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PubMed2004

Speed and accuracy on tests of executive function in obsessive-compulsive disorder.

Slowness in obsessive-compulsive disorder (OCD) has been attributed to intrusive thoughts or meticulousness. Recent research suggests that slowness in OCD may be particularly evident on tests of executive function subserved by frontostriatal circuitry. In the present study, the speed and accuracy of responding on neuropsychological tests of executive functions and psychomotor speed were investigated in 27 non-depressed, unmedicated adults with OCD and 27 healthy controls. The only group difference was that patients took significantly longer to copy a complex geometric design than controls. This finding was unrelated to residual depression or overall OCD symptom severity. Results suggest that slowness in OCD may be most apparent on executive tests requiring self-initiated organizational strategies, consistent with frontostriatal abnormality.

Adult↗
PubMed2005

Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study.

BACKGROUND: Functional neuroimaging studies have implicated hyperactivity of the frontal cortex in obsessive-compulsive disorder (OCD); however, relationships between abnormal brain activity, clinical improvement, and neuropsychological function have not been clarified in OCD. To clarify the pathophysiology of this disorder, regional changes in brain function were examined during administration of cognitive and symptom provocation tasks in patients with OCD before and after treatment. METHODS: Ten outpatients with OCD participated in the study. Functional magnetic resonance imaging (fMRI) was performed before and after treatment. Stroop and symptom provocation tasks were administered during fMRI. Each patient was randomly allocated to receive either pharmacotherapy with fluvoxamine 200 mg/day (n = 4) or behavior therapy (n = 6) for 12 weeks. RESULTS: After 12-week treatment, mean (+/- SD) total score on the Yale-Brown Obsessive-Compulsive Scale decreased from 29.00 +/- 3.59 to 14.60 +/- 9.22, representing symptomatic improvement from moderate to mild. After symptom improvement, symptom provocation-related activation in the orbitofrontal, dorsolateral-prefrontal, and anterior cingulate cortices decreased. Conversely, Stroop task-related activation in the parietal cortex and cerebellum increased. CONCLUSIONS: After improvement of OCD with either fluvoxamine or behavioral therapy, hyperactivation of the frontal lobe related to a symptom-provocative state decreases, and posterior brain activity related to action-monitoring function increases.

Antidepressive Agents, Second-Generation↗
PubMed2006

Prenatal, perinatal, and postnatal risk factors in obsessive-compulsive disorder.

BACKGROUND: The etiology of obsessive-compulsive disorder (OCD) remains unknown, although it is thought to involve an interaction of genetic and environmental factors. This study aimed to identify prenatal, perinatal, and postnatal risk factors in OCD. METHODS: We compared retrospectively 68 OCD patients to 70 control subjects based on responses given on a standardized questionnaire. The questionnaire was designed to evaluate environmental factors, with a special focus on gestation, labor, birth, and early infancy aspects. RESULTS: The group of OCD patients had risk factors with greater frequency than the control group. Notable among the significant findings (p < or = 0.001) were edema of the hands, feet, or face and excessive weight gain during gestation; hyperemesis gravidarum; prolonged labor; preterm birth; and jaundice. When socioeconomic class was used as a covariable in the logistic regression analysis, prolonged labor and edema during pregnancy remained statistically significant. CONCLUSIONS: Some early risk factors may be associated with the expression of OCD later in life such as edema during pregnancy and prolonged labor. If our findings are confirmed in future studies, greater attention should be given to such factors in predisposed individuals, especially in prenatal care and delivery.

Adolescent↗
PubMed2004

Neuropsychological performance in obsessive-compulsive disorder: a critical review.

There is growing evidence for neuropsychological dysfunction in obsessive-compulsive disorder (OCD) related to an underlying frontal lobe and/or basal ganglia dysfunction. The following paper is a systematical review of the existing literature on cognitive impairment in OCD patients. Fifty studies were surveyed with regard to methodological aspects and cognitive impairments found in OCD patients. In addition, the impact of confounding variables such as psychotropic medication, co-morbidity or severity of symptoms on neuropsychological functioning as well as effects of treatment are discussed. OCD is often related to memory dysfunction that seems to be associated with impaired organization of information at the stage of encoding. Several other executive functions are also commonly disturbed, though results are inconsistent. The results of our study suggest that some cognitive deficits seem to be common in OCD, but future studies should focus more on possible confounding variables such as co-morbidity or psychotropic medication.

