Response of phobic disorders with obsessive symptoms to MAO inhibitors.
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OBJECTIVE: To report cases of manic-like behavior induced by fluvoxamine, a selective serotonin-reuptake inhibitor; to review pertinent literature; and to encourage replication of our findings in larger patient samples. DESIGN: Description of a case series of fluvoxamine-induced, manic-like behavior. PATIENTS: Eight patients with depression or obsessive features who developed manic-like behavior after initiation of fluvoxamine therapy. RESULTS: Manic symptomatology resolved in all eight patients following dosage reduction or withdrawal of fluvoxamine. Four patients still are maintained on low-dose fluvoxamine without recurrent manic symptoms. CONCLUSIONS: Our case series suggests that fluvoxamine may have the ability to induce or unmask manic behavior in depressed patients. Clinicians are alerted to monitor for this "switching" effect, especially in patients previously or currently treated with neuroleptics or lithium, and in those patients exhibiting characteristics of obsessive-compulsive disorder.
To evaluate the role of serotonin (5-HT) function in obsessive-compulsive disorder (OCD), behavioral and biochemical responses to the 5-HT receptor agonist m-chlorophenylpiperazine (MCPP) and the 5-HT precursor tryptophan were examined in healthy subjects and patients with OCD. Baseline prolactin levels and the prolactin rise following MCPP were significantly reduced in female patients compared with female healthy subjects. In contrast, the increase in prolactin level following tryptophan administration was not significantly different between male or female patients with OCD and the respective sex-matched healthy subjects. The prolactin responses to MCPP and tryptophan were both significantly higher in female patients and healthy subjects than in their male counterparts. The cortisol and growth hormone responses to MCPP and tryptophan were similar in the patients and healthy subjects and were not related to gender. The behavioral responses to MCPP or tryptophan were not consistently different between patients and healthy subjects, and neither MCPP nor tryptophan had effects on obsessive or compulsive symptoms. These results lend only partial support to the hypothesis that 5-HT dysfunction may be linked to the pathophysiology of OCD and point to the need for the evaluation of other neurotransmitter systems in future investigations of OCD.
The results of this study support the notion that pathological gamblers drawn from the community would score higher on all three scores from the YBOCS than light gamblers. Consistent with hypotheses, pathological gamblers (lottery and scratch ticket) reported more obsessions, compulsions, and avoidance behavior than the light gamblers, and also reported having more urges to engage in injurious behaviors to themselves and others. These findings provide evidence that pathological gambling falls in a spectrum or family of disorders which have obsessive-compulsive disorder at its core. These findings support McElroy, Hudson, Philips, et al.'s (1993) suggestions of similarities between OCD and Impulse Control Disorders, and extend Blaszczynski (1999) findings of overlap between pathological gamblers and OCD in a treatment population. Heavy gamblers also reported significantly more hoarding symptoms and compulsive buying than light gamblers. More research in this area may show further evidence of a spectrum of disorders with obsessive compulsive disorder at its core, and show further links between impulse control disorders (such as pathological gambling) and OCD.
The two studies presented in this paper investigated the impact of controllable versus uncontrollable stressful life events (SLE) and low versus high thought suppression upon symptoms of obsessive-compulsive disorder (OCD) in both a non-clinical sample (Study 1) and a clinical sample (Study 2). The sample for Study 1 consisted of 269 undergraduate university students and the sample for Study 2 consisted of 91 participants obtained from the Obsessive Compulsive and Anxiety Disorders Foundation of Victoria, Australia. Participants in both studies were given identical questionnaires measuring anxiety, depression, thought suppression, OCD, and, the control, magnitude and number of SLEs suffered during the previous 18 months. In both studies, analysis of covariance (ANCOVA) followed by post hoc tests indicated that high OCD scores were associated with high thought suppression and low perceived control over high magnitude stressful life events relative to controls. The results suggest that high thought suppression coupled with low control over stressful life events may interact with other predisposing factors, such as genetic vulnerability to produce OCD symptoms.
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Three cases of Gilles de la Tourette's syndrome (GTS) who experienced different tic related behaviours in response to both external and internal stimuli are described. Such behaviours might represent sensory tics, reflex motor tics, exaggerated startle responses, or obsessive compulsive behaviours. It is suggested that there is a continuum of stimulus induced behaviours, and that, in some cases, separations into individual descriptive entities may be difficult. There also seems to be a continuum between internal and external phenomena that induce the behaviours. Implications for the relation between GTS and obsessive compulsive disorder are also discussed.
The obsessive syndrome after an organic brain damage. The evolution of an obsessive syndrome which appeared after a vascular insult in the anterior parts of dominant hemisphere has been followed-up. The conclusion was that the disturbed cingular-dominant frontal connections might play an important role in the genesis of obsession.
