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PubMed1993

Cues to obsessive-compulsive symptoms: relationships with other patient characteristics.

The waxing and waning of symptoms in obsessive-compulsive disorder (OCD) suggests that environmental cues may impact on exacerbations of this disorder. Eighty-one Ss with OCD completed the Cues Checklist (CCL; Mackenzie, Ristvedt, Christenson, Lebow & Mitchell, 1992), a 339-item checklist of rationally-derived cues and circumstances that might be expected to elicit or worsen symptoms. Principal components analysis revealed four components: household order and organization, contamination and cleaning, negative affect, and prevention of harm and checking. Total number of cues endorsed and component scores were correlated with other characteristics of the disorder, and with the presence of other Axis I and II disorders. Patterns of cue endorsement related to standard measures of obsessive-compulsive content but not to symptom severity. Early-onset Ss endorsed a greater number of cues. History of depression, anxiety disorders and Axis II pathology related most strongly to scores on the negative affect component. The values and limitations of this approach are discussed.

Adolescent↗
PubMed1993

Memory in sub-clinical obsessive-compulsive checkers.

In a series of experiments we extended the research on possible memory deficits in subclinical obsessive-compulsive Ss who reported excessive checking. Using a variety of memory tests we compared 20 subclinical checkers to 20 Ss without obsessive-compulsive symptomatology. Contrary to hypothesis, checkers remembered self-generated words better than read words just as much as did normals, but they were more likely than normals to report thinking they had studied words that, in fact, had not been on the study list. Further, they more often confused whether they read or generated the words at study. Checkers did not appear to perseverate on already-recalled words on repeated free recall tests any more than did normals. However, checkers remembered fewer actions overall and more often misremembered whether they had performed, observed, or written these actions. Such memory deficits may contribute to the development of excessive checking.

Adult↗
PubMed1993

Obsessions, responsibility and guilt.

Introduction of the concept of "inflated responsibility" into the so-called anatomy of obsessions gives rise to an elaborated analysis of obsessions, responsibility and guilt. The analysis touches on a range of phenomena including anger and guilt, control of thoughts, the fusion of thoughts and action, resistance to additional responsibility, procrastination and unfinished tasks, hypochondriasis, brief holidays. Some clinical implications are deduced from the analysis.

Anger↗
PubMed1995

The utilization of nonpatient samples in the study of obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is increasingly studied in nonpatients, primarily through the selection of individuals who score high on a self-report measure of OCD. The usefulness of this methodology for understanding OCD presupposes that some of the individuals in the high-scoring group meet diagnostic criteria for OCD, that the obsessive-compulsive behaviors in the high-scoring individuals are stable across time to a certain degree, and that the features associated with OCD in patients also are found in the high-scoring nonpatients. Two studies are reported which provide support for these three assumptions. Together the studies suggest that OCD can be productively examined by the selection of individuals who score high on a self-report measure of OCD. Cautions in the use of this methodology for the study of OCD are also noted.

Adult↗
PubMed1995

Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder.

The present study is the first controlled study that evaluates the effects of cognitive therapy along the lines of Beck (1976) [Cognitive therapy and the emotional disorder. New York: International University Press] and Salkovskis (1985) [Behaviour Research and Therapy, 23, 571-583] in obsessive compulsive disorder (OCD) and compares these effects with those of self-controlled exposure in vivo with response prevention. Seventy-one patients were randomly assigned to either cognitive therapy or exposure in vivo. In each treatment condition seven patients dropped out. Both treatments consisted of 16 sessions. Cognitive therapy as well as exposure in vivo led to statistically significant improvement. Multivariate significant differences suggesting a superior efficacy of cognitive therapy in comparison to exposure in vivo on the obsessive compulsive measures and on the measures for associated psychopathology. However, no univariate differences were found. Further, in both treatment conditions a considerable percentage of the patients was rated as "recovered". Significantly more patients were rated as "recovered" in the cognitive therapy. The results show that this form of cognitive therapy is an effective treatment for OCD and suggest that cognitive therapy may be even more effective than exposure in vivo.

Adult↗
PubMed1995

The usefulness of the Obsessive Compulsive Scale of the Symptom Checklist-90-Revised.

