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PubMed2002

[The "AMDP-rating scale for obsessive-compulsive symptoms": The 2nd version].

The "Association of Methodology and Documentation in Psychiatry" (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version of the scale comprised 20 items on the dimensions "description", "distress and impairment" and "emotion and cognition". The item pool of the 2. version was enlarged to 44 items to accomplish a differentiated assessment of obsessions and compulsions and to assess the associated passive avoidance behaviour. The results of an empirical study (n = 141) demonstrated excellent internal consistency (Cronbach's alpha = 0,93), a split-half reliability of 0,83 (Spearman-Brown), a test-retest reliability of r = 0,84, a high interrater-reliability, a high differential validity and good convergent validity with the Hamburger Zwangsinventar (HZI) and the SCL-90-R. The results are presented and their implications on the final steps of the development of the scale will be discussed.

Adult↗
PubMed2003

Fluoxetine in Alzheimer's disease with severe obsessive compulsive symptoms and a low density of serotonin transporter sites.

The treatment of behavioral disturbances is particularly challenging in patients suffering from dementia. In an 80-year-old female patient with probable AD and severe obsessive and compulsive symptoms, we demonstrated a significant reduction in the density of serotonin transporter sites using 1231-beta-CIT SPECT. Treatment with fluoxetine for 6 months resulted in significant symptom relief and an increasing density of serotonin transporter sites when compared to the beginning of treatment. Therefore, this report provides evidence that fluoxetine is a treatment option for patients with AD and severe obsessive-compulsive symptoms and highlights the importance of the serotoninergic system.

Aged↗
PubMed2005

[Neurological soft signs in patients with obsessive-compulsive disorder].

Neurological soft signs (NSS) are minor neurological deviations signifying unspecific brain dysfunction. Several studies have reported an abnormally high prevalence of NSS in obsessive-compulsive disorder (OCD); however, the significance of their presence in OCD patients is not yet clear. We reviewed studies that investigated NSS in OCD patients, using a clinical examination or kinematical methods. In most studies, OCD patients showed an excess of NSS, especially in the areas of motor coordination, sensory integration and primitive reflexes. NSS in OCD patients may be associated with more severe obsessions as well as disturbances of visuo-spatial function and visual memory. Moreover, they may be already present at childhood, combined with anxiety disorders, thus possibly representing a marker of high risk for OCD. In conclusion, more studies are needed in order to assess both sensory and motor soft signs associated with OCD in a methodologically rigorous manner, to integrate the results with neuroimaging findings and to elucidate the role of NSS as markers of neuropsychological dysfunction in OCD.

Anxiety↗
PubMed1997

Changes in platelet markers of obsessive-compulsive patients during a double-blind trial of fluvoxamine versus clomipramine.

Abnormalities of platelet serotonin (5-HT) transporter, which are supposed to reflect similar dysfunctions in the central nervous system (CNS), have been reported in obsessive-compulsive disorder (OCD). Other platelet parameters altered in OCD are represented by phenolsulfotransferase (PST) activity, an enzyme involved in the catabolism of catecholic neuro-transmitters, and peripheral benzodiazepine receptors. Since no information is available on the behavior of these putative markers during antiobsessive treatments, the aim of the present study was to measure and compare 3H-imipramine (3H-IMI) binding, which labels the 5-HT transporter, PST activity, and 3H-PK 11,195 binding, which labels peripheral benzodiazepine receptors, in a group of 18 patients with obsessive-compulsive disorder (OCD) before and after a treatment with fluvoxamine versus clomipramine. The results showed that at baseline the patients had a decreased number of 3H-IMI binding sites, which correlated negatively with the Y-BOCS total score, an increased PST activity and no difference in 3H-PK 11,195 binding, as compared with healthy volunteers. After eight weeks of treatment with either clomipramine or fluvoxamine, which was effective in all patients, the number of 3H-IMI binding sites increased significantly toward normal values, while the PST showed no change. These findings suggest that the reduction in 3H-IMI binding sites in OCD may be related to the severity of the illness and possibly to a positive response to serotonin re-uptake inhibitors, and might be considered as a state-dependent marker, whereas the PST activity would seem to be a trait of the illness.

Adult↗
PubMed2002

Specificity of conditional associative-learning deficits in obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders.

