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PubMed2005

Tic disorders and obsessive compulsive disorder: where is the link?

Over the last years evidence on the overlap between tic-disorders (TD) and obsessive compulsive behavior/disorder (OCB/OCD) has increased. The main focus of research have been the phenomenological and epidemiological similarities and differences in samples of different age, primary diagnosis (TD vs. OCD) including the co-occurrence of both. Unfortunately, only a minority of studies included all three groups (TD, TD + OCD, OCD). Nevertheless, new insight concerning possible subtypes for both TD and OCD has been gained. While some authors concentrated on OCD with/without tics we will summarize the field of TD and OCB/OCD from the viewpoint of tics, since OCB plays an important role in patients with TD. Thereby we will not only sharpen the clinicans' awareness of known differences in phenomenology, epidemiology, genetics and neurobiology, aimed to improve their diagnoses and treatment but also highlight the gaps of knowledge and discuss possibilities for further research in this field.

Child↗
PubMed1987

Effects of yohimbine in obsessive compulsive disorder.

The alpha 2-adrenergic receptor antagonist yohimbine was administered to 12 drug-free patients with obsessive compulsive disorder (OCD) and to 12 healthy subjects. Changes in behavior, cardiovascular symptoms, and in plasma levels of cortisol and the norepinephrine metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), were assessed. Yohimbine had no significant effect on OCD symptoms. The OCD patients did not differ from healthy controls in their behavioral and MHPG response to yohimbine. In contrast to healthy subjects, OCD patients, like previous reports of depressed and panic disorders patients, had an increased cortisol response to yohimbine. These data suggest it is unlikely that abnormal noradrenergic function plays a primary role in the pathogenesis of OCD.

Adult↗
PubMed1994

Monoamine activity reflected in urine of young patients with obsessive compulsive disorder, psychosis with and without reality distortion and healthy subjects: an explorative analysis.

Positive psychotic symptoms are reported to be associated with high, negative symptoms with low dopamine (DA) activity and serotonin (5HT) activity may be altered in obsessive-compulsive disorder (OCD). We analysed 24 h urine samples in these patient groups and in healthy controls for supportive evidence. Young unmedicated OCD subjects excreted more adrenaline (AD) and homovanillic acid (HVA) and showed a higher HVA/MHPG ratio and metabolic rate than healthy controls. Independent of general metabolic rate they showed higher HVA concentrations which suggests that the relative activity of catecholamine systems in OCD (HVA/MHPG) is due more to high DA than to low noradrenergic (NA) activity. Concentrations of 5HT were also high in OCD patients. In psychotic patients low levels of DA, HVA, NA and MHPG probably resulted from neuroleptic medication. Patients diagnosed with paranoid psychosis showed higher DA utilization than controls and those with few paranoid symptoms showed high 5HT utilization. These results support studies suggesting that paranoid psychosis is associated more with increased DA activity (discussed in the context of neuroleptic reactivity), that non-paranoid forms are associated more with increased 5HT activity and that OCD patients are unusually aroused with high levels of Ad, 5HT and HVA.

Adolescent↗
PubMed1995

Obsessive-compulsive disorder in children and adolescents. A 6-22 year follow-up study of social outcome.

Twenty-eight adult males and 19 females with childhood obsessive-compulsive disorder (OCD) were followed-up in young adulthood, six to 22 years after their first referral, and their social outcome was described. The overall, social outcome was illustrated with The Global Assessment Scale (GAS). Ten patients (21.2%) had a poor outcome with GAS-scores under 50; 19 patients (40.4%) had a GAS-score between 50 and 70; and 18 (38.3%) of the patients had a good prognosis with GAS-scores over 70. Childhood OCD-patients were more socially isolated in adulthood than a non-OCD psychiatric comparison group and an age and sex standardised group from the normal population: more still lived with their parents, and fewer had partnerships. Seventeen percent had been granted disability pension, which was significantly different from the normal population, but not from that of the psychiatric comparison group. Age of onset of OCD, social background factors, and symptomatology in childhood did not seem to predict the social outcome. OCD at follow-up was strongly associated with a poor outcome.

Activities of Daily Living↗
PubMed2006

Obsessive-compulsive disorder as a disturbance of security motivation: constraints on comorbidity.