Attention↗
PubMed2006

Spontaneous magnetoencephalographic activity in patients with obsessive-compulsive disorder.

Non-invasive functional imaging techniques have begun to delineate the underlying neurophysiological basis of obsessive-compulsive disorder (OCD). In the present study, we investigated slow (2-6 Hz) and fast (12.5-30 Hz) spontaneous magnetoencephalographic (MEG) activity in ten patients with obsessive-compulsive disorders compared to ten healthy control subjects. Fast MEG activity was significantly elevated in OCD patients. The corresponding dipole density maxima were concentrated on the left superior temporal gyrus. Although no differences were detected in the absolute dipole numbers between controls and OCD patients regarding slow MEG activity, only the latter showed a clustering of slow MEG activity over their left dorsolateral prefrontal cortex. We conclude that alterations of spontaneous MEG activity in prefrontal and temporal cortices may be linked to the pathogenesis of OCD. Therefore, we provide further functional neuroimaging evidence that the complex features of OCD have neural correlates, which may help in a future understanding of this disease.

Adult↗
PubMed2004

The relationship between miscellaneous symptoms and major symptom factors in obsessive-compulsive disorder.

The diverse symptomatology of obsessive-compulsive disorder (OCD) is being increasingly regarded as reducible to a few symptom dimensions. However, prevailing factor-analytically derived models of symptom structure omit a number of the well-recognized "miscellaneous" symptoms of OCD. This study sought to determine whether miscellaneous OCD symptoms, ascertained by the Yale-Brown Obsessive-Compulsive Scale symptom checklist, could be differentially and reliably predicted by four symptom factors (obsessions and checking, symmetry and ordering, contamination and cleaning, and hoarding) in two independent groups of individuals with OCD (n=381 and n=107). Logistic regression analyses were used to determine the association of each of the miscellaneous symptoms with the symptom factors; then a single confirmatory factor analysis was conducted to test the model of associations in the smaller sample. Sixteen (89%) of the 18 symptoms examined were reliably predicted by one (11 items) or two (5 items) of the factors, with obsessions and checking and symmetry and ordering emerging as foremost predictors. The expanded four-factor model showed good fit with data from the second sample. Results are conceptually meaningful, but suggest the inadequacy of groupings based solely upon overt behaviors. These findings may aid clinical understanding of OCD and be of value to studies using symptom factors to guide investigation of its causes and correlates.

Adult↗
PubMed2005

Not just right experiences and obsessive-compulsive features: experimental and self-monitoring perspectives.

Individuals with obsessive-compulsive disorder (OCD) often report compulsions aimed at reducing feelings of something not being just right or sensations of incompleteness. Research using self-report questionnaires has demonstrated a link between not just right experiences (NJREs) and OCD symptoms (Behav. Res. Therapy 41 (2003) 681; Anxiety, 1 (1995) 208). Extending previous work, this paper presents experimental and self-monitoring data on NJREs in an undergraduate sample. NJREs produced distress and urges to change something, but feared consequences were rare. Stronger responses were found for naturally occurring self-monitored NJREs compared to NJREs elicited in the laboratory. Several significant relationships were found between features of NJREs and OC symptoms and constructs theoretically related to OCD (e.g., responsibility, incompleteness), but no significant relationships were found between features of NJREs and non-OCD-related constructs (worry, depressive symptoms, social anxiety). Further consideration of NJREs will be useful in improving our understanding of the phenomenology, neurobiological substrates, and treatment, of OCD.

Adolescent↗
PubMed2005

Dysfunctional belief-based obsessive-compulsive disorder subgroups.

