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PubMedDate not supplied

Comparative psychopathology of women with bulimia nervosa and obsessive-compulsive disorder.

Twenty women with bulimia nervosa (BN) and 20 women with obsessive-compulsive disorder (OCD) were compared on responses to the Minnesota Multiphasic Personality Inventory (MMPI), Symptom Checklist-90-Revised (SCL-90-R), and the Beck Depression Inventory (BDI). Multivariate analyses showed no significant differences between bulimic and OCD women on the MMPI, although a greater number of bulimic women showed significant elevations on several of the clinical scales. Analyses of SCL-90-R profiles indicated higher scores on somatization, interpersonal sensitivity, and psychoticism in the BN sample. Bulimic women did not differ significantly from OCD women on either obsessive-compulsive measures or other measures of anxiety. Similarities and differences in symptom profiles between these two groups are discussed, as well as their implications for alternative treatment approaches for BN.

Adult↗
PubMedDate not supplied

DSM-III personality disorders in generalized anxiety, panic/agoraphobia, and obsessive-compulsive disorders.

In an earlier report, we stated that personality profiles of patients with panic disorder/agoraphobia (n = 187) and obsessive-compulsive disorder ([ODC] n = 51) were similar, albeit more pronounced in OCD, suggesting that the link between panic disorder/agoraphobia and DSM-III personality disorders (PDs) or traits may be nonspecific. The present report extends the comparative study of DSM-III PDs/traits, as assessed by the Personality Diagnostic Questionnaire (PDQ), by adding a third diagnostic group of 39 patients with generalized anxiety disorder (GAD). The personality assessment of panic disorder/agoraphobia and GAD patients yielded virtually identical results on the PDQ and Eysenck Personality Inventory (EPI). Because GAD lacks the prominent panic, phobic, and obsessive-compulsive symptoms of other anxiety disorders, the present findings provide strong support for a nonspecific link between panic disorder/agoraphobia and DSM-III PDs/traits and for the presence of common personality characteristics in anxiety disorders.

Adult↗
PubMedDate not supplied

Posttraumatic obsessive-compulsive disorder: a case study.

Recent epidemiologic evidence has pointed to a disproportionate rate of obsessive-compulsive disorder (OCD) among high-combat-exposed Vietnam veterans. This case report describes an individual without previous overt psychopathology who under the stress of combat developed concurrent OCD and posttraumatic stress disorder (PTSD) persisting for more than 20 years. Phenomenologic, behavioral, psychodynamic, and biologic considerations all help to elucidate the potential role of emotional trauma in the pathogenesis of obsessions and compulsions.

Combat Disorders↗
PubMedDate not supplied

An MCMI cluster typology of obsessive-compulsives: a measure of personality characteristics and its relationship to treatment participation, compliance and outcome in behavior therapy.

The two-fold purpose of this investigation was to (a) define personality subtypes among patients diagnosed with obsessive-compulsive disorder (OCD) and (b) examine the relationship between the resulting typology and treatment participation, compliance and outcome of OCD patients treated with behavior therapy, using exposure and response prevention. A hierarchical agglomerative cluster analysis was performed on the Millon Clinical Multiaxial Inventory (MCMI) scale scores of 137 OCD patients seeking outpatient treatment; four cluster types emerged. Patients' OCD symptom severity was assessed at pretreatment, posttreatment, and 6-month follow-up using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Patients with no evident personality pathology and those with dependent qualities demonstrated the best overall outcome. Patients whose personalities indicated particular difficulties with interpersonal interaction were most likely to refuse behavior therapy and, among these patients who engaged in treatment, evidenced no reduction in OCD symptoms at posttreatment and follow-up. Patients with histrionic/borderline traits showed symptom reductions at posttreatment, but did not maintain their treatment gains at follow-up. The clinical implications of these findings are discussed.

Adult↗
PubMed1984

Abnormal dexamethasone suppression test in primary obsessive-compulsive patients: a confirmatory report.

The dexamethasone suppression test (DST) was administered after baseline cortisol measurements in 20 patients (10 males, 10 females) who met DSM-III criteria for obsessive-compulsive disorder (OCD). Six patients (30%) showed an abnormal escape from dexamethasone suppression. DST suppressors vs. DST nonsuppressors showed no differences on age, rate of secondary depressive disorders, or scores on the Hamilton Rating Scale for Depression, the Minnesota Multiphasic Personality Inventory D scale, or OCD rating scales. Surprisingly, there was a trend for suppressors to have a stronger family history of depressive disorders, and for nonsuppressors to include an excess of male subjects. Moreover, there was a significant correlation between levels of cortisol before and after DST. In five of six nonsuppressors, both depressive symptoms and obsessive-compulsive behaviors showed a diminution in response to antidepressant therapy combined, in one case, with intensive behavior therapy. The relationships between OCD and endogenous depression, as well as the specificity of the DST, are discussed.

Adolescent↗
PubMed1990

The Yale-Brown Obsessive-Compulsive Scale: a reliability and validity study.

