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PubMed2003

Fluoxetine decreases stereotypic behavior in primates.

BACKGROUND: Primates reared in captivity may display stereotypic behaviors. These behaviors are arguably reminiscent of human obsessive-compulsive or posttraumatic symptoms, which respond to selective serotonin reuptake inhibitors (SSRIs). Captive primates with marked stereotypic behaviors were entered into a randomized controlled study of the SSRI, fluoxetine. METHODS: A sample of 10 vervet monkeys with behaviors such as marked saluting, somersaulting, weaving, or head tossing was selected. Subjects were randomized to receive fluoxetine 1 mg/kg for 6 weeks (n=5) or no treatment (n=5). A rater blind to the medication status of subjects noted the frequency of the stereotypic behaviors. RESULTS: Repeated-measures analysis of variance (RM-ANOVA) demonstrated a significant GroupxTime difference with significantly fewer stereotypic symptoms in the fluoxetine group by endpoint. At this time, three of the five fluoxetine-treated subjects (but none of the no-treatment subjects) were responders on the Clinical Global Impressions (CGI) change item (CGI < or =2). CONCLUSIONS: Stereotypic behaviors in captive vervets gradually and partially decrease in response to administration of an SSRI, paralleling research on human anxiety symptoms. Further research on animal stereotypies may be useful in providing appropriate veterinary care, and in exploring the underlying neurobiology of certain psychiatric disorders.

Animals↗
PubMed1993

The genetics of the Gilles de la Tourette syndrome: a review.

The Gilles de la Tourette syndrome (GTS) is a hereditary, neuropsychiatric-neurobehavioral disorder with childhood onset that is characterized by motor and vocal tics that may vary from relatively mild to very severe. The exact pathogenesis is still unknown. Following anecdotal reports of familial occurrence, systematic family studies have been carried out since 1980 to establish the mode of inheritance and ultimately to map and clone the susceptibility gene(s). Currently, as a result of combined North American, English, and Dutch studies, the most accepted genetic model is an autosomal dominant pattern of inheritance with incomplete penetrance and a variable expression. The objective of linkage studies is to "link" a particular DNA sequence (with known chromosomal localization) with the disease in all affected family members. Essential for these gene mapping studies is a clear and rigorous definition of the phenotype. Such studies are vastly more difficult if the disease phenotype is ambiguous, proper subject assignment being clouded by incomplete penetrance, cases mild enough to escape detection, or genetically unrelated but highly associated traits. Indeed, because of just these features, the initial optimism about the "well-defined and easy-to-objectivate" phenotype of GTS has gradually been tempered. The tics vary in frequency and severity, are frequently suppressed during examination, or might go unnoticed when associated behavioral symptoms like disturbed impulse control, obsessive-compulsive disorder and attention deficit disorder with hyperkinesia (among others) dominate the clinical picture. Whether these associated behavioral symptoms are a part of the phenotype remains to be established.(ABSTRACT TRUNCATED AT 250 WORDS)

Adoption↗
PubMed1993

Inpatient treatment of patients with severe obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder may experience severely disabling symptoms and require hospitalization. Based on treatment of 77 such patients admitted to a long-term general psychiatric research unit over a seven-year period, the authors present pharmacologic, psychosocial, and behavioral management strategies for treating these patients on general psychiatric units. The treatment guidelines require only modest modifications of standard practice and can be adapted for use on general units without specialized staff training. Some patients with obsessive-compulsive disorder exhibit strong control and dependency needs and disrupt the milieu in characteristic ways. These patients may generate conflict among staff about whether the patients can control obsessive-compulsive behaviors; they may anger other patients because of the large amount of staff attention they demand. Educating staff about obsessive-compulsive patients' control and dependency needs and enlisting the support of fellow patients can improve the milieu.

Adult↗
PubMed1988

Coprolalia in obsessive-compulsive disorder: a missing link.

Although recent clinical research has emphasized the relationship between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD), coprolalia, the most dramatic of the TS symptoms, has not been described in DSM-III OCD. The case presented here shows that coprolalia can indeed occur in OCD. This finding further erodes the phenomenological distinction between these two disorders. It also supports the role of psychological factors in the genesis of tic symptomatology.

Adult↗
PubMed2005

Tourette syndrome: not just a tic disorder.

Although tics are considered the hallmark of Tourette syndrome, arguably tics may not be the only or primary presenting symptom. For many children diagnosed with Tourette syndrome irritability, frustration intolerance, hyperactivity, inattention, ritual behavior or other difficulties may have been present a number of years before the appearance of tics. Children with Tourette syndrome are often highly co-morbid with attention deficit-hyperactivity disorder, obsessive compulsive symptoms, and other related behavioral problems that should be detected and treated effectively. Therefore tics should not be the sole indicator or receive over emphasis in the detection and treatment of Tourette syndrome.

