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Perospirone, a novel antipsychotic drug, inhibits marble-burying behavior via 5-HT1A receptor in mice: implications for obsessive-compulsive disorder.

Perospirone is a novel atypical antipsychotic drug with dopamine (DA) D(2)- and serotonin (5-hydroxytryptamine, 5-HT) 5-HT(2A)-receptor antagonist, and 5-HT(1A)-receptor agonist properties. In the present study, we examined the effect of perospirone on marble-burying behavior, which has been considered an animal model of obsessive-compulsive disorder (OCD), compared with the effects of other antipsychotics such as haloperidol and risperidone. Perospirone at a dose of 10 mg/kg (p.o.) inhibited marble-burying behavior without affecting the locomotor activity in mice. On the other hand, haloperidol (0.1 mg/kg, i.p.) and risperidone (1 mg/kg, p.o.) showed significant suppression of locomotor activity at the dose that inhibited marble-burying behavior. Furthermore, the inhibition of marble-burying behavior by perospirone was antagonized by WAY100135 (10 mg/kg, i.p.), a selective 5-HT(1A)-receptor antagonist. WAY100135 at the same dose also antagonized the inhibition of marble-burying behavior by 8-OH-DPAT (3 mg/kg, i.p.), a selective 5-HT(1A)-receptor agonist. These findings suggest that perospirone may exhibit anti-OCD activity in clinical use and that 5-HT(1A)-receptor agonistic activity may be involved in the inhibition of marble-burying behavior by perospirone.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

Review of long-term results of stereotactic psychosurgery.

Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence Scale-Revised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild transient urinary incontinence. These long-term results indicate that stereotactic psychosurgery is a safe and effective method of treating some medically intractable psychiatric illnesses.

Brain↗

Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder.

Recent research has suggested that body dysmorphic disorder (BDD) is part of the obsessive-compulsive compulsive spectrum of disorders. As such, it has been hypothesized that these disorders respond in a similar manner to obsessive-compulsive disorder when behavioral interventions are used. A continuation of follow-up was conducted with a group of patients with BDD following treatment. Ten patients completed an intensive behavioral therapy program and either participated in a 6-month maintenance program or served as controls. At 12-, 18-, and 24-month follow-up assessments, patients participating in the maintenance program were more effective at managing limited symptom return and had significantly lower anxiety and depression. Both groups remained improved for acute symptomatology and behavioral avoidance. The results suggest that maintenance programs following behavioral treatment are effective in preventing symptom relapse and assist in patient self-management of lapses typically associated with BDD.

Adult↗

Cognitive behavioral therapy of childhood OCD.

Obsessive-compulsive disorder is a chronic, recurrent, and often disabling disorder in childhood. Comorbid emotional and behavioral disturbance and family dysfunction are common and can serve to complicate both course of illness and treatment outcome. Although traditional psychotherapies have not been shown to be effective for treating core OCD symptoms, controlled trials with adults have shown cognitive-behavioral approaches that include ERP to be highly effective in treating the disorder. The recent development and open evaluation of a handful of standardized and developmentally sensitive ERP-based treatment protocols for childhood OCD indicates that this treatment approach is similarly effective and well-tolerated in teh younger age group. These studies also suggest that adjunctive interventions including family involvement in treatment, anxiety management training, cognitive restructuring, contingency management, and supportive therapy may enhance the efficacy of ERP through the enhancement of treatment compliance and motivation. More study is needed to evaluate the best use of medication and CBT in children and adolescents.

Adolescent↗

The early course of the Tourette's syndrome clinical spectrum.

We retrospectively studied 101 children with Tourette's syndrome to characterize the early course of illness and associated behavioral disturbances of attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), disruptive behavior (DB), and school problems (SP). For patients without ADHD (45%), OCD (50%), DB (67%), or SP (52%) at the time of initial evaluation, 13% developed ADHD, 8% OCD, 28% DB, and 25% SP during the observation period of 1.6 +/- 1.3 years (range, 0.5 to 7 years). For patients with behavioral disturbances initially, the problems were controlled or resolved for many over time and with therapy: ADHD, 46%; OCD, 47%; DB, 50%; and SP, 67%. Medication changes, assessed after a drug adjustment period between the initial and first follow-up visits (6 +/- 6 months), showed that drug dosages remained largely unchanged and few patients required the addition of new drugs: tic suppressants, 10%; anti-obsessional agents, 5%; and stimulants, 12%. Tic suppressants were withdrawn from 12%.

Adolescent↗

Quinpirole induces compulsive checking behavior in rats: a potential animal model of obsessive-compulsive disorder (OCD).

Rats treated chronically with the dopamine agonist quinpirole (0.5 mg/kg, twice weekly x 10) met 5 criteria for performance of compulsive checking. Specifically, in a large open-field with single small objects in 4 of 25 locales, quinpirole rats revisited two places/objects excessively often and rapidly, compared with other locations in the environment or saline controls. They performed a ritual-like set of behavioral acts at these two places/objects and stopped in relatively few locales before returning to the preferred places/objects. Finally, they shifted their behavior to a new location when the object was moved there. Clomipramine (10 mg/kg, daily) postponed but did not prevent the development of the quinpirole effect. Quinpirole-induced compulsive checking may be an exaggeration of normal checking of home site in rats. Results suggest an animal model of obsessive-compulsive disorder and a role for dopamine in this disorder.

Animals↗

A cognitive theory of obsessions: elaborations.

The theory that obsessions are caused by catastrophic misinterpretations of one's intrusive thoughts/ images/impulses is elaborated in an attempt to explain the frequency of obsessions and why they persist. The internal and external provocations of obsessions are considered, and an explanatory framework for the varying contents of obsessions is set out. The role and functions of neutralization and inflated responsibility are assessed, and the treatment implications of the theory are described.

