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PubMed1995

A comparison of two structured diagnostic interviews: CIDI and SCAN.

The relationship between and the inter-rater reliability of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) for anxiety and depressive disorders were explored. The CIDI and the SCAN were administered by trained interviewers in counterbalanced order. A subsample of interviews was observed to determine the inter-rater reliability of the instruments. Subjects were 101 patients accepted for treatment at an Anxiety Disorders Clinic; 29 of the 101 patients participated in the inter-rater reliability study. Concordance between the instruments as measured by canonical correlation analysis was moderate for current (r = 0.69, p = 0.05) and for lifetime (r = 0.66, p = 0.05) diagnoses. Inter-rater reliability of the CIDI was perfect (overall intraclass kappa = 1.00), and of the SCAN was good (overall intraclass kappa = 0.67). It is concluded that although the two instruments made similar diagnostic distinctions, the clinical judgment involved in administering the SCAN resulted in the more moderate levels of agreement between the interviewer and observer than those found for the CIDI.

Adult↗
PubMed1978

Differential response of heroin and nonheroin abusers to inpatient treatment.

Differences between heroin and nonheroin users were determined at intake and discharge from an inpatient rehabilitation program. Background data as well as attitudes toward drug-related concepts, mood, and symptoms were gathered from 65 male veterans. Data were analyzed by analysis of variance and covariance comparing heroin and nonheroin users at intake and discharge. There were no significant differences between these two groups on their prescores, indicating that heroin and nonheroin patients were quite similar at time of intake. However, at discharge significant differences were found in terms of Tense and Thoughtful from the Mood Scale and Somatization, Obsessive/Compulsiveness, Interpersonal Sensitivity, Depression, and Anxiety from the Symptom Checklist. The heroin subjects had consistently more positive rating than the nonheroin subjects following treatment.

Adult↗
PubMed1994

The course of tics in Tourette syndrome: a 5-year follow-up study.

The current study was undertaken to explore the course of tics in Gilles de la Tourette's syndrome (TS). As part of a prospective 5-year follow-up of non-clinically based TS subjects who had originally participated in a comprehensive research protocol, 23 subjects (ages 11 to 53 years) were reevaluated for tics and obsessive-compulsive (OC) characteristics. Three (13%) of the subjects had an improvement in total tic symptomatology, while 15 (65.2%) had no change and 5 (21.7%) worsened. Improvement or worsening was independent of baseline developmental age across child, adolescent, and adult subgroups. Complex motor tics at baseline predicted complex motor tics and simple phonic tics at follow-up. Baseline OC and complex motor tics independently predicted subsequent OC and complex motor symptoms. Data from the current study provide evidence of the stability of tic subtypes over time and developmental period.

Adolescent↗
PubMed1994

An open-label study of nefazodone in the treatment of depression with and without comorbid obsessive compulsive disorder.

An 8-week open-label study of nefazodone treatment of DSM-III-R major depressive episode (MDE) (n = 18) is reported. Nine of 15 individuals completing treatment also met DSM-III-R criteria for obsessive compulsive disorder (OCD). A significant reduction in depressive and anxiety symptoms was observed in treatment completers; no differences were found between those patients with and those without comorbid OCD. A trend toward an antiobsessional response was seen among those with OCD. The degree of anxiolytic response was found to be significantly correlated with the degree of antidepressant response. Nefazodone was well tolerated in most patients, with dizziness, joint pain, dry mouth, and sedation as the most commonly reported adverse events.

Adult↗
PubMed1999

Open trial of flutamide for treatment of obsessive-compulsive disorder.

