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PubMed1987

Psychiatric manifestations of homocystinuria due to cystathionine beta-synthase deficiency: prevalence, natural history, and relationship to neurologic impairment and vitamin B6-responsiveness.

Homocystinuria commonly affects the central nervous system (CNS), primarily as mental retardation, seizures, and stroke. Case reports have long suggested a predisposition to schizophrenia, but no careful study of predisposition to psychiatric illness has been performed. Accordingly, we evaluated 63 persons with homocystinuria due to cystathionine beta-synthase deficiency for psychiatric disturbance, intelligence, evidence of other CNS problems, and responsiveness to vitamin B6. The overall rate of clinically significant psychiatric disorders was 51%, predominated by four diagnostic categories: episodic depression (10%), chronic disorders of behavior (17%), chronic obsessive-compulsive disorder (5%), and personality disorders (19%). The average IQ was 80 +/- 27 (1 SD); and an IQ of less than or equal to 79 was two-thirds more common among vitamin B6-nonresponsive patients compared to vitamin B6-responsive patients. Aggressive behavior and other disorders of conduct were particularly common among patients with mental retardation and among vitamin B6-nonresponsive patients.

Cystathionine beta-Synthase↗
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↗
PubMed1999

The familial and developmental context of obsessive-compulsive disorder.

This article discusses developmental and familial factors in childhood obsessive-compulsive disorder (OCD) highlighting the spectrum of normative to pathologic obsessions and rituals. In addition, it explores the possible role of family functioning in the emergence and maintenance of OCD in childhood and adolescence. Finally, it posits a developmental model that integrates genetic and neurobiologic vulnerability, cognitive models of information processing, behavioral coping strategies, and familial and peer relationships.

Child↗
PubMed1995

Demographic and clinical features of obsessive-compulsive disorder in children and adolescents.

OBJECTIVE: To describe the demography, symptomatology, and comorbidity of 31 clinically referred children and adolescents with obsessive-compulsive disorder. METHOD: The patients were assessed in an outpatient clinic for lifetime psychopathology with the Diagnostic Interview for Children and Adolescents. The child and adolescent version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used to group obsessive-compulsive symptoms and rate symptom severity. Demographic, medical, developmental, academic, and behavioral information was recorded by the parents in the Yale Children's Inventory and the Child Behavior Checklist. RESULTS: The male-female ratio was approximately 3:2. Most patients had had multiple obsessions and compulsions that had changed over time. The CY-BOCS correlated highly with another measure of obsessive-compulsive behavior, but not with any of the Child Behavior Checklist scales. Symptom severity was influenced by an interaction between gender and age at onset of the illness. More than 80% of the subjects had other lifetime psychiatric diagnoses. CONCLUSIONS: The results provide further evidence that obsessive-compulsive disorder is a chronic, severe illness in children and adolescents that is often associated with other forms of psychopathology. The data support the concurrent and discriminant validity of the CY-BOCS.

Adolescent↗
PubMed1998

Manic behaviors associated with fluoxetine in three 12- to 18-year-olds with obsessive-compulsive disorder.

In a sample of 40 youths (ages 11-17) with obsessive-compulsive disorder (OCD) and mood disorders who were treated with behavior therapy, 20 patients received serotonin reuptake inhibitors (SRIs) and 20 did not. In open-label clinical treatment, 30% of the patients (6/20) treated with SRIs developed manic or hypomanic symptoms (5/15 on fluoxetine, 1/1 on sertraline). Symptoms included impulsivity, grandiosity, pressured speech, and disinhibition and did not resemble akathisia or "behavioral activation." These behaviors emerged despite gradual dose elevation (2-5 mg/wk), conservative dosing (maximum 40 mg daily), and careful weekly outpatient monitoring of each patient. Fluoxetine-induced mania occurred at doses as low as 10 mg daily. It is unclear whether mania/hypomania would appear in OCD children without comorbid mood disorders or, alternatively, whether OCD is a stronger risk factor than mood disorder for manic switch in SRI-treated youths. Clinicians are advised to be aware of the risk and to be vigilant in monitoring manic and hypomanic behaviors when using SRIs to treat OCD in youth, even with low doses and gradual dose elevation.

Adolescent↗
PubMed1991

Effects of chronic fluoxetine treatment on behavioral and neuroendocrine responses to meta-chlorophenylpiperazine in obsessive-compulsive disorder.

