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Treating disgust reactions in contamination-based obsessive-compulsive disorder.

Contamination fear associated with obsessive-compulsive disorder (OCD) has features that strongly suggest it is based in part on disgust. In particular, sympathetic magic, or the tendency for disgust-evoking stimuli to transfer that property to previously neutral stimuli, is common in contamination fear. Treatment for OCD typically involves exposure with response prevention for feared stimuli. Unexamined, however, has been the habituation for specific disgust stimuli among individuals with contamination fear. This study is a preliminary investigation with a group of primary contamination fearful participants diagnosed with OCD (C-OC; n = 9) compared to a group with primarily other symptoms of OCD (O-OC; n = 8). All participants were exposed to a set of disgust stimuli that were not associated with anxiety reactions for 30 min across five sessions, and exposed to anxiety-evoking stimuli specific to their OCD symptoms for 30 min. Comparisons showed that, while both groups had reduced disgust reactions, the C-OC group habituated more slowly and to a lesser degree than the O-OC group. No differences existed between the groups for anxiety reduction. The findings suggest that contamination fear is based in part on disgust reactions, and that disgust is amenable to exposure-based interventions.

Adult↗

Trans-cultural aspects of obsessive-compulsive disorder: a description of a Brazilian sample and a systematic review of international clinical studies.

Little is known about the extent and the mechanisms through which culture may affect the clinical manifestations of obsessive-compulsive disorder (OCD). In this study, our objective was to identify culture-related symptomatological patterns in OCD. We described the socio-demographic and phenomenological characteristics of 101 adult patients with OCD seen at an university clinic for anxiety and depressive disorders in Rio de Janeiro, Brazil, and compared them with those reported in 15 clinical samples from North and Latin America, Europe, Africa, and Asia identified through a systematic review in MEDLINE, PsychINFO, and LILACS. Patients with OCD were almost universally characterized by: (1) a predominance of females, (2) a relatively early age of onset, and (3) a preponderance of mixed obsessions and compulsions. In contrast, a predominance of aggressive and religious obsessions was found only in Brazilian and Middle Eastern samples, respectively. The core features of OCD are probably relatively independent of cultural variations. The sole exception to this rule seems to be the content of the obsessions, in which cultural factors may play a significant role.

Adult↗

Increased nocturnal secretion of ACTH and cortisol in obsessive compulsive disorder.

Information on the function of the hypothalamic-pituitary-adrenal (HPA) axis, the main mammalian system of stress response, in obsessive compulsive disorder (OCD) is inconsistent. In this study, nine inpatients with a DSM-IV diagnosis of OCD without comorbid major depression (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score >15; HAMD-21 total score 16) and nine healthy matched controls were included. Blood of patients (seven males; 31.8 +/- 9.3 years, Y-BOCS: 27.3 +/- 4.3, HAMD-21: 13.3 +/-1.9) and controls (seven males, 31.6 +/- 9.1 years) was drawn every 20 min between 23:00 and 7:00 h during sleep using a long catheter for later ACTH and cortisol analysis. Secretion patterns of cortisol and ACTH were similar in both groups, in OCD, however, at a higher level. Area under the curve plasma concentrations of both ACTH (p<0.05) and cortisol (p<0.005) were significantly greater in patients with OCD (ACTH: 674.3 +/- 57.4; cortisol: 2148.4 +/-271.7) than in controls (ACTH: 460.2 +/- 61.0; cortisol: 1191.2 +/- 124.1). In conclusion, our findings suggest that the activity of the HPA axis in patients with OCD is increased compared to healthy controls.

Adrenocorticotropic Hormone↗

MR perfusion-weighted imaging and quantitative analysis of cerebral hemodynamics with symptom provocation in unmedicated patients with obsessive-compulsive disorder.

We evaluated the potential effectiveness of dynamic contrast-enhanced perfusion-weighted images (PWI) in determining hemodynamic activation in brain structures that may be involved in mediating the symptomatology of patients with obsessive-compulsive disorder (OCD), as manifested by contamination obsessions with washing compulsions. Ten unmedicated female patients with OCD were subjected to PWI, and relative cerebral blood flow (rCBF) in each region of interest (ROI) and self-ratings of OCD symptoms were compared before and after symptom provocation. We found that increases in the Anxiety Analogue Scale (AAS) and OCD Analogue Scale (OCDAS) scores were each significantly associated with provocation. The correlations between OCDAS and AAS scores were also statistically significant during both the control and provoked conditions. Compared with the control state, there was a significant increase in rCBF during the symptomatic state in the right head of caudate nucleus, thalamus, and bilateral orbitofrontal cortices (OFC). No statistical changes in rCBF were found in the bilateral anterior cingulate cortices (ACC). These findings demonstrate that OCD symptomatology is accompanied by anxiety, and that abnormal features are particularly apparent in the orbitofrontal-subcortical circuits.

