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[Obsessive-compulsive disorder in girls with eating disorders].

30 girls aged 13-19 who met criteria DSM-IV for anorexia nervosa were investigated by using a semistructured diagnostic interview assessing general psychopathology as well as anorectic and bulimic behavior, The Yale-Brown Obsessive-Compulsive Scale. The Eating Disorder Inventory, The Anxiety Hamilton Scale, The Depression Hamilton Scale. The comparison group consisted of 30 healthy girls aged 13-19. 1/3 of the girls with anorexia nervosa met the DSM-IV criteria for OCD, 1/10 subjects had OCD and depressive disorder. The comorbidity of eating disorder and OCD or OCD and depressive disorder worsened the course of anorexia nervosa and prognosis.

Adolescent↗
PubMed2006

The impact of levetiracetam on challenging behavior.

An observational longitudinal design was employed to evaluate whether treatment with the antiepileptic drug levetiracetam (LEV) adversely impacts behavior in people with intellectual disabilities and/or acquired brain damage. Thirty-five adults were assessed once off the drug and once when on LEV therapy, with a 2-month interval between assessments. Behaviors were rated using an adaptation of the Yale-Brown Obsessive Compulsive Scale and the Challenging Behaviour Scale. Challenging behaviors were rated as more frequent and severe when individuals were taking LEV. Behavioral worsening was not related to better seizure control or increased levels of engagement in activities. Families and professionals need to be aware of the potential reversible adverse effects of this drug.

Adult↗
PubMed1986

Parent-child agreement on child psychiatric symptoms assessed via structured interview.

Correlations between scores derived from structured interviews with 299 disturbed children aged 6-18 and their parents indicated low-to-moderate levels of agreement regarding the presence and severity of child psychiatric symptoms. Agreement was higher on behavior and conduct problems than on anxiety, fears, obsessions-compulsions, psychotic symptoms and affective disturbances. Parents reported more child behavior and conduct problems than children, whereas children reported more affective and neurotic symptoms than parents. Parent-child agreement also increased sharply with age.

Adolescent↗
PubMed2002

[Obsessive-phobic disorder typology in schizophrenia].

The study aims at clinical characteristics of obsessive-phobic disorders (OPD) in schizophrenia with regard to their modification in main disease development and interaction with basic schizophrenia symptoms (positive and negative). Eighteen patients, mean age 28.2 years, were examined. An affinity degree of schizophrenia to OPD was found to be associated with endogenous progressive process. In slowly progressive schizophrenia, an affinity is selective, concerning to one of the obsessive phobic syndrome component (phobic component proper or avoidance behavior) and realizing in either positive, or negative manifestation of schizophrenia. Two obsessive-phobic syndrome types were determined: OPD of the 1st type--panic and generalized anxiety disorder (52 patients) are modified because of overlapping by chronic endogenous anxiety, obsessive-phobic symptoms being not represented in structure of negative changes (asthenia defect); in OPD of the 2nd type (agora and social phobias, 80 patients) an overlapping of psychopathological symptoms related to avoidance behavior and negative changes (psychopathic-like defect "verschroben" type) was found. Phobic syndrome component does not tend to psychopathological transformation and undergoes reverse changes. In typical cases of progressive schizophrenia has no affinity. But exclusion is--the OPD of the 3rd type (obsessive-compulsive disorders with a fear of external threat and massive defense rituals, 49 patients). In this case, total affinity to schizophrenia is realized in overlapping of both obsessive syndrome components with positive and negative manifestation of schizophrenia.

Adult↗
PubMed1999

[Drug treatment of obsessive-compulsive disorder. With proper drugs and some patience many patients can be helped].