To investigate the effect of fluoxetine on serotonergic sensitivity in obsessive-compulsive disorder (OCD), the partial serotonin agonist metachlorophenylpiperazine (mCPP) was compared to placebo under double-blind conditions in six patients with OCD before and during treatment with fluoxetine. Readministration of oral mCPP (0.5 mg/kg) after at least 12 weeks of fluoxetine treatment did not increase obsessive-compulsive (OC) symptoms, in contrast to exacerbation of OC symptoms produced by mCPP before treatment. Chronic fluoxetine treatment resulted in a significant increase in prolactin and cortisol response to mCPP. This may be accounted for, however, by substantially increased plasma mCPP levels during fluoxetine treatment. Chronic fluoxetine treatment diminished the behavioral sensitivity to mCPP and did not diminish, but may have partially normalized, the neuroendocrine response to mCPP in patients with OCD. These adaptive homeostatic effects may reflect fluoxetine's antiobsessional mechanism.

Adult↗
PubMed1986

Clomipramine: an antiobsessive drug.

In the past decade, various investigators have attempted to find new pharmacological agents for the treatment of obsessive disorders. Of these, the drug which has attracted attention and has been most promising is clomipramine. This paper attempts to review the usefulness of clomipramine in the treatment of obsessive disorder. Accidentally, it was discovered that clomipramine was effective in alleviating obsessive symptoms in depressed patients by a Spanish psychiatrist, Lopez-Ibor. Initial studies carried out mainly on patients with major depression reported that obsessive symptomatology benefited with clomipramine therapy. A number of uncontrolled and controlled studies confirmed the efficacy of this drug in obsessive neurosis. The drug improves the obsessive symptoms. Discontinuation of the drug is followed by a relapse. The efficacy, dosage, duration and side effects of treatment with clomipramine are discussed in this paper.

Anxiety↗
PubMedDate not supplied

An integrative approach to the treatment of obsessive-compulsive disorder.

We reviewed the research literature concerning the etiology and treatment of obsessive-compulsive disorder (OCD). Cognitive behavioral and neurobiological treatments were the two most frequently used treatment approaches. The majority of research on the treatment of OCD has focused on implementing these treatment approaches in isolation, rather than in combination, which has often resulted in a high symptom relapse rate. We focused on integrating the most effective elements of each treatment approach into a new treatment regimen. More specifically, the longlasting benefits of cognitive behavioral therapy and the rapid symptom relief of neurobiological treatments are integrated in such a manner as to take full advantage of each, while at the same time controlling for the shortcomings of each treatment approach. It is proposed that this newly integrated treatment approach represents a superior treatment regimen, as compared with the combined treatment approaches currently used.

Cognitive Behavioral Therapy↗
PubMed1987

Reactive-narcissistic character, obsessional personality and obsessive-compulsive behaviour: a study of the validity of Sandler and Hazari's typology.

Sandler & Hazari's (1960) questionnaire measuring reactive-narcissistic character and obsessional personality was filled in by 120 medical students. Principal components analysis was applied to their scores. The resulting factor structure is highly similar to Sandler & Hazari's. Both reactive-narcissistic character and obsessional personality can be measured in a reliable way. In support of the hypotheses, reactive-narcissism is correlated positively with achievement motivation, but shows no correlation with traits reflecting lack of self-confidence (external locus of control and negative fear of failure), nor with aggression. Contrary to expectation, a positive correlation was found with control uncertainty. According to expectation obsessionality is correlated negatively with achievement motivation and positively with traits reflecting lack of self-confidence and with aggression. The hypothesis that obsessional subjects exhibit more obsessive-compulsiveness in a decision-making task than reactive-narcissistic subjects could not be confirmed. Results are discussed in the light of previous findings. The conclusion is that the typology as measured by Sandler & Hazari's (1960) questionnaire has high construct validity. The question whether the typology is predictive of future obsessive-compulsive behaviour remains unanswered.

Achievement↗
PubMed2004

Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial.

