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PubMed2006

A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men.

OBJECTIVE: Compulsive sexual behavior (CSB) is a condition characterized by loss of control over sexual behavior and repeated negative consequences, including unsafe sex. Selective serotonin reuptake inhibitors have been found to reduce CSB symptomatology in open-label trials. The objective of this study was to conduct a preliminary double-blind, placebo-controlled evaluation of the efficacy, acceptability, and tolerability of citalopram in the treatment of CSB. METHOD: Twenty-eight men who have sex with men who met the threshold for CSB on the basis of existing validated measures participated in a 12-week, double-blind trial of citalopram 20 to 60 mg/day to evaluate its effects on CSB symptoms. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale-Compulsive Sexual Behavior. The study was conducted from June 2002 to April 2004. RESULTS: Significant treatment effects were obtained for sexual desire/drive (p < .05) and frequency of masturbation (p < .01) and pornography use (p < .05). Both groups reduced sexual risk, but did not differ significantly. CONCLUSIONS: This study provides partial support for the effectiveness of citalopram for reducing symptoms of CSB in this population. Larger-scale trials are recommended to determine the public health benefits of this treatment.

Adult↗
PubMed1995

Kleptomania, compulsive buying, and binge-eating disorder.

Although recognized since at least the early 19th century, kleptomania, compulsive buying, and binge-eating disorder are poorly understood conditions that have received little systematic study. In this article, we review the available studies of these three conditions, which suggest that they are more common than realized, occur more frequently in women than in men, cause significant morbidity, are related to other psychiatric disorders (especially to one another, impulse control disorders, obsessive-compulsive disorder, and mood disorders), and often respond to available psychopharmacologic and psychological treatments. We hypothesize that these three conditions might best be viewed as impulse control disorders that belong to an extended family of compulsive-impulsive spectrum disorders. The compulsive-impulsive spectrum disorders may, in turn, belong to the larger family of affective spectrum disorder.

Adolescent↗
PubMed1991

A double-blind comparison of clomipramine and desipramine treatment of severe onychophagia (nail biting).

Twenty-five adult subjects with severe morbid onychophagia (nail biting) and no history of obsessive-compulsive disorder were enrolled in a 10-week double-blind cross-over trial of clomipramine hydrochloride and desipramine hydrochloride. For the 14 subjects who completed the study, clomipramine hydrochloride (mean +/- SD dose, 120 +/- 48 mg/d) was superior to desipramine hydrochloride (mean +/- SD dose, 135 +/- 53 mg/d) in decreasing nail biting as measured by a repeated-measures analysis of variance on the Nail Biting Severity, Nailbiting Impairment, and Clinical Progress scales. The high dropout rate at every stage of the study was in sharp contrast to that seen with psychiatric populations. From a neuroethologic perspective, similar biologic systems are hypothesized to mediate a spectrum of grooming behaviors, including onychophagia, trichotillomania, and obsessive-compulsive disorder.

Adult↗
PubMed2005

The A-OCDS predicts both craving and alcohol cue reactivity in adolescent alcoholics.

Adolescents with alcohol dependence may experience marked craving and physiologic reactivity in the presence of alcohol cues which could undermine treatment gains. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed to help quantify the severity of alcohol craving in adolescents with alcohol use disorders. The A-OCDS is a relatively new instrument, and empirical data are needed to support its value in clinical trials. The present investigation uses data collected as part of a clinical laboratory study examining alcohol craving and cue reactivity in adolescents with and without alcohol dependence. A-OCDS total and subscale scores from adolescent alcoholics (N = 28) were examined regarding their relationship to drinking and several indices of craving and alcohol cue reactivity. In addition, regression analyses were performed to characterize the predictive ability of A-OCDS total scores and drinking indices (drinks per drinking day and percent days abstinent) on two measures of alcohol craving and cue reactivity. Results showed that the A-OCDS total scores, but not drinks per drinking day or percent days abstinent, predicted scores on both indices of craving. The study uses a small but well-defined sample of adolescents with alcohol dependence and supports the construct validity of the A-OCDS and suggests that, as in adults, alcohol craving and drinking behavior are related but separate elements of alcohol dependence. The results are intended to guide future studies in which the A-OCDS may be employed to measure craving and changes in craving over the course of treatment for adolescents with alcohol dependence.

Adolescent↗
PubMedDate not supplied

Dental management considerations in children with obsessive-compulsive disorder.

Children suffering from obsessive-compulsive disorder frequently manifest bizarre behaviors that contribute to the development of oral pathology. The medications used in management of the disorder can cause profound xerostomia and compound the magnitude of oral disease. An understanding of the diagnosis and treatment of the disorder will better prepare the dentist to meet the needs of this unique group of patients.