Pharmacotherapy which, together with behavior therapy, is a major pillar in the treatment of obsessive-compulsive disorder (OCD), can bring about a distinct symptomatic improvement in 50-70% of the patients. In addition to the classical tricyclic antidepressant, clomipramine, a number of new selective serotonin reuptake inhibitors have now been approved for the treatment of OCD. In comparison with depression, pharmacotherapy of OCD is characterized by a long latency of effect of eight to twelve weeks, and by the high doses required by some patients. A combination of pharmacotherapy and behavior therapy is superior to behavior therapy alone, in particular in the case of patients with predominantly obsessive thoughts and additional symptoms of depression. In the case of aggregation with the Tourette syndrome or schizotypal personality disorders, the additional administration of a neuroleptic is recommended. Open studies and case histories have reported good results with pimozide, haloperidol, clozapine and risperidone.

Behavior Therapy↗
PubMed2006

Sydenham's chorea is associated with decreased verbal fluency.

BACKGROUND: Sydenham's chorea (SC) is a disorder associated with rheumatic fever and related to Streptococcus-induced immune reaction cross-reactive with basal ganglia antigens. Obsessive-compulsive disorder and other behavioral abnormalities have been described in SC. There are scarce data of cognitive function in this condition. OBJECTIVE: To assess verbal fluency in patients with SC. PATIENTS AND METHODS: We have compared the semantic (SVF) and phonemic verbal fluency (PVF) of 20 subjects with SC and 40 controls matched by age, gender and years of school. RESULTS: The scores of the control group on the SVF and PVF tests were 26.3 +/- 5.7 and 18.0 +/- 6.4 whereas the SC patients scored 25.1 +/- 6.9 and 12.5 +/- 8.2. PVF was significantly decreased in the SC group (p < 0.01). CONCLUSION: SC is associated with reduction of PVF. This finding may reflect disruption of the dorsolateral prefrontal-striatal circuit caused by the auto-immune process characteristic of SC.

Adolescent↗
PubMed1998

A diagnostic aid for detecting (DSM-IV) mental disorders in primary care.

This study was designed to develop and validate a new computerized version of the Symptom Driven Diagnostic System for Primary Care (SDDS-PC) and examine its feasibility in primary care practice. One thousand and one patients (ages 18-70) coming for routine care to Kaiser-Permanente were screened on a self-administered symptom scale for major depression, alcohol and drug dependence, generalized anxiety, panic and obsessive compulsive disorders, and suicidal behavior. The screen was followed up by a brief diagnostic interview, administered by a nurse, which yielded a one-page summary of positive symptoms and a provisional computer-generated diagnosis for the physician. The physician reviewed the summary results and made a diagnosis. The nurse and physician were blind to the screen results. Patients were reinterviewed within 96 hours by a mental health professional (MHP) blind to previous results. The nurses' interviews ranged between 1.5 and 3.5 minutes for a screened positive diagnosis. Agreement between the nurse and physician diagnoses was excellent to moderate. Disagreement was usually in the direction of the physician ruling out major mental disorders in favor of subsyndromal or medical explanations. Only rarely did physicians diagnose disorders not detected by the nurse interview. Agreement between physician and MHP was moderate. Physicians using the SDDS-PC seldom made diagnoses that were not confirmed by the independent assessment of the MHP. The SDDS-PC may facilitate recognition of psychiatric disorders and minimize the physician's time in information gathering.

Adolescent↗
PubMed2002

Social anxiety spectrum: gender differences in Italian high school students.

Gender differences in the social anxiety spectrum and their correlation with other psychopathological features were analyzed in 520 students by using two questionnaires: the Social Anxiety Spectrum Self-Report (SHY-SR), which explores social anxiety spectrum, and the General Spectrum Measure (GSM), which explores panic-agoraphobia, mood, obsessive-compulsive, and eating-behavior features. Mean SHY-SR total score was significantly higher in women than in men, and gender differences were particularly pronounced for interpersonal sensitivity domain. Likewise, GSM scores were higher in women, except for the manic section. The SHY-SR domains correlated significantly with all GSM sections, except for the manic section. In conclusion, women reported more symptoms than men (who belonged to different psychopathologic dimensions) and displayed a profile of social anxiety spectrum that differs quantitatively but not qualitatively from the men's profile. The correlation between social anxiety spectrum and other psychopathological features mirrors previous findings concerning the high comorbidity of axis-I social anxiety disorder.

