. All 6 improved on all OCD measures. The mean +/- SD Y-BOCS score was 23.8 +/- 2.6 prior to exposure and ritual prevention and 12.2 +/- 4.3 after it (p < .001). The mean percentage decrease on the Y-BOCS was 49% (range, 26%-61%). Patients were rated by the therapist and rated themselves as much (N = 4) or very much (N = 2) improved. Blood drug levels did not change in most patients during exposure and ritual prevention; thus, the improvement was attributed to this type of therapy. No patients discontinued their medication. CONCLUSION: This open trial suggests that CBT using exposure and ritual prevention can lead to a significant reduction in OCD symptoms in patients who remain symptomatic despite an adequate trial of an SRI.

Ambulatory Care↗
PubMed1991

5-Hydroxytryptamine1A receptor responsivity in obsessive-compulsive disorder. Comparison of patients and controls.

To evaluate 5-hydroxytryptamine1A receptor responsivity in obsessive-compulsive disorder, we examined hypothermic, neuroendocrine, and behavioral responses to the selective 5-hydroxytryptamine1A receptor ligand ipsapirone in patients with primary obsessive-compulsive disorder and healthy controls. Twelve patients and 22 controls received a single dose of ipsapirone, 0.3 mg/kg, or placebo under double-blind, random assignment conditions. Ipsapirone induced hypothermia and release of corticotropin and cortisol but had no effect on behavior, including obsessive or compulsive symptoms. Thermoregulatory and neuroendocrine responses to ipsapirone were not consistently different between healthy controls and patients with obsessive-compulsive disorder. These results provide no direct support for the hypothesis that a serotonergic dysfunction related to 5-hydroxytryptamine1A receptors may be linked to the pathophysiologic characteristics of obsessive-compulsive disorder and point to the need for the evaluation of other 5-hydroxytryptamine receptor subtypes. Future studies of the responsivity of 5-hydroxytryptamine1A receptors to direct-acting ligands, such as ipsapirone, should facilitate assessment of the integrity of the 5-hydroxytryptamine system and its involvement in antiobsessional drug effects.

Adrenocorticotropic Hormone↗
PubMed1978

Case report of an obsessive-compulsive personality: a precurser to accident proneness.

The social/physiological/psychological review of an aircraft accident involving input of incorrect controls and low-altitude ejection of a student naval aviator enlightened the investigators as to maybe a not-so-uncommon problem--accident proneness resulting from an obsessive-compulsive nonpsychotic personality. Review of the pilot's history reflected a perfectionist attitude since childhood with continuous associated near-serious accidents. Flight training revealed occurrences of over-correction, channelized attention, and denial of errors. With the demands of Naval Aviation that spurs the growth of the perfectionist, normal/abnormal parameters of obsession-compulsion as they present themselves must be cautiously examined.

Accident Proneness↗
PubMed2003

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs.

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.

Adult↗
PubMed2003

Two different types of obsession: autogenous obsessions and reactive obsessions.

We propose that obsessions are categorized into two subtypes, i.e. autogenous obsessions and reactive obsessions, which are different in terms of identifiability of their evoking stimuli, subjective experiences, contents, and subsequent cognitive processes. Autogenous obsessions tend to come abruptly into consciousness without identifiable evoking stimuli, which are perceived as ego-dystonic and aversive enough to be repelled, and include sexual, aggressive, and immoral thoughts or impulses. On the other hand, reactive obsessions are evoked by identifiable external stimuli, which are perceived as relatively realistic and rational enough to do something toward the stimuli, and include thoughts about contamination, mistake, accident, asymmetry, loss, etc. Through three empirical studies, we confirmed the differences between the two types of obsessional intrusion in their frequency, subjective experiences, subsequent appraisal and control strategy. In particular, autogenous obsessions led to high appraisal on 'control over thought' and 'importance of thought' and frequent use of 'avoidant control strategies', while reactive obsessions linked with high appraisal on 'responsibility' and frequent use of 'confrontational control strategies'. These findings are expected to provide a basis for classifying and explaining the heterogeneous phenomena of obsessive-compulsive disorder.

Adolescent↗
PubMed1997

What do patients do with their obsessive thoughts?

Current models of Obsessive-Compulsive Disorder (OCD) accord a key role to neutralization in the maintenance of obsessional thoughts. Although overt compulsions are well known and have frequently been described in the literature, their cognitive equivalents have not been described to any great extent. This study systemically described the repertoire of strategies used by 29 OCD patients with dominant obsessive thoughts. Extensive repertoires were reported, characterized by low to moderate mean efficacy in removing the thoughts. The majority of strategies were not cognitive rituals nor neutralization in the narrow sense of 'attempts at putting right', even though they were effortful, intentional, and deployed in a strategic way. The results are discussed in terms of the need for a broad definition of neutralization that includes all strategies including coping strategies. Clinical implications are discussed and comprehensive response prevention is recommended for the treatment of obsessive thoughts.

Adaptation, Psychological↗