Child↗
PubMed1987

[Complex use of benzodiazepines, lithium salts and haloperidol in the treatment of obsessive movements and tics of different origin].

Seventy-two children and adolescents with obsessive movements and tics of residual-organic etiology were treated by combined application of benzodiazepins (diazepam, phenazepam), lithium carbonate and haloperidol. The nature of obsessive syndromes and tics is considered in the light of the theory of generator mechanisms of neuropathological syndromes. The use of the studied combination due to its synergic action on the structures of the pathological system elicited a good therapeutic response while using lower doses of each drug (half to two-thirds of the conventional age-specific dosage). Reduction in drug doses in combined therapy decreases the risk of side effects and complications. The above treatment was followed by disappearance of essential and facultative symptoms in 21 patients, considerable improvement with a marked reduction of facultative symptoms in 22 cases, clear-cut improvement in combination with decreased facultative symptomatology in 14 patients, and insignificant improvement in 6 patients.

Adolescent↗
PubMed1984

A rapid multi-component treatment for an obsessive-compulsive disorder.

A 67-yr-old woman with a 45-yr history of obsessive-compulsive problems related to fear of contamination was treated rapidly by a multi-component intervention. Questionnaire data following treatment showed the patient to be free of obsessive-compulsive complaints, and these were corroborated by behavioral observations. Follow-up probes conducted 6, 12 and 18 months later revealed continued maintenance of treatment gains. Patient-therapist contact time totalled 6 hr, about one-third of the time employed by Marks for exposure and response prevention, indicating the cost-effectiveness of a multi-component treatment intervention.

Aged↗
PubMed2005

Rituals, stereotypy and compulsive behavior in animals and humans.

From a survey of the behavior of animals in the wild, in captivity, under the influence of psychoactive drugs and in a model of obsessive-compulsive disorder (OCD), we identify that the behavioral repertoire invariably includes motor rituals, and that such rituals are performed at a few specific locations/objects in the environment with an orderly transition amongst locations/objects. The concept and parameters of this stable organization of rituals in time and space were used to analyze rituals of OCD patients, compared with control individuals performing the same actions (e.g. car locking). It was found that human rituals also converged to a few places/objects where repetitive acts were performed in a regular order, with the acts in OCD patients overlapping with those of control individuals. Across a very diverse range of animals and conditions, motor rituals are thus characterized by their close linkage to a few environmental locations and the repeated performance of relatively few acts. Such similarity in form may reflect a similarity in the mechanisms that control motor rituals in both animals and humans.

Animals↗
PubMed2002

Co-occurrence of obsessive-compulsive personality traits in young and middle-aged Japanese alcohol-dependent men.

BACKGROUND: Previous studies may have underestimated the potential importance of the prevalence of obsessive-compulsive traits among persons with alcoholism. Although many studies have examined the characteristics of young alcoholics compared with middle-aged alcoholics, none has compared the prevalence of obsessive-compulsive traits in young and middle-aged alcoholics. METHODS: This study compared the prevalence of obsessive-compulsive traits (Leyton Obsessional Inventory) and depressive symptoms (Zung Self-Rating Depression Scale) among young (n=41) and middle-aged (n=34) hospitalized Japanese male alcoholics and in young (n=28) and middle-aged (n=25) nonalcoholic subjects. RESULTS: Both young and middle-aged male alcoholics reported more obsessive-compulsive personality traits and depressive symptoms than their comparison groups. However, the alcoholic subjects' obsessive-compulsive personality traits were not related to their level of depressive symptoms. CONCLUSIONS: Young and middle-aged male Japanese alcoholics have more obsessive-compulsive personality traits than nonalcoholic males of similar ages. Their alcohol-related psychological and behavioral characteristics may derive, in part, from their obsessive-compulsive symptoms.

Adult↗
PubMed2006

Mood disorders and Gilles de la Tourette's syndrome: An update on prevalence, etiology, comorbidity, clinical associations, and implications.

Gilles de la Tourette's syndrome (GTS) consists of multiple motor tics and one or more phonic tics. Psychopathology occurs in approximately 90% of GTS patients, with attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) being common. Depression is common, with a lifetime risk of 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of GTS patients attending specialist clinics, respectively. In controlled studies embracing over 700 GTS patients, the patients were significantly more depressed than controls in all but one instance. In community and epidemiological studies, depression in GTS individuals was evident in two of five investigations. Clinical correlates of depression in people with GTS appear to be: tic severity and duration, the presence of echophenomena and coprophenomena, premonitory sensations, sleep disturbances, obsessive-compulsive behaviors/OCD, self-injurious behaviors, aggression, conduct disorder (CD) in childhood, and, possibly, ADHD. Depression in people with GTS has been shown to result in a lower quality of life, potentially leading to hospitalization and suicide. The etiology of depression appears to be multifactorial. Bipolar affective disorder (BAD) and GTS may be related in some individuals. However, it is noted that sample sizes in most of these studies were small, and it is unclear at the present time as to why BAD may be overrepresented among GTS patients.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

Vasopressin-dependent flank marking in golden hamsters is suppressed by drugs used in the treatment of obsessive-compulsive disorder.