Cognition↗

Enhancement of excessive lever-pressing after post-training signal attenuation in rats by repeated administration of the D1 antagonist SCH 23390 or the D2 agonist quinpirole, but not the D1 agonist SKF 38393 or the D2 antagonist haloperidol.

The authors have recently shown that attenuation of an external response feedback leads to excessive lever-pressing that is not associated with attempts to collect reward, and they have suggested that this may be an analogue to "unreasonable" excessive behavior characteristic of obsessive-compulsive disorder. The present study shows that repeated administration of SCH 23390 or quinpirole, but not SKF 38393 or haloperidol, enhances this behavioral pattern. On the basis of data regarding the enduring effects of chronic treatment with dopaminergic agents, these results suggest that overstimulation of striatal D1 receptors underlies enhanced response to signal attenuation. These results may link the hypothesis that obsessions and compulsions result from a deficient response feedback mechanism with findings implicating dopaminergic abnormalities in the production of obsessions and compulsions.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗

Revision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions.

The Padua Inventory (PI), a self-report measure of obsessive and compulsive symptoms, is increasingly used in obsessive compulsive disorder (OCD) research. Freeston, Ladouceur, Rheaume, Letarte, Gagnon and Thibodeau (1994) [Behaviour Research and Therapy, 32, 29-36], however, recently showed that the PI measures worry in addition to obsessions. In an attempt to solve this measurement problem, this study used a content distinction between obsessions and worry to revise the PI. The revision was constructed to measure five content dimensions relevant to OCD i.e. (1) obsessional thoughts about harm to oneself or others; (2) obsessional impulses to harm oneself or others; (3) contamination obsessions and washing compulsions; (4) checking compulsions; and (5) dressing/grooming compulsions. A total of 5010 individuals participated in the study, 2970 individuals completing the PI and the Penn State Worry Questionnaire (PSWQ) and an additional 2040 individuals completing only the PI. The results provided support for the reliability and validity of the revision. In addition, the revision of the PI was more independent of worry, as measured by the PSWQ, than the original PI. Support was thus found for the validity of the content distinction between obsessions and worry. The importance of this content distinction is also discussed for the evaluation of other hypothesized distinctions between obsessions and worry.

Adult↗

Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy.

BACKGROUND: The present study examined a group of patients who have obsessive compulsive disorder (OCD) and certain comorbid personality disorders to provide data on types of clinical problems that complicate treatment. Data are presented on patient response to a comprehensive behavior therapy. METHOD: Forty-one consecutively referred, adult, nonpsychotic patients with OCD were evaluated independently by their attending psychiatrist and a consulting psychologist for presence of DSM-III-R personality disorder. Thirty-one of these patients, for whom there was 100% agreement on presence or absence of a comorbid personality disorder, participated in a course of comprehensive behavior therapy. OCD patients with comorbid personality disorder (OCD+PD) were compared with a group of OCD patients without comorbid personality disorder (nonPD OCD) on pretreatment and treatment-related variables. RESULTS: There was significantly high interrater reliability between psychiatrist and psychologist on diagnosis of personality disorder (p < .001). OCD+PD patients demonstrated poorer response to prior psychiatric treatments and greater psychosocial and psychiatric impairment at pretreatment than did nonPD OCD patients. The OCD+PD patients demonstrated a moderate response to comprehensive behavior therapy, but below that of nonPD OCD patients. OCD+PD patients were also rated as more difficult to treat, required more psychiatric hospitalizations during treatment, and were more likely to terminate behavior therapy prematurely than were nonPD OCD patients. CONCLUSION: In modest samples of OCD+PD patients (N = 26), and nonPD OCD patients (N = 5), this study found that OCD patients with personality disorder had greater psychopathology, fewer coping and living skills, and were more resistant to psychiatric treatment than the nonPD OCD patients. In addition, when treated with a comprehensive behavior therapy that focuses on other clinical problems in addition to the OCD symptoms, the OCD+PD patients had an enhanced response to treatment.

Activities of Daily Living↗

Self-injurious behavior and serotonin in Prader-Willi syndrome.

Low central nervous system (CNS) serotonin levels have been associated with impulsive, aggressive and self-injurious behavior (SIB). Persons with Prader-Willi Syndrome (PWS) often engage in self-injury by severe compulsive skin picking and gouging and often manifest compulsive eating, hoarding, and explosive outbursts. Some of the compulsive behaviors seen in patients with obsessive-compulsive disorder (OCD) bear similarity to behaviors associated with PWS: Skin picking, trichotillomania, and onychophagia (nail biting). There is abundant evidence that selective serotonin reuptake inhibitors (SSRIs) are effective in treating OCD. Three cases are described in which persons with PWS responded favorably to SSRI treatment. Two persons showed a significant decrease in skin picking. The third case showed a significant decrease in hoarding and explosive outbursts. Strategies are discussed for investigating the possibility of a shared neurochemical basis for the self-injurious, aggressive, and compulsive behaviors in persons with PWS. PWS may provide a relatively homogenous model for the study of skin picking and explosive outbursts among other populations.

Adult↗

Cognitive-behavioral and insight-oriented psychotherapy of an eleven-year-old boy with obsessive-compulsive disorder.

This article describes the use of combined cognitive-behavioral and insight-oriented psychotherapy with an 11-year-old boy who had severe obsessive-compulsive disorder of recent onset. Treatment was well accepted by the child and his parents and resulted in rapid relief of symptoms. At 12- and 18-month follow-ups this child was functioning well at home and in school.

Awareness↗