Adolescent↗
PubMed1991

Nursing implications of Tourette's syndrome.

Gilles de la Tourette syndrome is a neurological disorder of gradual childhood onset which usually persists for life. Manifestations include motor, vocal and sensory tics. Behavioral manifestations such as obsessive-compulsive disorder, attention-deficit disorder and learning disabilities may also occur. Nurses can play a major role in assisting patients and their families, through education and fostering effective coping mechanisms, to adjust to Tourette's syndrome. Through a case study and review of the literature, this article presents the etiology, manifestations, management and nursing implications of Tourette's syndrome.

Antipsychotic Agents↗
PubMed1991

Neuropsychological performance in medicated and unmedicated patients with Tourette's disorder.

OBJECTIVE: To date, there have been no formal investigations of neuropsychological performance in patients with Tourette's disorder who are taking psychotropic medications. The authors conducted this study to provide such information. METHOD: They examined the neuropsychological performance of 96 patients 6-18 years old who met DSM-III-R criteria for Tourette's disorder; 51 of these patients were taking neuroleptic medications and 45 were not. The groups were well matched with regard to age, sex, education, and duration of symptoms. Each group was given a complete neuropsychological test battery as well as instruments rating symptoms of Tourette's disorder, obsessive-compulsive characteristics, and other behavioral disturbances. RESULTS: The patients taking medications did not differ from those not taking medications on any of the neuropsychological, intellectual, or educational measures. In addition, the groups did not differ with regard to level of Tourette's disorder symptoms. CONCLUSIONS: The results of this investigation suggest that patients with Tourette's disorder who do not experience intolerable side effects from neuroleptic medications are able to perform on educational, intellectual, and neuropsychological tests at a level comparable to that of unmedicated patients. These results have positive implications for patients with Tourette's disorder who respond to neuroleptic medications.

Adolescent↗
PubMed1998

Tourette's syndrome and 'PANDAS': will the relation bear out? Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection.

Despite strong evidence of the importance of hereditary factors in the etiology of Tourette's syndrome (TS), research findings have consistently pointed to a role of environmental influences. A recent line of research has suggested that tic disorders and associated behavioral disturbances, such as obsessive-compulsive disorder, might develop following streptococcal infection by the process of molecular mimicry, whereby antibodies directed against bacterial antigens cross-react with brain targets. Such investigations have given rise to the notion that there is a spectrum of childhood neurobehavioral disorders (termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection [PANDAS]) that arise by postinfectious autoimmune mechanisms. This article reviews research results supporting the concept of PANDAS and discusses their limitations. Well-designed and adequately controlled studies are needed to determine whether there is a true etiologic relation between streptococcal infection and the onset or exacerbation of childhood neuropsychiatric disorders and whether the use of immune-modifying therapies for these conditions is rational.

Autoimmune Diseases↗
PubMed2001

An open-label study of the treatment efficacy of olanzapine for Tourette's disorder.

BACKGROUND: An open-label trial was performed to explore efficacy and safety of olanzapine, an atypical neuroleptic with diverse receptor activity including both dopamine-2 and serotonin-2A and -2C antagonism, for treatment of Tourette's disorder. METHOD: Ten adult patients aged 20 to 44 years with Tourette's disorder were treated using an open-label, flexible dosing schedule for 8 weeks. Three patients who continued olanzapine were reevaluated after 6 months. Three subjects were psychotropic medication naive, 5 patients experienced intolerable side effects with conventional neuroleptics, and 2 patients had remote (> or = 10 years) successful response to conventional neuroleptics. Tic severity was rated by the Yale Global Tic Severity Scale; weight, vital signs, and adverse effects were assessed weekly. Electrocardiogram, laboratory studies, and comorbid symptoms, assessed by the Yale-Brown Obsessive Compulsive Scale and ADHD Behavior Checklist for Adults, were measured at baseline and at week 8. RESULTS: Two of 10 patients prematurely discontinued olanzapine owing to excessive sedation. Of 8 patients who completed the 8-week trial, 4 (50%) demonstrated reduction of global tic severity scores by > or = 20 points, and 6 (75%) demonstrated reductions by > or = 10 points. No significant changes in comorbid symptoms were demonstrated. Sedation, weight gain, increased appetite, dry mouth, and transient asymptomatic hypoglycemia were the most common side effects. Tic improvements were maintained in 3 patients reassessed 6 months later. Final olanzapine dosages ranged from 2.5 mg to 20 mg daily (mean = 10.9 mg/day). CONCLUSION: This open-label study suggests that olanzapine should be explored as a potential alternative to conventional neuroleptic medications for treatment of motor tics and Tourette's disorder.