Child↗
PubMed2002

[Clinical aspects of "folie du doute"].

"Folie du doute" related to obsessive disorders manifests with doubts about managing habitual actions, reality of what is happening and existence of surrounding subjects; ruminations, indecision emerged as incapability to choose a definite behavior line. Sixty-six patients, 27 men and 39 women (mean age 31.3 years) have been examined. Three clinical "folie du doute" variants were distinguished: "repeated control" obsessions (doubts are realized by re-control of the actions committed); obsessive doubts defined by contrastive ideas of expedience for choosing the approach contrastive to the taken decision; anxious ruminations (lack of assurance in the past actions and obsessive doubts of the variants supposed-to-be). "Folie du doute" emerged in different psychic disorders, the first variant manifesting in the scope of neurotic-like schizophrenia; the second one--in psychogenic states or psychogenically-provoked exacerbations of psychopathic-like schizophrenia; the third one being regarded in the structure of cyclothymiac's depressive phases. In the clinical contest, "folie du doute" manifestation proves to be unfavorable prognostic marker.

Adult↗
PubMed1993

Diagnosis and fluoxetine treatment of compulsive behavior disorder of adults with mental retardation.

A set of research diagnostic criteria was developed to identify potential obsessive-compulsive disorders among individuals with mental retardation and aberrant behaviors. The behavior disorders of 10 subjects who met criteria for compulsive behavior disorder and 6 subjects who did not (comparison subjects) were treated using the medication fluoxetine. All subjects were evaluated using an A-B open-trial method with 4-month baseline and treatment phases. Seven of the 10 subjects with compulsive behavior disorder responded favorably to fluoxetine treatment; none of the comparison subjects responded favorably to this medication. Further, there appeared to be a relation between manifest motor stereotypies, compulsive behaviors, and response to fluoxetine.

Adult↗
PubMed2002

Treatment of late-onset OCD following basal ganglia infarct.

Current consensus on the treatment of obsessive-compulsive disorder (OCD) includes cognitive behavior therapy (CBT) in the form of exposure and response prevention (ERP). However, the generalizability of these methods to elderly populations remains largely undocumented. This clinical case study examines the effectiveness of medications and intensive, inpatient ERP in an elderly patient with onset of OCD following basal ganglia infarcts. There was a dramatic reduction from baseline to follow-up in both obsessions and compulsions with Yale-Brown Obsessive-Compulsive Scale [YBOCS; Goodman et al., 1989] total scores decreasing by over 20 points. These gains were maintained up to 1 year post-treatment. Age-specific issues and the application of standard therapeutic methods to elderly clients are discussed.

Aged↗
PubMed1998

Psychogenic seizures in obsessive-compulsive disorder with poor insight: a case report.

Psychogenic seizures or psychogenic nonepileptic seizures occur in various mental disorders. Obsessive-compulsive symptoms can also imitate epileptic partial seizures, but detailed observations of this phenomenon are rare in the literature. A girl of 13 years was referred to the Department of Child Psychiatry because of sudden falls that had occurred during a 1-year period, mainly at school. She had been diagnosed previously as having epilepsy or conversion seizures. After a fall, she demonstrated no response for periods up to 10 minutes, postictal somnolence had occasionally been observed. From the age of 10 years, the patient was reported to have had intrusive recurrent thoughts about dirt and contamination and had also demonstrated some signs of separation anxiety disorder. She was diagnosed as having obsessive-compulsive disorder with poor insight. The chronic falling disappeared completely when behavioral therapy was begun, but the girl still exhibits obsession and separation anxiety.

Adolescent↗
PubMed1993

CSF somatostatin in obsessive-compulsive disorder.

OBJECTIVE: Because the central administration of somatostatin to experimental animals produces behaviors with some similarities to the compulsions of patients with obsessive-compulsive disorder and because serotonin reuptake inhibitors have been reported to reduce brain content of somatostatin, the authors examined central somatostatin activity in patients with obsessive-compulsive disorder. METHOD: CSF for measurement of somatostatin was obtained from 15 drug-free outpatients with obsessive-compulsive disorder and 27 normal volunteers. RESULTS: The mean CSF somatostatin level was significantly higher in the patients with obsessive-compulsive disorder than in the normal subjects. CONCLUSIONS: Although the functional significance of this finding is unknown, these data are consistent with a role for somatostatin in the clinical symptomatology of obsessive-compulsive disorder and its response to neuropharmacological agents. The high levels of CSF somatostatin reported here in a patient subgroup whose predominant symptoms consisted of overly focused, perseverative thought processes are in contrast to the consistently low levels of CSF somatostatin seen in patients with a spectrum of disorders characterized by substantial cognitive deficits.

Adolescent↗
PubMed1987

Serotonergic responsivity in obsessive-compulsive disorder. Comparison of patients and healthy controls.