The acquisition of conditional associations using neutral and disease-related nouns was studied in 15 inpatients with obsessive-compulsive disorder (OCD), 15 inpatients with non-OCD anxiety disorders and 15 chronic pain inpatients. Patients were comparable with respect to age, sex, depression, intelligence, executive functions, verbal and spatial memory, visuoconstructive functions, and handedness. The investigation took place in the diagnostic phase prior to the patient's beginning a standardized behavioral treatment program. It was hypothesized that anxiety patients acquired disease-related material faster than pain patients but that only OCD patients show inferior performance with respect to neutral stimuli. Results show that the three patient groups were widely comparable concerning neuropsychological background measures and showed equivalent results with respect to disease-related stimuli. But OCD patients yielded an inferior degree of performance when neutral stimuli were used whereas non-OCD anxiety disorder and pain patients displayed an equivalent degree of performance both for neutral and disease-related material, respectively. Results are discussed within the framework of obsessive-compulsive spectrum disorders.

Adult↗
PubMed2003

Declarative and procedural learning in individuals with subclinical obsessive-compulsive symptoms.

Previous neuropsychological research suggests that psychometrically defined subclinical obsessive-compulsive (OC) individuals perform worse than non-OC controls on specific tests of executive functioning. This study aimed to extend these findings by comparing the performance of 25 subclinical OC and 28 non-OC control subjects on measures of declarative learning (Rey Auditory Verbal Learning Test), motor procedural learning (star maze), spatial problem solving (single administration of the 3-disk version of the Tower of Hanoi; TH3), and "cognitive" procedural learning (repeated administrations of the 4-disk version of the Tower of Hanoi; TH4). In addition, the subjects were administered measures of general intelligence, anxiety and depression. No between-group differences were observed on measures of declarative and motor procedural learning. Subclinical OC subjects needed significantly more moves than controls to solve TH3, suggesting poorer spatial problem solving ability. A significant group x trial interaction on the TH4 suggested reduced cognitive skill acquisition in the subclinical OC group. However, performance on TH3 and TH4 was significantly correlated in the OC group but not in the control group, suggesting that the suboptimal acquisition of cognitive skills among subclinical OC subjects is more likely to be related to inefficient spatial problem solving strategies than to a cognitive procedural learning deficit per se. These results replicate and expand upon previous findings and support a dimensional model of Obsessive-Compulsive Disorder.

Adolescent↗
PubMed2001

Bilateral orbitomedial leucotomy for obsessive-compulsive disorder: a single-case study using positron emission tomography.

OBJECTIVE: The objective of this report is to correlate the clinical outcome of neurosurgery for obsessive-compulsive disorder (OCD) with regional cerebral glucose metabolic changes. CLINICAL PICTURE: The patient was a 37-year-old female patient with severe and intractable OCD. TREATMENT: The patient was treated with bilateral stereotactic lesions in the frontal white matter superior to the orbito-medial cortex. OUTCOME: She had a remarkable improvement in her obsessive-compulsive symptoms, which was sustained up to 3 years of follow up. A positron emission tomography (PET) scan performed 18 days after surgery demonstrated an obvious reduction of metabolism in the caudate head, anterior cingulate and orbital, medial and lateral prefrontal cortices and the thalamus. At 1 year postsurgery, metabolic rate was still reduced in the anterior cingulate gyrus, caudate and thalamus compared with preoperative baseline. The patient demonstrated no long-term cognitive effects of the surgery. CONCLUSIONS: This case supports some of the cortical-subcortical circuit dysfunction models of OCD and argues for the further evaluation of neurosurgery for the treatment of a severe and intractable disorder.

Adult↗
PubMed1994

Behavioral group therapy with obsessive-compulsives: an overview.

During the last two decades, effective psychotherapeutic interventions have been developed and proven successful in treating patients with Obsessive-Compulsive Disorder (OCD). Behavior therapy, using exposure to anxiety-evoking stimuli and response prevention directed toward rituals, provides lasting benefit for most patients who engage in and comply with treatment. A recent study indicated that, for certain OCD patients, these interventions could be applied successfully in a group therapy context. This article describes the general procedures used in this study to treat obsessive-compulsives with exposure and response prevention in a group context.

Behavior Therapy↗
PubMed2002

Hypothalamic digoxin deficiency in obsessive compulsive disorder and la Tourette's syndrome.