The reliability and validity of the SCL-90-R Obsessive Compulsive Scale were examined using a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). The OC scale proved to be internally consistent. Evidence for convergent validity was mixed, and the results suggest poor divergent and criterion-related validities. The scale demonstrated sensitivity to changes with behavioral treatment. Overall, the SCL-90-R proved to be a poor measure of OCD symptoms.

Adult↗
PubMed1994

Selective processing of emotional information in obsessive compulsive disorder.

Three possible explanations for attentional bias effects in anxious subjects have been formulated: the threat-relatedness hypothesis, the emotionality hypothesis and the concern-relatedness hypothesis. In order to investigate these three hypotheses, an experiment was carried out with 33 obsessive compulsive (OC) patients and 29 normal controls. Both groups colour-named a Stroop card with 5 word sets: neutral words and 4 emotional word sets (a 2 x 2 matrix of words, related/unrelated to obsessive compulsive disorder and positively/negatively valenced). In line with previous studies, OC patients selectively attended to negative OC-related cues; this supports the threat-relatedness hypothesis. Although the set-up of the experiment was similar to the Mathews and Klug (1993, Behaviour Research and Therapy, 31, 57-62) study, no evidence was found for the concern-relatedness hypothesis, i.e. the OC patients did not show an attentional bias for positive OC-related words. Two possible reasons for these contradicting findings are discussed.

Arousal↗
PubMed1994

Qualitative dimensions of normal worry and normal obsessions: a comparative study.

Despite the crucial role typically given to negative thoughts in cognitive conceptualizations of emotional problems, few studies have compared the characteristics of varieties of such thoughts. The present study compared the process features of naturally occurring worries and obsessions in a non-patient group. Analyses of variance revealed several significant differences between these types of thought. The relationship between worries and obsessions, and the clinical and conceptual importance of the observed differences is briefly discussed.

Adult↗
PubMed1996

The assessment of obsessive-compulsive phenomena: psychometric and normative data on the Padua Inventory from an Australian non-clinical student sample.

The Padua Inventory (PI) is a measure of obsessive-compulsive phenomena, which is used in clinical and research settings. One reason for the PI's growing acceptance is the emergence of a good deal of evidence supporting the adequacy of its reliability, convergent validity, and evidence supporting the stability of its factor structure. However, there have been some concerns about its discriminant validity. The use of the PI in Australia has been limited by the lack of local normative data and information about its psychometric properties. The cross-national validation of the PI has both theoretical and practical implications, and could add further evidence for its adequacy as a measure of obsessive-compulsive phenomena. Results from the present study found that the PI exhibited a similar but not identical factor structure compared to previous studies, consistently good reliability, adequate convergent validity, and differences in normative data compared with previous studies. Overall, while one may not necessarily assume the generalisability of normative data across different cultural contexts, there is a good deal of consistency in the psychometric properties of the PI. However, there is a need to further demonstrate the PI's discriminant validity, particularly for the "Urges and Worries" subscale.

Adolescent↗
PubMed1987

Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology.

The diagnosis, treatment, and pathophysiology of obsessive-compulsive disorder (OCD) were examined in a series of studies utilizing psychobiological approaches. Putative biological markers previously reported in depression were studied in this disorder and revealed that on some measures [Dexamethasone Suppression Test and rapid eye movement (REM) latency on sleep electroencephalogram (EEG)], OCD patients resemble those with major depressive disorder (MDD), whereas on others [REM density, platelet serotonin uptake, probably platelet 3H-imipramine binding, and 5-hydroxy-indoleacetic acid (5-HIAA) in cerebral spinal fluid (CSF)] they do not. The relationship between OCD and MDD was further explored in a double-blind, randomized crossover study designed to compare the antiobsessional effects of two tricyclic antidepressants, clomipramine (CMI) and desipramine (DMI), in a nondepressed cohort of OCD patients. CMI was found to have significant antiobsessional effects in this group, whereas in the same patients, DMI lacked therapeutic effects. These results suggest that not all antidepressants are antiobsessive and that some property of CMI, such as its potent serotonergic effects, may be of pathophysiological relevance for OCD. The role of serotonin in this disorder was then tested using the pharmacological challenge strategy. A novel serotonin postsynaptic receptor (5HT-1) agonist, m-chlorophenylpiperazine (m-CPP), was administered orally (0.5 mg/kg) under double-blind, placebo-controlled conditions to OCD patients and controls. In addition, a serotonergic receptor antagonist, metergoline (4 mg), was given to a subset of OCD patients. Relative to healthy volunteers, the OCD patients became significantly more anxious, depressed, and dysphoric after m-CPP administration. Moreover, in the OCD patients, obsessive-compulsive symptoms increased markedly after m-CPP and decreased significantly following metergoline administration. These results demonstrate that agents that bind to the 5HT-1 receptor can acutely affect the symptoms of OCD patients. The striking behavioral effects of these direct postsynaptic receptor ligands and the relative specificity of clomipramine as an antiobsessional agent suggest that serotonergic neurons may play a role in the pathophysiology, as well as mediating the pharmacological reduction, of obsessional symptoms.