CONTEXT: The empirical literature on treatment of obsessive-compulsive disorder (OCD) in children and adolescents supports the efficacy of short-term OCD-specific cognitive-behavior therapy (CBT) or medical management with selective serotonin reuptake inhibitors. However, little is known about their relative and combined efficacy. OBJECTIVE: To evaluate the efficacy of CBT alone and medical management with the selective serotonin reuptake inhibitor sertraline alone, or CBT and sertraline combined, as initial treatment for children and adolescents with OCD. DESIGN, SETTING, AND PARTICIPANTS: The Pediatric OCD Treatment Study, a balanced, masked randomized controlled trial conducted in 3 academic centers in the United States and enrolling a volunteer outpatient sample of 112 patients aged 7 through 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD and a Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score of 16 or higher. Patients were recruited between September 1997 and December 2002. INTERVENTIONS: Participants were randomly assigned to receive CBT alone, sertraline alone, combined CBT and sertraline, or pill placebo for 12 weeks. MAIN OUTCOME MEASURES: Change in CY-BOCS score over 12 weeks as rated by an independent evaluator masked to treatment status; rate of clinical remission defined as a CY-BOCS score less than or equal to 10. RESULTS: Ninety-seven of 112 patients (87%) completed the full 12 weeks of treatment. Intent-to-treat random regression analyses indicated a statistically significant advantage for CBT alone (P = .003), sertraline alone (P = .007), and combined treatment (P = .001) compared with placebo. Combined treatment also proved superior to CBT alone (P = .008) and to sertraline alone (P = .006), which did not differ from each other. Site differences emerged for CBT and sertraline but not for combined treatment, suggesting that combined treatment is less susceptible to setting-specific variations. The rate of clinical remission for combined treatment was 53.6% (95% confidence interval [CI], 36%-70%); for CBT alone, 39.3% (95% CI, 24%-58%); for sertraline alone, 21.4% (95% CI, 10%-40%); and for placebo, 3.6% (95% CI, 0%-19%). The remission rate for combined treatment did not differ from that for CBT alone (P = .42) but did differ from sertraline alone (P = .03) and from placebo (P<.001). CBT alone did not differ from sertraline alone (P = .24) but did differ from placebo (P = .002), whereas sertraline alone did not (P = .10). The 3 active treatments proved acceptable and well tolerated, with no evidence of treatment-emergent harm to self or to others. CONCLUSION: Children and adolescents with OCD should begin treatment with the combination of CBT plus a selective serotonin reuptake inhibitor or CBT alone.

Adolescent↗
PubMed2004

Case study: successful medication withdrawal using cognitive-behavioral therapy for a preadolescent with OCD.

The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and handwashing compulsions. The addition of cognitive-behavioral therapy reduced the participant's daily number of obsessions and avoidance behaviors after three sessions. When medication was tapered during the cognitive-behavioral therapy program, the participant's symptoms continued to decline, and after treatment, she no longer met diagnostic criteria for obsessive-compulsive disorder. Impressively, the participant remained medication free and treatment gains were maintained at 4 months' follow-up.

Child↗
PubMed1993

[Differential diagnosis and therapeutic problems in tics and obsessive-compulsive disorders during the developmental age].

In order to point to the differential-diagnostic issue of tics and obsessive-compulsive disorders because of similar clinical manifestations of some forms of tics with compulsive behavior, and ebcause of frequent obsessive features found in children with tics, we have examined 121 patients with tic and 9 patients with obsessive-compulsive disorder. In the tic group we found a significant occurrence of differently manifested obsessive line, while in the compulsive disorders group we found a great percentage of tics. Attempts made in order to differentiate these two clinical pictures in practice were based on the recognition that in both cases we deal with a unique etiopathogenetic factor in the form of frustration which in some children cause a feeling of tension which in some cases further manifests itself in the deterioration of voluntary movements initiating tics, sometimes provoke defensive mechanisms leading to the obsessive-compulsive syndrome and sometimes both issues are present. Such recognition implicates a more complex approach to the child's personality by neglecting the differences between the two disorders and includes a therapeutic program consisting of psychomotor reduction and relaxation, medication, parent assistance and school cooperation.

Adolescent↗
PubMed1999

Preoccupations and behaviors associated with romantic and parental love. Perspectives on the origin of obsessive-compulsive disorder.

This article first examines the hypothesis that the early phases of romantic love and early parental love share phenomenologically an overlapping set of mental states and behaviors. Second, the authors consider what is known of the neurobiologic substrates of these behaviors. Third, the authors evaluate the hypothesis that these highly conserved behavioral and neural systems and the genetic messages that guide their development are intimately involved in the pathogenesis of OCD.

Adult↗
PubMed2000

Personality and polymorphisms of genes involved in aminergic neurotransmission.

Genetic factors significantly contribute to the determination of human personality traits assessed by self-report questionnaires. However, only in the past few years have common genetic polymorphisms especially the dopamine D4 receptor and the serotonin transporter promoter region been associated with specific personality traits such as novelty seeking and harm avoidance, respectively. The effects of these genes are modest and several genes are likely accounting for individual differences in personality dimensions that can be attributed to genetic factors. Molecular genetic studies of adult personality have also been extended to investigations of early human temperament and some of the genes associated with adult personality traits are also contributing to the earliest developmental expressions of human behavior. Additionally, some of these same genes have also been implicated in various types of abnormal behavior including addiction, obsessive-compulsive disorder, attention deficit, depression, aggression and psychosis. Future research directions will no doubt take advantage of the bioinformatics revolution coinciding with the completion of the first phase of the human genome project. It should soon be possible to identify many of the genes contributing to specific personality traits and to better define their role in determining normal and abnormal behavior from early development through adulthood.

Animals↗