Adolescent↗

Sex differences on spontaneous alternation in prepubertal rats: implications for an animal model of obsessive-compulsive disorder.

UNLABELLED: Sex differences in the prevalence of obsessive-compulsive disorder (OCD) in prepubertal children have been described. Deficits on spontaneous alternation behavior (SAB) have been proposed as an animal model of OCD. OBJECTIVES: To explore possible sex differences in the ontogeny of SAB and in the effect of the 5-HT1A agonist, 8-OH-hydroxy-2 (di-n-propylamino)-tetralin (8-OH-DPAT) in an animal model of OCD. METHODS: The ontogeny of SAB and the perseveration produced by 8-OH-DPAT were compared between male and female prepubertal rats. RESULTS: Males alternated their arm choose from postnatal day 32 onwards, while females perseverated in the chosen arm until postnatal day 38. The mean number of repetitive choices remained close to 1 in males from postnatal day 23 onwards, but females showed a mean number of repetitive choices higher than 1.5 until the end of the test. The 8-OH-DPAT (0.125, 0.5 and 2.0 mg/kg, 15 min) produced perseveration in males but not in females. CONCLUSIONS: These data show important sex differences in the ontogeny of SAB and the effect of 8-OH-DPAT in a model of OCD. Such differences could be relevant for the sex differences in the prevalence of childhood OCD.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

Nicotine treatment of obsessive-compulsive disorder.

Following initial observations of marked effects of nicotine self-medication in a patient with obsessive-compulsive disorder (OCD), another four OCD patients were treated with nicotine for eight weeks in an open label fashion. Patients fulfilling DSM-IV criteria for OCD and with initial Yale-Brown Obsessive-Compulsive Scale (YBOCS) score>15 were included in the study. The patients were scored with YBOCS, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), NIMH Global Obsessive-Compulsive Scale (NIMH) and Global Assessment of Functioning (GAF). Four of five patients receiving nicotine treatment displayed a favourable response with reductions in YBOCS scores. For these four patients, the nicotine chewing gum enabled a more adequate behaviour in stressful, OCD-eliciting, situations. We feel that these results are encouraging enough to warrant a larger, controlled study on nicotine treatment of OCD.

Adult↗

The descriptive epidemiology of obsessive-compulsive disorder.

Since the early eighties, there has been a growing interest in the descriptive epidemiology of obsessive-compulsive disorder (OCD). In this narrative review, the authors describe the findings of a number of studies that employed selected instruments, such as the Diagnostic Interview Schedule, the Composite International Diagnostic Instrument, and the Schedule for Affective Disorders and Schizophrenia, to ascertain the prevalence and incidence rates for OCD in several different countries. We noted that there is a great heterogeneity of findings and that the potential reasons for this variability include not only the intrinsic characteristics of the population under study but also extrinsic factors (i.e., the several methodologically-informed decisions that are to be made before undertaking such investigations, such as the adoption of a specific diagnostic instrument). In order to further the knowledge on the epidemiology of OCD, it would be worthwhile to establish a global consensus regarding a standard assessment package for OCD, to produce more cross-culturally valid versions of the key research instruments, and to conduct studies specifically aimed at comparing the sociodemographic, clinical and prognostic aspects of OCD across different countries.

Diagnostic and Statistical Manual of Mental Disord↗

The neurocircuitry of obsessive-compulsive disorder and disgust.

Recent evidence from human research has indicated that discrete regions of the brain control different basic emotions. Whether the recognition and formulation of emotions truly stem from compartmentalized systems or arise from a multidimensional framework has yet to be elucidated, however. Disgust is a basic emotion that has been hypothesized to constitute an evolutionary function of contamination and disease avoidance. Disgust involves the appraisal of objects and events for their potential role in contamination, and OCD conceivably involves a dysfunction of this appraisal process. Disgust sensitivity has been shown to be positively correlated with OCD and to significantly predict contamination fear. Likewise, functional imaging studies of OCD patients with contamination concerns demonstrate activation of the same neural regions with disgust-inducing pictures as symptom relevant stimuli. Therefore, the neurocircuits involved in disgust processing may be relevant to OCD and, in particular, the contamination subtype. This review focuses on describing what is known to date concerning the neurocircuitry of disgust, and its relevance to the apparent neurocircuitry of OCD.