An attempt was made to identify obsessive-compulsive disorder (OCD) subgroups based on differences in OCD related beliefs. OCD patients (N=367) were assessed with the Obsessional-Beliefs Questionnaire prior to treatment. Individuals' scores on measures of inflated personal responsibility and the tendency to overestimate threat, perfectionism and intolerance of uncertainty, and over-importance and over-control of thoughts were subjected to cluster analysis. Support for both a simple and complex subgroup model was found (2-subgroup and 5-subgroup taxonomies). A low-beliefs subgroup was identified in both taxonomies. The low-beliefs subgroups reported scores on belief measures equivalent to scores reported for non-OCD comparison groups in earlier studies. Additional analyses were conducted to determine relations between belief-based and symptom subgroups. Significant relationships were found (e.g., Symmetry symptom subgroup membership was associated with membership in the Perfectionism/Certainty beliefs subgroup), although the shared variance was modest. Implications for understanding OCD heterogeneity and for cognitive theory are discussed.

Adult↗
PubMed2006

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.

Adult↗
PubMed2006

An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics.

UNLABELLED: The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive-compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. METHODS: A total of 28 youngsters, aged 8-17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. RESULTS: Twenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. CONCLUSION: The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.

Adolescent↗
PubMed2006

Clinical features associated with treatment response in obsessive-compulsive disorder.

OBJECTIVE: This study aims to investigate the effect of sociodemographic and clinical features on the short-term response to pharmacological treatment in obsessive-compulsive disorder (OCD). We focused especially on investigating factors previously associated with poorer prognosis, such as comorbidity with tic disorders, early onset of symptoms, and sensory phenomena preceding compulsions, which have been described as common in both tic-related and early-onset OCD. METHOD: The study involved 41 consecutive adult patients with OCD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and was conducted at the OCD Spectrum Disorders Clinic of the University of Sao Paulo School of Medicine in São Paulo, Brazil, between January of 2000 and December of 2001. All patients were treated exclusively with oral clomipramine for 14 weeks. Treatment response, measured for Yale-Brown Obsessive-Compulsive Scale score decrease from baseline, was assessed by an investigator blinded as to the variables of interest present. RESULTS: Linear regression analysis showed that having a partner and sensory phenomena preceding compulsions were associated with better response to clomipramine treatment (P = .04 and P = .002, respectively). Tic comorbidity and early onset of symptoms were not associated with poorer response. CONCLUSIONS: In OCD, having a partner and sensory phenomena preceding compulsions seem to be associated with a favorable response to pharmacological treatment.

Adult↗
PubMed2004

A critical evaluation of obsessive-compulsive disorder subtypes: symptoms versus mechanisms.

Recently, experts have suggested that obsessive-compulsive disorder (OCD), a highly heterogeneous condition, is actually composed of distinct subtypes. Research to identify specific subtypes of OCD has focused primarily on symptom presentation. Subtype models have been proposed using factor analyses that yield dimensional systems of symptom categories, but not necessarily distinct subtypes. Other empirical work has considered the role of neuropsychological functioning and comorbidity as part of a comprehensive scheme for subtyping OCD. The identified dimensions from all of these studies have implications for the treatment of OCD. In this article, we review the research on subtypes of OCD, focusing on subtype schemes based upon overt symptom presentation and neuropsychological profiles. We also review research pertinent to alternative subtyping schemes, both conceptually and methodologically. The research is critically examined and implications for treatment are discussed. Recommendations for future investigations are offered.

Diagnosis, Differential↗
PubMed2005

Do personality disorders predict negative treatment outcome in obsessive-compulsive disorders? A prospective 6-month follow-up study.

BACKGROUND: Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive-compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD. METHOD: The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission. RESULTS: A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive-aggressive) were baseline determinants for later treatment failure at trend level. CONCLUSIONS: Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Adolescent↗
PubMed2005

Self-help with minimal therapist contact for obsessive-compulsive disorder: a review.

Though there are effective psychological and drug treatments for obsessive-compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.

Bibliotherapy↗
PubMed2007

Impaired response inhibition in obsessive compulsive disorder.