BACKGROUND: We describe the demographic characteristics, hoarding phenomenology, comorbid disorders, family histories, and treatment response of 20 adult obsessive-compulsive disorder (OCD) patients exhibiting hoarding behavior. METHOD: We utilized the Structured Clinical Interview for DSM-III-R, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview to gather data. RESULTS: We studied 9 women and 11 men. Their hoarding began from age 5 years to age 46 years (mean +/- SD age at onset = 20 +/- 11 years); hoarding was evident before the onset of other OCD symptoms in 9 patients. The most commonly hoarded items were newspapers and magazines, junk mail, old clothes, notes or lists, and old receipts. Hoarded material occupied from one room plus most or all closets to more than one room plus all closets, the garage, and yard. Seven patients rented additional storage space for hoarded items. Eighty-four percent of patients reported a family history of hoarding, and 80% grew up in a household where someone else hoarded. The most frequent primary motives for hoarding were fears of discarding something useful and discarding something that would be needed in the future. Lifetime prevalence of major depression and of impulse-control disorders, especially compulsive shopping, were high; only 3 patients met DSM-IV criteria for obsessive-compulsive personality disorder. Response of hoarding to selective serotonin reuptake inhibitors was less robust than is expected for obsessive-compulsive disorder. CONCLUSION: Whether hoarding behaviors mark a subset of obsessive-compulsive disorder patients with a different pathophysiology or functional anatomy deserves investigation.
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Previous research by Rachman and de Silva (1978, Behaviour Research and Therapy, 16, 233-248) and by Salkovskis and Harrison (1984, Behaviour Research and Therapy, 22, 549-552) has shown that abnormal and normal obsessions are similar in content. The present study examined whether the same is true for abnormal and normal rituals. A sample of normal subjects (N = 150) were asked about their idiosyncratic rituals. A majority of them (54.7%) indicated that they had such rituals. While these rituals were less frequent, less intense, and less often associated with negative affect than the compulsions of a sample of patients with obsessive-compulsive disorder, differences in terms of content between normal and abnormal rituals were small. Experts often tended to misclassify abnormal compulsions as normal rituals. By and large, the present findings indicate that there is continuity between abnormal and normal compulsions.
Repetitive unpleasant thoughts and ritualized behaviors are the key features of obsessive-compulsive disorder (OCD). The classical neuroethological models of OCD rely largely on behavioral similarities between animal stereotypies and human compulsive rituals and are unable to account for the cognitive component of OCD. The cognitive symptoms of OCD need to be addressed in an evolutionary psychological context that incorporates information about human brain evolution. OCD can be understood as an extreme on a continuum of evolved harm-avoidance strategies. A pathological exaggeration of our evolved capacity to cognitively represent future scenarios, including imagined consequences of our own thoughts and actions (metarepresentation), may be part of the set of evolved psychological mechanisms contributing to the psychopathology of OCD. The costly side of the adaptive ability to anticipate future needs or threats could be that etiologically heterogeneous affections of the underlying striatal-frontal brain circuits may render an individual vulnerable to develop OCD.
BACKGROUND: Obsessive-compulsive behaviours are common and disabling in autistic-spectrum disorders (ASD) but little is known about how they compare with those experienced by people with obsessive-compulsive disorder (OCD). AIM: To make such a comparison. METHOD: A group of adults with high-functioning ASD (n=40) were administered the Yale-Brown Obsessive-Compulsive Scale and Symptom Checklist and their symptoms compared with a gender-matched group of adults with a primary diagnosis of OCD (n=45). OCD symptoms were carefully distinguished from stereotypic behaviours and interests usually displayed by those with ASD. RESULTS: The two groups had similar frequencies of obsessive-compulsive symptoms, with only somatic obsessions and repeating rituals being more common in the OCD group. The OCD group had higher obsessive-compulsive symptom severity ratings but up to 50% of the ASD group reported at least moderate levels of interference from their symptoms. CONCLUSIONS: Obsessions and compulsions are both common in adults with high-functioning ASD and are associated with significant levels of distress.
This paper reports on the treatment of a 14-year-old boy with severe obsessive-compulsive disorder. Baseline measures indicated that two checking behaviors were of extreme frequency. Personal discomfort was severe and parental ratings of anxiety and depression were high. Treatment employed an alternating design of response prevention and cognitive therapy. Parent and client ratings of levels of anxiety and depression were taken daily in addition to frequency levels of the compulsive behaviors. The treatment procedures over 24 sessions eliminated the compulsive behaviors and reduced self-reported anxiety. The study is unique in demonstrating that the cognitive therapy had a significant influence in diminishing the obsessive-compulsive behaviors.