BACKGROUND: Several lines of evidence suggest that gonadal steroid hormones play a role in the onset and exacerbation of obsessive-compulsive disorder (OCD). In this study, we examined the effects of treatment with flutamide, a synthetic, nonsteroidal, competitive antagonist of the androgen receptor, on OCD symptoms. METHOD: Eight outpatients meeting DSM-III-R criteria for OCD participated in an 8-week open trial of flutamide. The dose was increased from 250 mg/day to 750 mg/day over the first 4 weeks and maintained at 750 mg/day for the final 4 weeks. The primary outcome measures for OCD symptoms were the Yale-Brown Obsessive Compulsive Scale and the Maudsley Inventory and for anxiety symptoms, the Beck Anxiety Inventory and the Hamilton Rating Scale for Anxiety. Subjects also provided self-ratings of aggression and sexual interest and activity. RESULTS: There were no reductions in measures of obsession and compulsions or measures of anxiety over the 8-week trial. However, self-ratings of feelings of aggression did fall significantly over the 8-week trial (p < .001). CONCLUSION: The lack of response to treatment with flutamide, an androgen receptor antagonist, suggests that any effects of gonadal steroids to exacerbate OCD symptoms are more likely to be mediated through estrogen receptors or through mechanisms that do not involve classical intracellular androgen receptors. Future treatment trials should examine agents that antagonize estrogen receptors or otherwise inhibit estrogen activity.

Adult↗
PubMed2001

Patterns of temperament and character in subjects with obsessive-compulsive disorder.

BACKGROUND: The purpose of this study was to assess the temperament and character patterns of obsessive-compulsive disorder (OCD) patients and to investigate the relationship between patterns of temperament and character and the severity of obsessive-compulsive symptoms. METHOD: The subjects were 40 patients who met DSM-IV criteria for OCD and 40 age-, sex-, and IQ-matched healthy controls. All subjects completed Cloninger's Temperament and Character Inventory. Other instruments included the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS: OCD patients showed significantly higher scores of harm avoidance and lower scores of novelty seeking and self-directedness compared with healthy comparison subjects. In addition, the high harm avoidance and low self-directedness scores are correlated with a greater severity of obsessive-compulsive symptoms in OCD subjects (multiple regression analysis, beta = 0.39, t = 2.54, df = 34, p = .016; beta = -0.41, t = 2.46, df = 34, p = .019, respectively). CONCLUSION: OCD patients had distinct patterns of temperament and character compared with healthy comparison subjects. In addition, these patterns are specifically related to the severity of obsessive-compulsive symptoms.

Adult↗
PubMed2002

Venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder: a preliminary single-blind, 12-week, controlled study.

BACKGROUND: The objective of this study was to investigate, in a single-blind manner over a period of 12 weeks, the efficacy and tolerability of venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder (OCD). METHOD: Patients with a DSM-IV diagnosis of OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score >/= 16 were randomly assigned to receive venlafaxine, 225 to 350 mg/day (26 patients), or clomipramine, 150 to 225 mg/day (47 patients), for 12 weeks, with dosage adjustments according to tolerability and response to treatment. All patients were medication-free from at least 2 months prior to study enrollment. Efficacy measures were the YBOCS and the Clinical Global Impressions scale (CGI), which were completed at baseline and every 4 weeks. We defined responders as patients who had an improvement from baseline in YBOCS score of >/= 35% and a CGI score </= 2. An investigator who was blinded to patients' current medication administered rating scales independently. Moreover, patients were instructed not to reveal their current treatment to this investigator. RESULTS: Twenty-five patients in the venlafaxine group and 40 in the clomipramine group completed the 12-week trial. Responder rates at the end of the 12 weeks were 36% for venlafaxine (9/25) versus 50% for clomipramine (20/40) according to the visitwise analysis and 34.6% (9/26) for venlafaxine versus 42.6% (20/47) for clomipramine according to the last-observation-carried-forward analysis, with no statistically significant difference between the 2 drugs. Adverse experiences were reported by 61.5% of patients receiving venlafaxine (16/26) and by 91.5% of those receiving clomipramine (43/47). CONCLUSION: Our results indicate that venlafaxine might be as efficacious as clomipramine in the acute treatment of OCD, with fewer side effects.

Acute Disease↗
PubMed2003

Possible basal ganglia pathology in children with complex symptoms.

BACKGROUND: Clinical observation of children presenting with a myriad of motor, behavioral, emotional, and sensorial symptoms who do not respond to treatment led to the hypothesis that these children may constitute a unique population, perhaps even a new clinical entity. The literature on child and adolescent psychopathology does not specifically address the phenomenological, diagnostic, and etiological factors that make these children unique. For this reason, a preliminary study was conducted to identify additional symptoms and features that make these children different. METHOD: Data were collected in 2001 on 7 children with complex symptomatology using the Behavior Assessment System for Children, the Anxiety Disorders Interview Schedule for DSM-IV, and a neurological illnesses and symptoms questionnaire designed by the authors. RESULTS: On average, these children met full DSM-IV criteria for 1 to 5 diagnoses. The most prevalent diagnoses were attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, oppositional defiant disorder, and pervasive developmental disorder. These children also exhibited a high incidence of sensory hyperarousal, aggressiveness, hypersexuality, and neuroethological behaviors. Almost all of the children also had indications of a history of bacterial or viral infection. CONCLUSION: The specific symptoms identified and the biological factors found in many of the children seem to suggest basal ganglia involvement.