The isoprenoid pathway related cascade was assessed in 15 patients with obsessive compulsive disorder (OCD) and la Tourette's syndrome (TS). The pathway was also assessed in right hemispheric dominant, left hemispheric dominant, and bihemispheric dominant individuals to assess whether hemispheric dominance has any correlation with these disease states. The levels of serum digoxin, HMG CoA reductase activity, and dolichol were found to be decreased in OCD and la Tourette's syndrome as well as in left hemispheric dominant individuals with a corresponding increase in RBC Na(+)-K+ ATPase activity, serum ubiquinone, and magnesium levels. There was an increase in tyrosine and its catabolites, and a reduction in tryptophan and its catabolites in the serum. The total and individual glycosaminoglycan (GAG) fractions, carbohydrate residues of glycoproteins, and the concentration of glycolipids decreased in the serum. The activity of GAG degrading enzymes and glycohydrolases were decreased. The RBC membrane glycoconjugates were increased while the membrane cholesterol:phospholipid ratio was decreased. The activity of free radical scavenging enzymes increased while the concentration of free radicals decreased significantly. On the other hand, there was hyperdigoxinemia and the reverse biochemical patterns in those with right hemispheric dominance. Membrane Na(+)-K+ ATPase stimulation can result in decreased intracellular Ca2+ and increased magnesium levels. Increased levels of dopamine can lead to a tic syndrome, while reduced levels of serotonin and increased dopamine can both lead to obsessive compulsive disorder. Decrease in fucose and sialo-ligands, increased immunosuppressive morphine levels, decreased T-cell calcineurin signal transduction related to decreased intracellular calcium, reduced free radical production, and altered presentation of bacterial glycoconjugate antigens can lead to a hypoimmune response and recurrent respiratory infection in OCD patients. OCD and la Tourette's syndrome are associated with left hemispheric chemical dominance.

Cholesterol↗
PubMed2003

Quantitative EEG analysis in obsessive compulsive disorder.

Quantitative analysis of the EEG (q-EEG) in patients with obsessive compulsive disorder (OCD) showed a decreased beta and an increased theta power at frontotemporal regions. The patients who had higher scores in doubting test (Maudsley Obsessive Compulsive Questionnaire) and more severely ill patients shared similar q-EEG features. The relative theta powers were significantly increased and alpha powers were significantly decreased in these patients, particularly in the frontotemporal region. It was suggested that the q-EEG may be useful in investigating the OCD patients with heterogeneous characteristics.

Adult↗
PubMed2003

Death obsession in Kuwaiti and American college students.

Two samples of Kuwaiti (n = 460) and American (n = 273) male and female undergraduates responded to the Death Obsession Scale (DOS) in Arabic and English, respectively. Cronbach's alpha reliability statistics were .96 and .91, respectively, denoting high internal consistency. In the same vein, all the item-remainder correlations in both samples were significant denoting item validity and content validity. A general factor of death obsession was disclosed in the Kuwaiti sample, whereas two salient factors (death rumination, and death dominance and repetition) were extracted in the American sample. Gender-related differences were significant in the Kuwaiti sample, that is, females attained higher mean score than their male counterparts, whereas there were no significant gender differences in the American sample. Kuwaiti students attained significantly higher mean DOS score than their American counterparts in the total and all the individual items of the DOS.

Adolescent↗
PubMed2003

Obsessive-compulsive disorder after traumatic brain injury.

Traumatic brain injury ( TBI) neuropsychiatric sequelae are a significant cause of morbidity in TBI victims. Among the recognized sequelae are anxiety, obsessions, compulsions and obsessive-compulsive disorder (OCD). This review addresses the emergence of OCD and OCD symptoms after TBI with an emphasis on neural circuits that underlie OCD symptom expression that may be affected by the injury. Current studies suggest that post-TBI emergent psychopathology, including OCD, is influenced by underlying sub-clinical diathesis, brain injury lesions sites, environmental stressors and the rehabilitation process. Pre-morbid status can be obtained by structured psychiatric interviews, and TBI brain lesions can be defined with advanced neuroimaging techniques. This information along with the management of family and environmental stressors and the enhanced clinical identification of symptoms of anxiety and OCD can be used in the rehabilitation process to improve prognosis after TBI.

Anxiety↗
PubMedDate not supplied

A double-blind combination study of clonazepam with sertraline in obsessive-compulsive disorder.

This double blind, randomized, parallel, placebo-controlled study investigates whether clonazepam accelerates and/ or increases the overall response in patients with obsessive compulsive disorder (OCD) who are treated with sertraline. Thirty-seven patients were randomized with 20 in the sertraline and clonazepam group and 17 in the sertraline and placebo groups. Male and female outpatients, age 18-65 years, met criteria for a primary diagnosis of obsessive compulsive disorder according to DSM-IV, as determined by the structured clinical MINI interview. Appropriate safety and efficacy parameters were measured throughout the study. The determination of efficacy was based primarily on changes from baseline to the last observation taken through week 12. Analysis revealed no significant difference between groups at endpoint on the main scale.