Animals↗

Common and distinct neural correlates of obsessive-compulsive and related disorders.

Obsessive-compulsive disorder (OCD) often co-occurs with other anxiety disorders and a number of other disorders of similar phenomenology known as the "OCD spectrum" disorders. Neurobiologically, it is unclear how all these disorders relate to each other. The picture is further complicated by the clinical heterogeneity of OCD itself. This article reviews the literature on the common and distinct neural correlates of OCD, its symptom dimensions, and other anxiety and OCD spectrum disorders with the hope of providing a conceptual and heuristic framework to help understand the relationship between these phenomena.

Anxiety Disorders↗

Serotonin and dopamine transporter imaging in patients with obsessive-compulsive disorder.

In obsessive-compulsive disorder (OCD), the success of pharmacological treatment with serotonin re-uptake inhibitors and atypical antipsychotic drugs suggests that both the central serotonergic and dopaminergic systems are involved in the pathophysiology of the disorder. We applied [123I]-2beta-carbomethoxy-3beta-(4-idiophenyl)tropane (beta-CIT) and a brain-dedicated high-resolution single photon emission computed tomography (SPECT) system to quantify dopamine transporter (DAT) and serotonin transporter (SERT) availability. By comparing 15 drug-naïve patients with OCD and 10 controls, we found a significantly reduced availability (corrected for age) of striatal DAT and of thalamic/hypothalamic, midbrain and brainstem SERT in OCD patients. Severity of OCD symptoms showed a significant negative correlation with thalamic/hypothalamic SERT availability, corrected for age and duration of symptoms. Our data provide evidence for imbalanced monoaminergic neurotransmitter modulation in OCD. Further studies with more selective DAT and SERT radiotracers are needed.

Adult↗

Proton magnetic resonance spectroscopy reveals an abnormality in the anterior cingulate of a subgroup of obsessive-compulsive disorder patients.

Numerous neuroimaging studies have suggested that obsessive-compulsive disorder (OCD) patients had a neurobiological abnormality in the frontal-subcortical circuits. On the other hand, there are distinct differences in the responses to pharmacological treatment among OCD patients. In the present study, we measured the concentration of N-acetyl aspartate (NAA), a putative marker of neuronal viability, with proton magnetic resonance spectroscopy (MRS) in OCD patients with different pharmacological responses. Participants comprised 20 patients and 26 healthy control subjects. OCD patients were divided into three groups according to the pharmacological response; responders to a selective serotonin reuptake inhibitor (SSRI) (group A: n=7), responders to SSRI with an atypical antipsychotic (group B: n=8) and non-responders to either SSRI or SSRI with an atypical antipsychotic (group C: n=5). Short echo proton MRS was used to measure NAA concentrations in the anterior cingulate, the left basal ganglia and the left prefrontal lobe of subjects. A significantly lower NAA concentration was observed only in group B compared with control subjects in the anterior cingulate. Our results suggest that a subgroup of OCD patients who respond to an SSRI with an atypical antipsychotic have distinct biological abnormalities in the anterior cingulate.

Adult↗

High sensitivity to punishment and low impulsivity in obsessive-compulsive patients with hoarding symptoms.

Recent factor-analytic studies involving over 2000 patients have reduced the symptoms of obsessive-compulsive disorder (OCD) into a few dimensions or potentially overlapping syndromes. Hoarding consistently emerged as a separate factor in all these studies. This study investigated the relationship between OCD symptom dimensions and normal personality traits in a sample of 56 OCD patients. They were administered the Sensitivity to Punishment and Sensitivity to Reward Questionnaire and the Eysenck Personality Questionnaire, derived from Gray's and Eysenck's personality models, respectively. The personality scores were correlated with previously identified symptom dimensions from the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (Y-BOCS-SC), controlling for overall illness severity. High scores on the hoarding dimension of the Y-BOCS-SC were positively correlated with scores on the Sensitivity to Punishment scale and negatively with Eysenck's Psychoticism scale. While high sensitivity to punishment is a personality feature common to many OCD patients, it is more strongly pronounced in patients with hoarding symptoms. These patients also appear to be less impulsive or novelty seeking as reflected by low scores on Eysenck's Psychoticism scale. High sensitivity to punishment and low novelty seeking in OCD hoarders might explain their poor compliance and response to conventional treatments, but this question needs to be explored further in a prospective treatment study.