BACKGROUND: Alterations in arginine vasopressin regulation and secretion have been proposed as one possible biochemical abnormality in patients with obsessive-compulsive disorder. In golden hamsters, arginine vasopressin microinjections into the anterior hypothalamus trigger robust grooming and flank marking, a stereotyped scent marking behaviors. The intensity and repetition of the behaviors induced by arginine vasopressin is somewhat reminiscent of Obsessive Compulsive Disorder in humans. The present experiments were carried out to test whether pharmacological agents used to alleviate obsessive compulsive disorder could inhibit arginine vasopressin-induced flank marking and grooming. RESULTS: Male golden hamsters were treated daily for two weeks with either vehicle, fluoxetine, clomipramine, or desipramine (an ineffective drug), before being tested for arginine vasopressin-induced flank marking and grooming. Flank marking was significantly inhibited in animals treated with fluoxetine or clomipramine but unaffected by treatment with desipramine. Grooming behavior was not affected by any treatment. CONCLUSION: These data suggest that arginine vasopressin-induced flank marking may serve as an animal model for screening drugs used in the control of Obsessive Compulsive Disorder.

Adrenergic Uptake Inhibitors↗
PubMed2005

Reductions in and relations between "craving" and drinking in a prospective, open-label trial of ondansetron in adolescents with alcohol dependence.

Recently, we reported that ondansetron (a 5-HT3 antagonist) as an adjunct to cognitive behavioral therapy (CBT) produced significant within-group decreases (improvement) in drinking in adolescents with alcohol dependence. We previously have hypothesized that the mechanism of ondansetron treatment response in adolescents with alcohol dependence should be similar to early onset adult alcoholics, wherein blockade of serotonin-3 receptors may decrease dopamine release and subsequent alcohol consumption and craving. We now suggest that one mechanism by which ondansetron diminishes drinking in adolescents with alcohol dependence is through a reduction in "craving" as measured by the Adolescent Obsessive-Compulsive Drinking Scale (A-OCDS). We conducted an 8-week, prospective, open-label study of ondansetron (4 microg/kg b.i.d.) in 12 adolescents (age 14-20 years) who had alcohol dependence. Results showed that "irresistibility" and total scores as measured by the A-OCDS were correlated significantly with drinking indices (drinks/day, percent days abstinent) at the end of treatment, and that "irresistibility" and total A-OCDS scores decreased significantly by the end of treatment. These preliminary results suggest that the A-OCDS can be useful as an outcome measure in clinical studies of adolescents with alcohol dependence.

Adolescent↗
PubMed1997

Hoarding symptoms in patients on a geriatric psychiatry inpatient unit.

BACKGROUND: While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised. METHODS: The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored. RESULTS: Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients. CONCLUSIONS: A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.

Aged↗
PubMed1997

HMPAO SPET does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette's syndrome.

BACKGROUND: Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas. METHODS: Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET. RESULTS: There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion. CONCLUSIONS: Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.

Adolescent↗
PubMed2005

[Epidemiology of obsessive-compulsive disorder: a review].

Epidemiological surveys are important because clinical samples are subject of several selection biases. Sociodemographic factors and clinical aspects of the morbid condition itself influence help seeking behaviors. Due to the egodystonic nature of obsessive-compulsive disorder, sufferers tend to hide their symptoms and avoid or delay treatment seeking. However, most of our current knowledge about obsessive-compulsive disorder is based on clinical samples, which do not represent the totality of cases. A conventional Medline, PsychoInfo and Lilacs review of epidemiological studies on obsessive-compulsive disorder from 1980 to 2004 was conducted, using the following keywords: "epidemiology", "obsessive-compulsive disorder", "populational surveys" and "prevalence". Studies from different countries show an average point-prevalence of 1% and lifetime prevalence of 2-2.5% for obsessive-compulsive disorder. In contrast with clinical samples, most populational samples have a predominance of females and cases with only obsessions. The frequent comorbidity with other mental disorders, particularly depression and other anxiety disorders, has also been found in cases from the community, which have an association with substances misuse as well. Many sufferers are not been treated, particularly the "pure" cases. Indicators of functional incapacitation show a considerable negative impact of obsessive-compulsive disorder. It is necessary to increase the awareness about obsessive-compulsive disorder symptoms in the community and among health professionals, in order to increase help seeking, as well as the proper identification and treatment of this rather serious medical condition.

Comorbidity↗