To examine the "serotonin hypothesis" of obsessive-compulsive disorder (OCD), we studied the behavioral and neuroendocrine effects of metachlorophenylpiperazine (mCPP), a serotonergic agonist, in patients with OCD and healthy controls. Twelve patients and 20 controls were given a single dose of 0.5 mg/kg of mCPP, administered orally under double-blind, placebo-controlled, random-assignment conditions. Following mCPP, but not following placebo, patients with OCD experienced a transient but marked exacerbation of obsessive-compulsive symptoms. Moreover, compared with healthy controls, patients exhibited greater other behavioral (but not endocrinologic or thermal) changes after mCPP. These findings are consistent with a special role for the neurotransmitter serotonin in OCD psychopathology.

Adult↗
PubMed2000

Obsessive and compulsive symptoms in schizophrenia: a randomized controlled trial with fluvoxamine and neuroleptics.

Obsessive-compulsive-related disorders are frequently comorbid with schizophrenia. The existence of obsessive and compulsive symptoms in patients with schizophrenia represents one of the most severe types of psychotic disorders and may predict a poor prognosis in most cases. Previous pilot studies and case reports have shown that the condition of some patients with schizophrenia did not exacerbate and even improved when serotonin reuptake inhibitors (SSRIs) were added to their standard neuroleptic regimen. The aim of this study was to evaluate the efficacy of a combination treatment of an SSRI (fluvoxamine) and standard neuroleptics for the treatment of obsessive-compulsive (OC) symptomatology in patients with schizophrenia compared with administration of neuroleptics only. Thirty inpatients who met DSM-IV criteria for schizophrenia and also had prominent OC symptoms were randomly divided into two groups. Fourteen patients were treated with conventional neuroleptics and fluvoxamine in doses of 100 to 200 mg/day for 8 weeks. Sixteen patients comprised a control group and received only their previous therapeutic neuroleptic therapy. The patients were assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Scale (CGI) at baseline and endpoint. Side effects were assessed weekly. The data were analyzed using an analysis of variance. A considerable reduction in PANSS (34.3%) and Y-BOCS (29.4%) scores was noted, and CGI scores decreased moderately in both groups. None of the patients showed an acute exacerbation at the end of the study. Side effects were mild and easily tolerated in most patients. This open, randomized, controlled study reveals that coadministration of fluvoxamine, an SSRI, and neuroleptics in patients with schizophrenia and OC symptoms was associated with specific improvements of these symptoms. Thus, the use of an SSRI in treating a patient with schizophrenia and OC symptomatology may be warranted and safe. Other implications of the findings, including general safety of the combined pharmacotherapy and the use of new antipsychotic medications, are also discussed.

Adult↗
PubMed2005

Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive-compulsive disorder: a 5-year follow-up.

BACKGROUND: Information regarding the long-term effectiveness of the combination of pharmacotherapy and cognitive-behavioral therapy (CBT) in the treatment of obsessive-compulsive disorder (OCD) is limited. Our study is the first to examine the long-term effectiveness of cognitive therapy (CT) and to compare long-term effectiveness of CT alone, exposure in vivo with response prevention (ERP) alone, and CBT (either CT or ERP) in combination with fluvoxamine in the treatment of OCD. METHOD: Of 122 outpatients with primary DSM-III-R-defined OCD originally enrolled in 2 randomized controlled trials, 102 patients (45 male/57 female; mean +/- SD age = 36.2 +/- 10.7 years; range, 19-64 years) were available to be assessed for the presence and severity of OCD and comorbid psychopathology at follow-up. Follow-up data were collected from November 1996 to June 1999. RESULTS: After 5 years, 54% of the participants no longer met the DSM-III-R criteria for OCD. Long-term outcome did not differ between the 3 treatment groups. At follow-up, treatment dropouts appeared to have more severe OCD complaints compared with treatment completers. Compared with patients receiving CT alone, significantly (p < .005) more patients receiving CBT with fluvoxamine used antidepressants 5 years later. CONCLUSIONS: This study demonstrates that at 5-year follow-up (1) prevalence of OCD had declined in all 3 treatment conditions, (2) the clinical benefits of all 3 treatment conditions were maintained, (3) OCD complaints were more severe for treatment dropouts than for treatment completers, and (4) about half of the patients initially treated with fluvoxamine continued antidepressant use.

Adult↗
PubMed1984

Are religious compulsions religious or compulsive: a phenomenological study.

Religious compulsions in four patients are presented to show the phenomenological similarities and differences between religious and compulsive rituals. The role of religious ritual observance in predisposing to obsessive-compulsive neurosis is discussed and minor modifications in the usual course of behavioral treatment are suggested. The proportion of religious compulsions among obsessive-compulsive neurotics is compared with two other populations studied.

Adult↗