Patients with OCD often meet criteria for additional psychiatric disorders, with the incidence of comorbidity being as high as 75% in some studies. Here we examine the theoretical plausibility that in OCD much of the domain of co-morbid presentations encompasses related perturbations of the security motivation system. According to a recent proposal, the security motivation system represents a biologically primitive special motivation that is activated by potential (as opposed to imminent) danger to self or intimate others and engages a set of specialized species-typical behaviors (such as checking and washing) to handle potential danger. Because the task of security motivation is open ended, in the sense that no consummatory stimuli can exist in the real world to indicate the absence of potential danger, the shutdown of security motivation is produced by a self-generated feeling of knowing, a satiety signal termed yedasentience. In this schema, OCD results from a failure to generate or respond to the yedasentience signal: without this negative feedback the patient persists abnormally long in a strong motivational state having to do with primal, basic threats to existence, a condition that leads to prolonged engagement in security-related behaviors, such as the checking and washing, characteristic of OCD compulsions and obsessions. Considering the proposed neuronatomy of security motivation system and OCD, we discuss the likelihood that the phenomenon of "spread of allied reflexes" can produce other security-related psychiatric conditions, as well as the possibility that disturbances along different pathways of the security motivation system can lead to apparently different disorders.

Anxiety↗
PubMed2006

[The feeling of incompleteness. Rediscovery of an old psychopathological symptom of obsessive-compulsive disorder].

This paper describes clinically relevant aspects of incompleteness experiences in obsessive-compulsive disorder (OCD) (feelings of incompleteness concerning the self, "not just right" experiences and inability to achieve "closure" concerning actions/perceptions, compensatory urge to achieve "just right" feelings) and reviews empirical results and important research areas (frequency, association with symptom-based subtypes, motivational heterogeneity within subtypes, harm avoidance and incompleteness as basic OCD elements, sensation-based perfectionism, and relation to tic-related OCD and dissociative processes, especially depersonalisation/derealisation). Neurobiological explanations, biographical reconstruction, and treatment approaches are briefly summarised. It is emphasised that cognitive-behavioural methods tailored to OCD as an anxiety disorder must be modified considerably for the treatment of incompleteness-motivated OCD.

Adaptation, Psychological↗
PubMed2003

Effects of sertraline on kinematic aspects of hand movements in patients with obsessive-compulsive disorder.

RATIONALE: Movement disorders such as disturbances of fine motor co-ordination are a frequent phenomenon in patients with obsessive-compulsive disorder (OCD). OBJECTIVES: Our aim was to investigate changes of hand-motor dysfunction in OCD patients under the influence of 10-week treatment with sertraline and behaviour therapy. METHODS: We examined the performance of 40 patients satisfying DSM-IV criteria for OCD before and under this therapy using a digitising tablet and kinematic analysis of handwriting and drawing movements. Forty healthy controls were also tested (test-retest interval: 10 weeks). RESULTS: The speed of drawing was significantly lower in OCD patients than in controls (mean+/-standard deviation=197.03+/-113.26 mm/s for patients and 182.48+/-189.61 mm/s for controls; P=0.01). After 10 weeks of therapy, this parameter normalised in patients (from 197.03+/-113.26 mm/s to 163.66+/-101.92 mm/s; P=0.001). CONCLUSIONS: Hand-motor dysfunction (especially bradykinesia) improves with a serotonin-enhancing therapy in OCD patients.

Adult↗
PubMed2006

The signal attenuation rat model of obsessive-compulsive disorder: a review.

During the last 30 years, there have been many attempts to develop animal models of obsessive-compulsive disorder (OCD), in the hope that they may provide a route for furthering our understanding and treatment of this disorder. The present paper reviews a recently developed rat model of OCD, namely, signal attenuation. Results of pharmacological and lesion studies are presented and evaluated with respect to the pharmacology and pathophysiology of OCD. It is argued that signal attenuation is a rat model of OCD with construct (derived from similarity in the underlying mechanisms), predictive (derived from similarity in response to treatment), and face (derived from phenomenological similarity between "compulsive" behavior in the model and compulsions in OCD patients) validity.

Animals↗
PubMed2004

Clinical outcome in patients with obsessive-compulsive disorder after discontinuation of SRI treatment: results from a two-year follow-up.