Twenty-eight nondepressed patients with DSM-III obsessive-compulsive disorder completed both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Leyton Obsessional Inventory (LOI) once a week for a total of three times change. In general, the correlations between the Y-BOCS change scores and the Global Ratings were significantly greater than between the LOI and the Global scores, the Y-BOCS was found to be more reliable than the LOI. Correlations were also obtained for the baseline period between the Y-BOCS and Leyton scores. At the end of a 14-week trial of clomipramine, the Y-BOCS and the LOI were again administered along with a Physician and Patient Global Rating of change. In general, the correlations between the Y-BOCS change scores and the Global Ratings were significantly greater than between the LOI and the Global Ratings. This last finding suggests that the Y-BOCS is a better measure of clinical change than is the LOI.

Adult↗
PubMed1991

Smooth pursuit and saccadic eye movements and neurological soft signs in obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder (OCD) demonstrate an increased number of neurological soft signs as well as neuroanatomic abnormalities detected with modern imaging techniques. Quantitative analysis of eye movements has proved fruitful in investigations of other neuropsychiatric disorders with similar findings. Therefore, we studied the smooth pursuit and saccadic eye movements of 8 OCD patients and 12 normal controls using infrared oculography and computerized pattern recognition software. We also measured neurologic soft signs using a standardized rating instrument. Despite having an increased number of neurological soft signs, OCD patients' performance on a variety of measures of eye movement was not significantly impaired. Neither the severity of obsessions or compulsions nor the number of neurologic soft signs correlated with any of the parameters of eye movement function. We conclude that OCD patients do not have prominent oculomotor dysfunction and that eye movement dysfunction and neurologic soft signs are not inextricably linked.

Adult↗
PubMed1991

Noradrenergic function in obsessive-compulsive disorder: behavioral and neuroendocrine responses to clonidine and comparison to healthy controls.

To evaluate noradrenergic (NE) function in obsessive-compulsive disorder (OCD), behavioral, physiological, and neuroendocrine responses to the alpha 2-adrenergic agonist clonidine were examined in 18 patients with OCD and 10 healthy subjects. Subjects received single i.v. doses of 2 micrograms/kg of clonidine administered under double-blind, placebo-controlled, random-assignment conditions. Following clonidine, but not following placebo, patients transiently experienced a significant reduction of obsessions and compulsions. Significant drowsiness and a reduction in anxiety were also noted, but the antiobsessional effect appeared independent of the soporific and antianxiety effects. Growth hormone (GH), cortisol, and 3-methoxy-4-hydroxyphenylglycol responses to clonidine did not differentiate patients from healthy controls. Blood pressure and pulse in response to clonidine did not differ between groups. Improvement in OCD symptoms after clonidine significantly correlated with GH response to clonidine, suggesting specific noradrenergic mediation. This finding lends only partial support for a primary defect of noradrenergic function in OCD.

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↗
PubMed1991

Brain MRI in obsessive-compulsive disorder.

Magnetic resonance imaging (MRI) brain scans were performed on 12 patients with obsessive-compulsive disorder and 12 healthy controls. Measurements of the area of the head of the caudate nucleus, cingulate gyrus thickness, intracaudate/frontal horn ratio, and area of the corpus callosum did not differ between the two groups. These limited data do not support the presence of a consistent gross brain structural abnormality in obsessive-compulsive disorder. Further studies using other anatomic measurements and other brain structural imaging techniques are warranted.

Adult↗
PubMed1993

Event-related potential and clinical correlates of neurodysfunction in obsessive-compulsive disorder.

The current study confirmed with increased sample sizes our preliminary findings of event-related potential (ERP) abnormalities in obsessive-compulsive disorder (OCD) (Towey et al., 1990) and examined their relationship to symptom severity, treatment response, and neurological soft signs. Unmedicated patients (n = 17) showed larger negativities in N200 and slow wave regions than normal control subjects (n = 16) to correctly detected auditory "oddball" stimuli. N200 amplitude was larger over left than right hemispheres of OCD patients, but not normal control subjects. Greater N200 amplitude correlated with less severe obsessions, better response to subsequent treatment with serotonin reuptake blockers, and fewer neurological soft signs in OCD. With increased task difficulty, N200 and P300 latencies lengthened for normal subjects, but not for OCD patients. The abnormal ERP pattern in OCD supports hypotheses of cortical hyperarousal and overfocused attention.

Adult↗
PubMed1992

Dermatology and conditions related to obsessive-compulsive disorder.

Patients with cutaneous disorders may have obsessive-compulsive symptoms but treatment for these symptoms has been limited. Advances in our understanding of obsessive-compulsive disorders have led to the concept of a spectrum with similar phenomenology, underlying neurobiology, and psychopharmacotherapeutic response. Many of these disorders, which include trichotillomania, neurotic excoriation, onychophagia, body dysmorphic disorder, and dermatitis artefacta may respond to specific therapeutic interventions.