OBJECTIVE: The present study investigates different three inhibitory control functions in patients with obsessive-compulsive disorder (OCD). Selective motor response inhibition was tested in a GO/NO-GO paradigm, the inhibition of a triggered motor response in a STOP paradigm and the ability to inhibit cognitive interference in a motor STROOP paradigm. METHODS: 27 patients who met DSM-IV criteria for OCD and 25 age, handedness and IQ-matched healthy control subjects were tested in the GO/NO-GO, STOP and motor STROOP tasks. RESULTS: OCD patients performed significantly worse than controls in the selective inhibition of their motor responses (GO/NO-GO) and in the inhibition of cognitive interference (STROOP), and also showed worse performance in suppressing previously triggered motor responses (STOP). CONCLUSION: Patients with OCD are impaired in motor and cognitive inhibitory mechanisms. The findings are consistent with psychobiological and neuropsychological models of OCD suggesting impairment of frontostriatal circuitries that mediate functions of inhibitory control.

Adult↗
PubMed2006

A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder.

Intolerance of uncertainty has been defined as the unwillingness to tolerate the possibility that negative events may occur in the future, no matter how low the probability [Personality Individual Differences 17 (1994), 791-802]. Previous research suggests that intolerance of uncertainty may be more specific to worry and generalized anxiety disorder (GAD) than to other anxiety disorders [e.g., Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in the etiology and maintenance of generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143-163). New York: Guilford Press]. However, Tolin et al. [J. Anxiety Disorders 17 (2003), 233-242] argued that intolerance of uncertainty may also play a central role in obsessive-compulsive disorder (OCD). Therefore, the current study compared intolerance of uncertainty in individuals with analogue GAD and/or OCD. Intolerance of uncertainty was strongly related to pathological worry, GAD symptoms, and OCD symptoms; however, neither worry nor GAD was found to be more strongly associated with intolerance of uncertainty than OCD. Further, individuals with analogue GAD or OCD reported more intolerance of uncertainty than controls, but they did not differ significantly from each other. These findings suggest that intolerance of uncertainty may be a central theme in a number of the anxiety disorders.

Adaptation, Psychological↗
PubMed2005

Differentiation of obsessive-compulsive-, panic-, obsessive-compulsive personality-, and non-disordered individuals by variation in the promoter region of the serotonin transporter gene.

Past research investigating the role of the serotonin transporter gene in OCD has produced mixed findings. One possible reason for the mixed findings is comorbidity. In this study, non-comorbid OCD individuals were compared to non-disordered controls. A sample of panic disordered individuals was also compared to a non-disordered group. Finally, as an exploratory analysis, individuals were assessed for OCPD and their allelic frequencies were also compared to non-disordered individuals. Analyses revealed that there were higher frequencies of the s/s genotype among the OCD group when compared to non-disordered controls. There were no differences in allelic frequencies on the serotonin transporter gene between the panic disordered group, the OCPD group, and the non-disordered control group. This study found that non-comorbid OCD individuals tended to have a higher percentage of the homozygous short genotype than non-disordered individuals. The s/s genotype might serve as a contributory risk factor for OCD.

Adult↗
PubMed2006

The OCI-R: validation of the subscales in a clinical sample.

The psychometric properties of the Obsessive-Compulsive Inventory-Revised (OCI-R) subscales have not been validated in a clinical sample of individuals diagnosed with obsessive-compulsive disorder (OCD). Data were collected on 186 patients diagnosed with OCD and 17 patients diagnosed with generalized anxiety disorder (GAD) using the OCI-R and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Confirmatory factor analysis revealed an acceptable factor structure. Patients with a given primary symptom subtype were elevated on the corresponding subscale of the OCI-R compared to other OCD patients and patients with GAD. In addition, patients who acknowledged that symptom subtype as present but not primary on the Y-BOCS had elevated OCI-R scores on that scale compared to patients who did not endorse that symptom subtype and patients with GAD. Results indicate that the subscales of the OCI-R are valid measures of six symptom subtypes of OCD. The OCI-R is a psychometrically sound, brief instrument. The current data combined with previous efforts suggest that it is appropriate for clinical and non-clinical populations, and for clinical and research purposes. Further research should examine the sensitivity of the specific subscales to treatment effects, and the potential for adding more items to account for other symptom domains of OCD.

Adult↗