Adult↗
PubMed2004

[Premorbid period of anorexia nervosa].

Premorbid period of anorexia nervosa was studied in 96 female patients. In 64 cases (group 1) anorexia nervosa was as a separate disease and in 32 cases (group 2)--as a syndrome of endogenous mental disorder. In group 1 premorbid period was characterized by the features of neuropathy and residual organic disorders in combination with accumulation of subjects with personality disorders in the patient's family that promoted development of prolonged neurotic disorders. In group 2 there was hereditary psychosis load, high frequency of obstetrical and other perinatal complications, overvalued ideas and predisposition to autistic games and fantasying. In both groups, psychopathological peculiarities included typical affective, obsessive-phobic, hypochondriac, cenesthopathic and behavioral disorders, of a stable character often provoked by psychotraumatic events.

Adolescent↗
PubMed2003

Alcohol craving predicts drinking during treatment: an analysis of three assessment instruments.

OBJECTIVE: The purpose of this investigation was to examine the utility of thee craving instruments to predict drinking during treatment. The three assessments used were the Penn Alcohol Craving Scale (PACS), the Alcohol Urge Questionnaire (AUQ) and Items 1-6 of the Obsessive subscale (OBS) of the Obsessive Compulsive Drinking Scale (OCDS). METHOD: The three instruments were administered during the course of a 9-month, double-blind, placebo-controlled trial of 100 mg/day of naltrexone, and a manual-based psychosocial intervention using the BRENDA manual conducted at the University of Pennsylvania's Treatment Research Center. Participants (133 men and 50 women at the initiation of the study) used these instruments to self-report craving on a weekly or biweekly basis. The weekly number of drinks was reported using the Timeline Followback interview. The data were analyzed with generalized estimating equations using craving scores at 1 week as the independent variable and number of drinks in the subsequent treatment week as the dependent variable. RESULTS: Each of the three scales predicted drinking during the subsequent treatment week. The PACS was the strongest predictor followed closely by the OBS and then the AUQ. Most important, craving as measured by the three scales was a stronger predictor of subsequent drinking than was drinking during the prior treatment week. CONCLUSIONS: Craving assessment provides a useful means of predicting drinking during treatment. Such information would be helpful in designing clinical trials and for many treatment modalities.

Adult↗
PubMed1988

Neuropsychiatric observations of proprioceptive sensitivity in motion sickness susceptibility.

The assessment of motion sickness susceptibility is still an unsolved problem, due in part to its unclear etiology. We studied 16 referred patients suffering from "idiopathic motion sickness" and 4 pilots suffering from motion airsickness. All clinical and neurological tests proved negative, including electroencephalograms, electronystagmograms, Doppler studies, and computerized tomography of the brain. Cervical spine X-rays and personality characteristics were assessed. Simultaneously, 35 asymptomatic pilots and pilot applicants were studied as controls. Both groups were exposed to cross-coupled accelerations on a Barany chair at 15 rpm along with 0.5 Hz head flexions. The pathological group showed a straightened cervical curvature as well as a significantly higher degree of malaise (scale of Graybiel and Lackner). Their personalities were highly alexithymic or obsessive compared to the control group (Kruskal-Wallis Test). Alexithymic and obsessive personalities may express their stress reactions and psychic conflicts through somatic signs, such as cervical muscle contractures; consequently, straightening the cervical spine with the subsequent alteration of proprioceptive inputs to the vestibular nuclei may increase motion sickness susceptibility.

Adult↗