Adolescent↗
PubMed2005

Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder: a crossover study.

BACKGROUND: Although serotonin reuptake inhibitors (SRIs) are the first-line treatment for obsessive-compulsive disorder (OCD), approximately half of patients with OCD do not respond adequately to SRI monotherapy. Patients with predominant obsessions are common in OCD and are often difficult to treat, necessitating adjunctive treatment. METHOD: This was a 9-week, double-blind, placebo-controlled, crossover study comparing the benefits of 2-week adjunctive treatments with risperidone, haloperidol, and placebo in patients with OCD (DSM-IV criteria) who continued to have severe symptoms despite taking a stable dose of an SRI. Eligible patients must have been receiving a therapeutic dose of an SRI for at least 12 weeks and at the screening visit had a score > or = 10 on items 1-5 (obsession) and a total score > or = 16 on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Data were collected from January 1999 through April 2002. RESULTS: Sixteen patients were enrolled and 12 completed the study. On the YBOCS, both risperidone and haloperidol significantly reduced obsession (p < .05) when compared with placebo. There was a tendency that haloperidol, and to a lesser degree risperidone, also reduced the compulsion and the total YBOCS scores. These results were accompanied by a reduction in the Hopkins Symptom Checklist 90-revised (SCL-90R) anxiety scale score. According to the 17-item Hamilton Rating Scale for Depression, the SCL-90R depression scale, and the Profile of Mood States, risperidone, but not halo-peridol, also improved depressed mood. Neither risperidone nor haloperidol changed neurocogni-tive function during the 2-week treatment. All 12 patients completed the 2-week risperidone treatment, but 5 of the 12 terminated haloperidol treatment early owing to intolerable side effects. CONCLUSION: Adjunctive risperidone improved obsessions and depressed mood and was well tolerated in patients with SRI-refractory OCD.

Adult↗
PubMed2005

Severe obsessive-compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications.

OBJECTIVE: Chronic hair pulling and trichotillomania are putative obsessive-compulsive spectrum disorders. This study determined the prevalence of hair pulling in an inpatient obsessive-compulsive disorder (OCD) population and compared clinical characteristics and treatment response between subgroups with and without comorbid hair pulling. METHOD: Patients with severe DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to an OCD residential treatment facility between August 2000 and July 2003 were included. Clinician-rated (Yale-Brown Obsessive Compulsive Scale) and patient-rated (Massachusetts General Hospital Hairpulling Scale, Beck Depression Inventory, and Posttraumatic Diagnostic Scale) measures were administered at index evaluation. OCD patients with and without moderate to severe hair pulling were statistically compared on clinical and treatment characteristics and treatment response. RESULTS: Of the OCD subjects, 18.8% (N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to severe hair pulling, and 7.8% (N = 12) had severe hair pulling comparable to that of a specialty trichotillomania clinic population. OCD patients with moderate to severe hair pulling were more likely to be women (p < .001), endorse > 1 comorbid tic (p < .05), and have earlier-onset OCD (p = .001). This cohort also had fewer contamination obsessions (p = .04) and checking compulsions (p = .04) and was more likely to be receiving stimulant (p = .006) or venlafaxine (p = .02) medication than those patients without hair pulling. Posttraumatic Diagnostic Scale scores were nearly significantly higher in the OCD + hair pulling group (p = .08). OCD treatment response was unaffected by the presence of comorbid hair pulling. CONCLUSION: Hair pulling is a highly common comorbidity in severe OCD. Women and early-onset OCD patients appear to be more vulnerable to comorbid hair pulling. OCD sufferers with comorbid hair pulling also exhibit an increased risk for tics and may present with different OCD symptomatology.

Adolescent↗
PubMed2005

Defining response in clinical trials for obsessive-compulsive disorder: a signal detection analysis of the Yale-Brown obsessive compulsive scale.