Adult↗

Clinical picture of obsessive-compulsive disorder with poor insight: a regression model.

DSM-IV included a type of obsessive-compulsive disorder (OCD) with poor insight in the official classification. The present study was performed using a continuous measure of the level of insight to analyze the association between this variable and characteristics of the disorder. Seventy-four consecutive OCD outpatients (DSM-IV criteria) were assessed using: a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive Scale (NIMH-OCS), the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS), and the Overvalued Ideas Scale (OVIS) as a continuous measure of the level of insight. Stepwise multiple regression analysis revealed that demographic and clinical factors were related to the OVIS score. The following four factors were found to be significantly related to the OVIS score: the Y-BOCS score for compulsions, OCD chronic course, and family history of OCD were positively related, while obsessive-compulsive personality disorder was negatively related. These results suggest that poor insight identifies a group of OCD patients with distinct clinical characteristics.

Adult↗

Reality monitoring and metacognitive beliefs related to cognitive confidence in obsessive-compulsive disorder.

The present study investigated general reality monitoring ability, and selective reality monitoring ability for anxiety relevant actions in a group of individuals with obsessive-compulsive disorder (OCD) and a group of non-anxious controls. In addition, reality monitoring confidence was assessed, as well as specific meta-cognitive beliefs related to cognitive confidence (by means of the Meta-Cognitions Questionnaire (MCQ)). No differences were found between both groups in actual reality monitoring ability. Unlike previous studies, the reality monitoring task included actions that were related to the individual concerns of the OCD patients and were ideographically selected. Nevertheless, no differential reality monitoring effect was observed for the anxiety relevant stimuli. Data from the MCQ, however, revealed that OCD patients had less overall confidence in their memory for actions and their reality monitoring ability. Analysis of the confidence ratings of the reality monitoring task showed that this reduced confidence was restricted to the neutral actions. No differences were observed for patients that reported low or high frequencies of checking behaviour. The whole of these data do not support memory deficit models of OCD, but are in line with recent emphasis on the importance of memory confidence and other meta-cognitive beliefs in OCD.

Adult↗

Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder.

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.

Adult↗

"Not just right experiences": perfectionism, obsessive-compulsive features and general psychopathology.

Individuals with obsessive-compulsive disorder (OCD) frequently report uncomfortable sensations of things not being just right ("not just right experiences"; NJREs) and a need to ritualize until they quiet these sensations. However, very little work has been conducted to empirically examine the nature and characteristics of this phenomenon. In this paper, we present two studies that systematically examine NJREs in large undergraduate samples. In Study 1, NJREs were shown to be related to both OCD features and maladaptive domains of perfectionism. In Study 2, NJREs were again significantly related to OCD features. Further, NJREs were shown to have particularly strong relationships with specific OCD symptom clusters (e.g., checking, ordering). Finally, NJREs were significantly more strongly correlated with features of OCD than symptoms from other domains of psychopathology (e.g., social anxiety, trait anxiety, worry, depression). General conclusions are drawn, and future directions are discussed.

Anxiety↗

Anxiety and selective attention in obsessive-compulsive disorder.

Recently, there has been increasing evidence for information-processing deficits in individuals with obsessive-compulsive disorder (OCD). While impairments in selective attention have been identified to be central to the symptomatology of OCD, the role that situational anxiety plays in attentional processes has not been fully explored. Previous research findings were limited to tasks containing anxiety-relevant materials, only permitting for the evaluation of the impact of anxiety on simultaneous cognitive processing. Furthermore, it has not yet been determined whether the impact of anxiety is limited to selective attention or is indicative of a more general cognitive impairment. This study was designed to examine the role that situational anxiety plays in selective attention impairments. OCD participants and controls were presented with an anxiety producing statement and a neutral statement, followed by the Stroop Task. Results indicated that situational anxiety plays a significant role in the performance of tasks that require selective attention in OCD. A significant deterioration was detected in performance on selective attention tasks for the OCD participants after confronting anxiety-provoking scenarios, as compared to neutral scenarios. Anxiety did not impair performance on simple reading tasks. Possible explanations are discussed.

Adult↗

Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy.

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.'s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.

Cluster Analysis↗