BACKGROUND: Combined treatment with serotonin-reuptake inhibitors (SRI) and cognitive-behavioral therapy (CBT) is a common therapy approach for obsessive-compulsive disorder (OCD). However, it is a matter of debate whether discontinuation of SRI after combined treatment leads to relapse. METHOD: Seventy-four consecutively admitted patients suffering from OCD were included in the study. Thirty-seven patients were treated with CBT alone, and 37 patients received combined CBT and SRI treatment. Of these latter patients, seventeen discontinued SRI treatment during the follow-up period (1 and 2 years after inpatient treatment). OCD symptom severity was determined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and mood was assessed by Hamilton Depression Rating Scale (HDRS). RESULTS: During the initial treatment, scores for Y-BOCS (p < 0.001), HDRS (p < 0.001) and the Global Assessment of Functioning Scale (GAF) (p < 0.001) improved significantly in all groups. Reassessment two years later revealed that a) OCD symptom severity and depression scores were similar between the groups and b) discontinuation of SRI did not prompt by a recurrence of symptoms. CONCLUSIONS: We interpret our results as suggesting that discontinuation of SRI treatment may be considered in formerly combined treated OCD patients after stable remission.

Adult↗
PubMed2004

Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial.

Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder (OCD) who have received adequate treatment are rare. In the current study, 30 of 37 inpatients (81%) with severe OCD were followed up 6-8 years after treatment with cognitive-behavioral therapy (CBT) in combination with either fluvoxamine or placebo in a randomized design. The significant improvements (with large effectsizes) in obsessive-compulsive symptoms from pre- to post-treatment (41% reduction on the Y-BOCS) remained stable at follow-up (45 %). Responder rates, defined as > or = 35% reduction on the Y-BOCS, were 67% and 60%, respectively. Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up. Re-hospitalization, which occurred in 11 patients (37 %), was associated with more severe depressive symptoms at pre-treatment and living without a partner. Full symptom remission at follow-up, defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD, was achieved by 8 patients (27 %). Patients without full remission at follow-up had a significantly longer history of OCD, assessed at pretreatment, compared to remitted patients. The shortterm treatment outcome had no predictive value for the long-term course. Throughout the naturalistic follow-up, nearly all patients (29 patients) received additional psychotherapy and/or medication. This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods.

Adult↗
PubMed2005

Insight and alexithymia in adult outpatients with obsessive-compulsive disorder.

OBJECTIVE: To elucidate the relationships between insight and alexithymia in a sample of adult outpatients with obsessive-compulsive disorder (OCD). METHODS: 112 adult outpatients with OCD were tested. Severity of OCD was assessed with the first 10-items of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and score for item # 11 on the Y-BOCS was considered as a measure of insight. Alexithymia was measured with 20-item Toronto Alexithymia Scale (TAS-20). Additional measures were Maudsley Hospital Obsessive Compulsive Inventory (MOCI) and Montgomery Asberg Depression Rating Scale (MADRS). RESULTS: Of the patients, 29.5% showed poor or no insight. Patients with poor or no insight were more alexithymic than patients with excellent, good and moderate insight. TAS-20 total score and subfactors positively correlated with score for item # 11 on the Y-BOCS, severity of OCD and MADRS scores. In stepwise regression model, MADRS scores, factor 3 of TAS-20 (Externally Oriented Thinking), somatic and hoarding-saving obsessions were significantly associated with lower insight. CONCLUSIONS: Results show a relationship between poor or absent insight and high alexithymia levels in OCD patients.

Adult↗
PubMed2004

Transmission disequilibrium studies in children and adolescents with obsessive-compulsive disorders pertaining to polymorphisms of genes of the serotonergic pathway.

Pharmacological and challenge study data showed an involvement of the serotonergic system in the development of obsessive-compulsive disorder (OCD). We studied transmission disequilibrium of polymorphisms in three candidate genes of the serotonergic pathway in 64 trios comprising patients with early onset OCD and both of their parents. Polymorphisms of the following genes were studied: tryptophan hydroxylase 1 (rs1800532), serotonin transporter (polymorphism in the promoter region; 5-HTTLPR) and the serotonin 1 B receptor (rs6296). This is, to our knowledge, one of the first family based association studies pertaining to children and adolescents with OCD. We did not detect transmission disequilibrium of the investigated polymorphisms in OCD. Hence, these polymorphisms do not play a major role in the genetic predisposition to early onset OCD.

Adolescent↗
PubMed2000

Obsessive-complusive disorder: pharmacological treatment.