OBJECTIVE: Many studies of the treatment of obsessive-compulsive disorder (OCD) have used percent reduction cutoffs on the Yale-Brown Obsessive Compulsive Scale (YBOCS) to classify patients as treatment responders. However, reduction criteria have varied from 20% to 50%, with studies of cognitive-behavioral therapy (CBT) using a more stringent criterion than studies of pharmacotherapy. The aim of this retrospective investigation was to determine optimal YBOCS reduction criteria for classifying patients as responders. METHOD: Data from 87 adult clinic and research outpatients meeting DSM-IV-TR criteria for OCD according to structured interview were examined, comparing the percent YBOCS reduction from pretreatment to posttreatment with 2 "gold standard" criteria from the Clinical Global Impressions (CGI) scale: much or very much improved and mild illness or better. Signal detection analyses were used to determine the sensitivity, specificity, predictive value of a positive test, predictive value of a negative test, and efficiency of various YBOCS reduction cutoffs. RESULTS: A YBOCS reduction cutoff of 30% was optimal for predicting improvement on the CGI. The 20% cutoff used by many pharmacologic studies resulted in a high number of false positives, whereas the 50% cutoff used by most CBT studies resulted in a high number of false negatives. For predicting mild illness or better at posttreatment, a YBOCS reduction cutoff of 40% to 50% was optimal. CONCLUSIONS: A YBOCS reduction criterion of 30% appears to be optimal for determining clinical improvement, whereas a 40% to 50% reduction criterion is appropriate for predicting mild illness at posttreatment. Future studies should employ a standard definition of treatment response in order to facilitate cross-study comparisons.

Adult↗
PubMed1976

"Dieters" and "vomiters and purgers" in anorexia nervosa.

Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes. The patients were divided into 2 groups. The first group consisted of subjects who had become emaciated solely because of dieting, food refusal and excessive exercising ("dieters"); the second of those who had used additional means to bring about weight loss such, as habitual vomiting and the abuse of purgatives ("vomiters and purgers"). Most "dieters" were intense, introverted, socially withdrawan individuals whose anorexia behaviour had started in response to psychological stress. They had become completely preoccupied with thoughts of food, eating and losing weight. Several did well in treatment, and recovered fully from their anorexic symptoms. "Vomiters and purgers", on the other hand, were more outgoing in respect to personality. Most had previously been obese and, as they had been unable to keep themselves thin by simply abstaining from food, they had learnt to use other means to control their weight. These latter patients did less well in treatment. They continued to experience difficulty in controlling their weight, and the majority persisted with their abnormal behaviour.

Adolescent↗
PubMed1999

Deficient social problem-solving in boys with ODD/CD, with ADHD, and with both disorders.

OBJECTIVE: To study social problem-solving skills in psychiatrically defined aggressive boys, starting from Dodge's social information-processing model. METHOD: Videotaped stimuli of problematic social situations and questions were presented to elicit responses that indicate boys' social problem-solving skills (encoding and interpretation of social cues, generation of possible responses, evaluation of responses, self-efficacy evaluation, and response selection). Boys aged 7 to 12 years with oppositional defiant or conduct disorder (ODD/CD) (n = 48), attention-deficit hyperactivity disorder (ADHD) (n = 27), and both disorders (ODD/CD + ADHD) (n = 29) were involved as well as a normal control group (n = 37) and a psychiatric control group with internalizing disorders (n = 23). RESULTS: When compared with normal controls, boys with ADHD, with ODD/CD, and with ODD/CD + ADHD encoded fewer social cues and generated fewer responses. Boys with ODD/CD and with ODD/CD + ADHD moreover were more confident in their ability to enact an aggressive response than normal controls. When ODD/CD boys and ODD/CD + ADHD boys were given the opportunity to select a response from various types of responses shown, they selected an aggressive response more often than normal controls. Thus, in ADHD boys social problem-solving was affected only in encoding and in the generation of responses, whereas in ODD/CD and ODD/CD + ADHD boys social problem-solving was affected throughout the process. CONCLUSION: For the further study of social problem-solving in aggressive children, it is essential to differentiate between children with ADHD and children with ODD/CD and ODD/CD + ADHD.

Aggression↗