Adolescent↗
PubMedDate not supplied

Hypochondriasis: conceptualization, treatment, and relationship to obsessive compulsive disorder.

BACKGROUND: Hypochondriasis (HC) involves preoccupation with fears of having a serious illness. The preoccupation is persistent and based on misinterpretation of benign bodily sensations. In response, patients often resort to frequent checks with doctors, of their own body, and of medical references, to reassure themselves of their health status. Some authors have likened HC to obsessive-compulsive disorder (OCD) on the basis of similarities between obsessions and illness preoccupation and the ritualistic checking behavior observed in each condition. METHODS: In this article, the phenomenology of HC is discussed in terms of factors that account for the development and persistence of this disorder. Treatment that is derived from this conceptual model is also described. RESULTS: HC is best considered as an anxiety problem in which pathological fear is focused on innocuous bodily sensations and other health-relevant cues. CONCLUSIONS: Many of the psychological mechanisms of HC are similar to those present in OCD.

Antidepressive Agents, Tricyclic↗
PubMed2005

Evaluation of an inference-based approach to treating obsessive-compulsive disorder.

This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

Adult↗
PubMed2005

Antipsychotic treatment in obsessive-compulsive disorder: a literature review.

OBJECTIVE: To review the role of antipsychotic medications in the treatment of obsessive-compulsive disorder (OCD); to explore current hypothesized conceptualizations of their mechanism of action; to highlight evolving interest in the validation of meaningful OCD subtypes within a heterogeneous spectrum of OCD, based on treatment response and other psychobiological variables. METHOD: A computerized literature search (MEDLINE: 1966 to December 2003, EMBASE: 1982 to December 2003) was used to locate relevant literature, using the terms obsessive-compulsive, antipsychotic and subtypes, with no restrictions imposed on searches. RESULTS: Earlier studies of augmentation of serotonergic antidepressants (SRIs) with typical antipsychotics including haloperidol and pimozide in OCD demonstrated favourable responses, also highlighting patient subgroups with robust treatment response. Studies examining augmentation with atypical agents are emerging. SRI-resistant OCD patients are likely to benefit from augmentation with atypical antipsychotics in around 50% of cases. CONCLUSIONS: While there is little role for antipsychotic monotherapy in OCD, there is growing evidence in support of adjunctive antipsychotics in OCD refractory to serotonin-reuptake inhibitors (SRIs). Further controlled trials are warranted. Particular subgroups of OCD patients, notably those with comorbid tic disorder and those with schizotypal personality disorder, have been shown to respond more robustly to augmentation strategies in some trials of both typical and atypical antipsychotics. Dopaminergic mediation with or without a moderating effect on serotonergic systems is likely to be important in the pharmacodynamic mechanisms of action of antipsychotic-SRI combinations in OCD.

Antipsychotic Agents↗
PubMed2006

Obsessive-compulsive spectrum of disorders: a defensible construct?

OBJECTIVE: To explore critically whether there is a robust basis for the concept of an obsessive-compulsive (OC) spectrum of disorders, and if so, which disorders should be included. METHOD: Selective literature review concentrating on three proposed members of the OC spectrum, namely body dysmorphic disorder, hypochondriasis and trichotillomania. RESULTS: Obsessive-compulsive disorder (OCD) itself is a heterogeneous condition or group of conditions, and this needs to be appreciated in any articulation of a 'spectrum' of OC disorders. The basis for 'membership' of the spectrum is inconsistent and varied, with varying level of support for inclusion in the putative spectrum. CONCLUSION: A more fruitful approach may be to consider behaviours and dimensions in OCD and OC spectrum disorders, and that this should be encompassed in further developments of the OC spectrum model.

Humans↗
PubMed2005

A comparison of the Yale-Brown Obsessive Compulsive Scale for "heavy drinking" with a single item craving measure: construct validity and clinical utility.

The measurement of alcohol "craving" began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd). The study compares its clinical utility with a single item visual-analogue craving scale. The study includes 212 alcohol dependent subjects (127 males, 75 females) undertaking an outpatient treatment program between 1999-2001. Subjects completed the Y-BOCS-hd and a single item visual-analogue scale, in addition to alcohol consumption and dependence severity measures. The Y-BOCS-hd had strong construct validity. Both the visual-analogue alcohol craving scale and Y-BOCS-hd were weakly associated with pretreatment dependence severity. There was a significant association between pretreatment alcohol consumption and the visual-analogue craving scale. Neither craving measure was able to predict total program abstinence or days abstinent. The relationship between obsessive-compulsive behavior in alcohol dependence and craving remains unclear.

Adult↗