Adult↗
PubMedDate not supplied

Oxytocin in obsessive compulsive disorder.

A double-blind, placebo-controlled study with syntocinon (oxytocin) was carried out in 12 patients, nine females and three males with obsessive compulsive disorder (OCD). Patients were treated by intranasal administration of oxytocin spray (18 IU per day) or placebo. No reductions in the number of obsessions or compulsive behaviors were observed in either treatment group. To evaluate whether a higher dosage would exert more beneficial effects, two additional patients were treated with a threefold higher dosage of oxytocin using an open design. In one patient a slight reduction in the number of checking rituals was observed, whereas in the other patient virtually no effect was observed. The results of this study do not support the hypothesis that oxytocin might be a potential anticompulsive agent.

Adult↗
PubMed1990

Impulse control in obsessive-compulsive disorder: a biopsychopathological approach.

1. The dichotomy between behaviors (some pathological, some falling into the realm of criminality) characterized by an excessive impulsivity and others, such as obsessive-compulsive disorder (OCD), in which a high resistance towards inner or outer impulses dominate, can not be sustained any more. 2. Classical descriptions of OCD include behavior patterns of low control of impulses, and individuals showing "low control of impulse disorders" are, more often than not, high controllers in the periods of time when the impulsivity is in the background. 3. Evidence from biological research and from treatment outcome studies also suggest common traits in the "hyponomic" (impulsive) and "hypernomic" (obsessive) individuals, related to serotonin (5-HT) metabolism disturbances.

Humans↗
PubMed1996

The use of fluoxetine in Gilles de la Tourette syndrome and obsessive compulsive behaviours: preliminary clinical experience.

1. Obsessive Compulsive Behaviours (OCB) occur in more than 50% of patients with the Gilles de la Tourette Syndrome (GTS) and in some cases these behaviours are more disabling than the tics themselves. 2. Fluoxetine, a specific serotonin reuptake inhibitor (SSRI) has been demonstrated to be effective in patients with Obsessive Compulsive Disorder. 3. The authors report on their clinical experience of fluoxetine in 30 GTS patients with OCB, in an open retrospective study. 4. There was an overall improvement in OCB as judged by the clinician in 76% of cases. Most patients received fluoxetine at a daily dose of 20 to 40mg for an average period of 6 months (24 +/- 4 weeks). In general, fluoxetine was well tolerated and further studies are indicated.

Adolescent↗
PubMed1996

Potentiation of fluoxetine by aminoglutethimide, an adrenal steroid suppressant, in obsessive-compulsive disorder resistant to SSRIs: a case report.

1. The role of serotonin in the aetiology of obsessive compulsive disorder (OCD) has been established through considerable indirect evidence (Landry and Chouinard, 1990). The strongest evidence comes from the fact that drugs known to be serotonin-selective reuptake inhibitors (SSRIs) have been found to be useful in the pharmacotherapy of OCD (Landry and Chouinard, 1990). 2. The authors investigated a new treatment approach by adding an adrenal steroid suppressant to a SSRI, fluoxetine, in the case of a severe obsessive-compulsive patient who was drug-resistant to clomipramine and SSRIs. 3. We found that the combination of aminoglutethimide 250 mg qid and fluoxetine 40 mg die significantly improved the patient's condition. Moreover, during a four and a half year period, each time we tried to decrease either fluoxetine or the steroid suppressant, the patient started to relapse, suggesting that the adrenal steroid suppressant had a potentiating effect on the SSRI.

Aminoglutethimide↗
PubMed1987

Intranasal oxytocin in obsessive-compulsive disorder.

A 55-year patient with obsessive-compulsive disorder showed clear improvement during 4 weeks of treatment with intranasal oxytocin compared to 4 weeks of intranasal placebo. This improvement was concurrent with the development of severe memory disturbances, supporting the amnestic properties of the peptide. However, the patient also developed psychotic symptoms and a marked decrease in plasma sodium and osmolality, which may have masked the obsessive symptomatology. This case highlights the need for careful monitoring in long-term oxytocin therapy.

Administration, Intranasal↗
PubMed1995

Plasma melatonin and cortisol circadian patterns in patients with obsessive-compulsive disorder before and after fluoxetine treatment.

The circadian rhythms of melatonin and cortisol were evaluated in seven outpatients with obsessive-compulsive disorder (OCD) before and after 8 weeks of fluoxetine treatment (20 mg/day in the first 2 weeks, and 40 mg/day afterwards), and in seven healthy subjects matched to patients on age, sex and season of testing. The results confirm our previous findings of a decreased 24-h production of melatonin (p < .05; two-way ANOVA with repeated measures) and of an increased circadian secretion of cortisol (p < .01) in OCD patients with respect to matched controls, and show, for the first time, that these hormonal alterations do not significantly change after 2 months of fluoxetine administration, in spite of a good clinical improvement. These data suggest that the normalization of the biochemical changes underlying the altered endocrine parameters in obsessive-compulsive patients is not necessary for effective therapy or clinical remission.

Adult↗