Adult↗
PubMed1989

Deficit in cognitive shifting ability in patients with obsessive-compulsive disorder.

Reports on cognitive test deficits in patients with obsessive-compulsive disorders and interpretations of the underlying dysfunction have been conflicting. In the present study, 15 obsessive-compulsive patients were compared with 15 matched normal controls on three types of test sensitive to: spatial ability, ability to shift cognitive set, and combinations of both. Performance deficits as compared with controls were shown in Block Design, the Short Wisconsin Card Sort, the Word Fluency Test, and on the Money Road Map Test. No deficits were present on a number of other measures. The pattern of results is interpreted partly as revealing deficits in ability to shift cognitive set, more particularly with nonverbal material.

Adult↗
PubMed1995

m-Chlorophenylpiperazine in patients with obsessive-compulsive disorder: absence of symptom exacerbation.

Oral administration of the serotonin mixed agonist-antagonist meta-chlorophenylpiperazine (mCPP) at 0.5 mg/kg has been reported to exacerbate symptoms of obsessive-compulsive disorder (OCD). In an attempt to replicate these findings, double-blind behavioral and biochemical measures were obtained in 12 drug-free patients (9 men, 3 women) with OCD who received either oral mCPP (0.5 mg/kg), intravenous (IV) mCPP (0.1 mg/kg over 20 min), or placebo in random order on 3 separate test days. Neither oral nor IV mCPP had significant effects on the severity of OCD symptoms. The magnitude of the mCPP-induced plasma prolactin response and plasma mCPP levels were similar to those values obtained in other published studies in which mCPP exacerbated OCD symptoms. In contrast, both oral and IV mCPP were associated with significant increases in ratings of anxiety. These findings suggest that mCPP, whether administered by an oral or intravenous route (as a slow infusion), may not be a reliable probe for investigating obsessive-compulsive symptoms. It is possible, however, that more reproducible behavioral findings might be obtained by identifying susceptible subgroups of OCD or by including a behavioral exposure condition.

Administration, Oral↗
PubMed1996

Elevated cerebrospinal fluid corticotropin-releasing factor in Tourette's syndrome: comparison to obsessive compulsive disorder and normal controls.

Stress- and anxiety-related fluctuations in tic severity are cardinal features of Tourette's syndrome (TS), and there is evidence for involvement of noradrenergic mechanisms in the pathophysiology and treatment of the disorder. To examine further the pathobiology of this enhanced vulnerability to stress and anxiety, we measured central activity of corticotropin-releasing factor (CRF) in patients with TS and the related condition, obsessive compulsive disorder (OCD). Lumbar cerebrospinal fluid (CSF) was obtained in a standardized fashion for measurement of CRF from 21 medication-free outpatients with TS, 20 with OCD, and 29 healthy controls. The TS patients had significantly higher levels of CSF CRF than both the normal controls and the OCD patients. However, there was no difference in CSF CRF between the OCD patients and the normal controls. Group differences in CSF CRF were unrelated to current clinical ratings of depression, anxiety, tics, and obsessive compulsive behaviors. Although the functional significance of this finding remains to be elucidated, these results are consistent with the hypothesis that stress-related neurobiological mechanisms may play a role in the pathobiology of TS.

Adolescent↗
PubMed1996

Tryptophan depletion in obsessive-compulsive patients.