Obsessive-compulsive disorder (OCD) in children and adolescents is often a disabling condition, which demands treatment with medication. Research shows that serotonin is involved in the disorder and empirical treatment studies show that antidepressants with serotonin activity are effective. The first choice of treatment in the psychopharmacological approach to OCD in children and adolescents are the SSRI agents, which have been documented as being effective as well as well-tolerated in children and adolescents. The best-documented SSRI to this point is sertraline. However, fluoxetine and fluoxamine have also undergone systematic studies in children and adolescents. Clomipramine has been proven effective, however, side effects caused by this agent would suggest that an SSRI is a better choice. Treatment with an SSRI seems to have effect in approximately 75 % of patients with OCD. There are still no systematic studies analyzing augmenting medication for children and adolescents with OCD. Research indicates that the combination of medication and psychotherapy (cognitive behavioural therapy) is important in most cases. Based on a few long-term follow-up studies on OCD children and adolescents there is not evidence that all children and adolescents suffer a lifetime course of the disease. It is therefore recommended that discontinuation is attempted after 1-1.5 years of successful treatment.

Adolescent↗
PubMed2001

Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence.

The aim of the catch-up follow-up study is to describe the long-term outcome of obsessive-compulsive disorder (OCD) with onset in childhood and adolescence. The psychiatric morbidity in adulthood including personality disorders was assessed and predictors in childhood for the course of obsessive-compulsive symptoms were examined. The total study group consisted of the entire patient population treated for OCD at our departments for child and adolescent psychiatry between 1980 and 1991. We reassessed 55 patients personally by way of structured interviews. The mean age of onset of OCD was 12.5 years and the mean follow-up time was 11.2 years. At the follow-up investigation 71% of the patients met the criteria for some form of psychiatric disorder, while 36% were still suffering from OCD. Of the patients with a present diagnosis of OCD 70% had at least one further clinical disorder (especially anxiety and affective disorders). The most frequent personality disorders diagnosed were obsessive-compulsive (25.5%), avoidant (21.8%), and paranoid (12.7%) personality disorders. In-patient treatment, terminating treatment against advice and tics in childhood or adolescence significantly correlated with more severe OC symptoms in adulthood.

Adolescent↗
PubMed2007

Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder.

Children with Autism Spectrum Disorders (ASD) and children with Obsessive Compulsive Disorder (OCD) were compared on a range of repetitive behaviours. Parents reported similar levels of sameness behaviour and repetitive movements in the clinical groups, although children with OCD engaged in more repetitive behaviour focussed around routines and rituals. Children with OCD reported more compulsions and obsessions than children with ASD; both groups reported more compulsions and obsessions than a typically developing comparison group. Types of compulsions and obsessions tended to be less sophisticated in children with ASD than those with OCD. Sameness behaviour was more prevalent in younger children with OCD, but for children with ASD, age was not significantly related to sameness behaviour, repetitive movements, compulsions, or obsessions.

Autistic Disorder↗
PubMed2006

Understanding obsessive-compulsive disorder: focus on decision making.

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.

Brain↗
PubMed1993

Reality monitoring in obsessive-compulsive disorder.

Individuals with obsessive-compulsive disorder (OCD) often doubt whether they have performed an action or merely imagined having performed it. Such doubts suggest that OCD patients may have deficits in reality monitoring--the ability to distinguish memories of doing from memories of imagined doing. We compared the reality monitoring abilities of OCD checkers, OCD noncheckers and normal control Ss. Although we found no evidence of reality monitoring deficits in OCD patients, they tended to express less confidence in their memories relative to control Ss. These findings suggest that obsessional doubt may reflect deficits in memory confidence rather than deficits in memory per se.

Adult↗
PubMed1996

Symptom subtypes of obsessive-compulsive disorder in behavioral treatment studies: a quantitative review.

Recent reviews and meta-analytic studies have provided an encouraging account of the effectiveness of behavioral interventions for obsessive-compulsive disorder (OCD). One question regarding these estimates concerns their degree of generalizability to the range of OCD subtypes encountered in clinical settings. The purpose of the present study was to provide a quantitative description of the prevalence of various OCD subtypes (i.e. type of compulsions) within the behavioral treatment literature. We examined 65 studies that permitted classification of patients according to symptom subtype. Patients with primarily cleaning and/or checking compulsions predominated, accounting for 75% of the treatment population. On the other hand, patients with multiple compulsions or other compulsions, such as exactness, counting, hoarding, or slowness rituals were underrepresented, comprising only 12% of the population, which is markedly less than clinical epidemiological estimates. Rates of improvements in patients with OCD are most applicable to patients with cleaning and checking compulsions, but may not yet be generalizable to patients with other symptoms. These findings encourage studies of the efficacy of existing and novel interventions for patients with counting, repeating, symmetry, hoarding, or multiple compulsions in order to broaden the clinical application of OCD behavioral treatment.

Behavior Therapy↗