Twelve patients with obsessive-compulsive disorder were studied after the administration of a mixture of amino acids devoid of tryptophan (TRP) or a mixture containing all the essential amino acids, in a double-blind, crossover design. The TRP-free mixture caused a marked depletion of plasma TRP. After TRP decrease, mean ratings of obsessions and compulsions, measured by Visual Analogue Scales (VAS) ratings, did not worsen. In contrast with other reports in literature, TRP depletion also failed to alter mood in our subjects.

Adult↗
PubMedDate not supplied

Toward a new nosology of obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is receiving increasing attention in the clinical research literature. This review briefly summarizes data concerning diagnosis, phenomenology, and epidemiology of OCD and examines other disorders that closely resemble OCD. In addition, the nosological and treatment implications of these data are discussed. We find that OCD is characterized by a focal anxiety point(s) reflected in obsessions and by behavioral or cognitive compulsions. The appearance of these characteristics in other disorders suggests some relation between them and, consequently, the treatment of these disorders may be enhanced by conceptualizing them as OCD "variants".

Anxiety Disorders↗
PubMedDate not supplied

Correlates of DSM-III personality disorder in obsessive-compulsive disorder.

Forty-three patients with primary obsessive-compulsive disorder (OCD) completed the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess axis II personality disorders (PD) from DSM-III. Results showed that 53% of the patients received at least one PD diagnosis. The most frequent diagnoses were avoidant (30%), histrionic (26%), dependent (19%), and schizotypal (16%). Consideration of the personality traits irrespective of diagnostic category showed that in addition to avoidant and dependent personality characteristics, the sample had strong passive aggressive and compulsive tendencies and substantial histrionic, paranoid, and schizotypal traits. Patients exhibiting a greater number of personality traits were also significantly more symptomatic. However, anxiety, phobic, and obsessive-compulsive symptoms were not selected as unique predictors of any personality variables in the regression analyses. Rather, the most important correlate of PD in these patients consisted of dysphoric mood as assessed by the Beck Depression Inventory (BDI) and, to a lesser degree, younger age or shorter duration of illness. These findings do not support a specific link between OCD and PD in general and compulsive PD in particular.

Adult↗
PubMedDate not supplied

Schizotypal features in obsessive-compulsive disorder.

This study examined the prevalence and nature of schizotypal features in obsessive-compulsive disorder (OCD). Although this symptom pattern has been related retrospectively to treatment resistance, no prospective data have addressed such an hypothesis. This study sets the stage for further work in this arena by prospectively identifying and characterizing a schizotypal subset of OCD patients. Twenty-eight percent of the sample had schizotypal features, although only 8% met criteria for schizotypal personality disorder. Social-evaluative concerns and psychotic-like symptoms characterized this subgroup. Schizotypal patients did not differ from nonschizotypes with regard to anxiety, depressive, or obsessive-compulsive symptoms.

Adolescent↗
PubMedDate not supplied

Evaluation of the reported association of obsessive-compulsive symptoms or disorder with Tourette's disorder.

This review evaluates the evidence reporting an association of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) with Tourette's syndrome or disorder (TS). Published reports in the literature describing a relationship between OCS-OCD and TS provided the data for the review. The methodological adequacy of the studies are discussed and rated on five criteria: adequacy of the experimental sample, presence and adequacy of the control sample, whether tics are defined as OCS-OCD, whether blind procedures are used to diagnose OCS-OCD in subjects and controls, and evidence for the reliability and validity of OCS-OCD measures. Although there are considerable clinical indications suggesting an association of OCS-OCD with TS and chronic motor tic disorder (CMT), and a possible overlap between OSC-OCD and TS, our evaluation of the evidence does not provide adequate support for an association between these disorders. To meaningfully evaluate the possible relationship between OCS-OCD and TS requires development of specific criteria for classification of OCS-OCD-TS symptoms, use of adequate experimental and control samples, blind evaluation, reliable and valid measures of OCS-OCD-TS, and appropriate statistical analysis. If such studies are performed, it is possible that the strong relationship reported between OCS-OCD and TS is more likely to be artifact than fact, and recent bandwagon effect rather than the latest breakthrough.

Diagnosis, Differential↗