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We report a case of combined levomepromazine-fluvoxamine treatment-induced seizures. It seems that combined treatment of fluvoxamine with phenothiazines may possess proconvulsive activity.
The purpose of this study was to determine whether mentally ill chemical abusers (MICA patients) report greater distress than do psychiatric patients who do not abuse psychoactive substances. Thirty-two MICA patients and 31 non-substance-abusing patients completed the SCL-90-R. Group comparisons indicated that MICA patients reported greater levels of somatization, depression, anxiety, obsessive-compulsiveness, paranoia, and psychotic symptoms. MICA patients also reported greater overall distress than did psychiatric patients without substance abuse problems.
The purpose of this study was to further examine the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES). A sample of normal adolescents (N = 331) aged 12 to 18 years completed the A-DES and questionnaires measuring posttraumatic stress disorder (PTSD) symptoms, other anxiety disorder symptoms, and fantasy proneness. Factor analysis indicated that the A-DES, at least in nonreferred youths, is assessing a single dimension of dissociation. Furthermore, A-DES scores are not only significantly related to PTSD symptoms but also to other anxiety disorder symptoms (i.e., generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder) and fantasy proneness. Theoretical and practical implications of these findings are briefly discussed.
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OBJECTIVE: Laxative abuse is common in patients with anorexia and bulimia nervosa and has been associated with longer duration of illness, suicide attempts, impulsivity, and greater eating and general psychopathology. We explored the extent to which laxative abuse was associated with specific psychopathological features across eating disorder subtypes. METHODS: Participants were 1021 individuals from the multisite, International Price Foundation Genetic Studies. Axis I disorders, personality disorders and traits, and obsessive compulsive features were assessed. RESULTS: Laxative abuse was associated with worse eating disorder and general psychopathology and higher prevalence of borderline personality disorder (BPD). Symptom level analyses revealed that specific features of BPD, including suicidality and self-harm, feelings of emptiness, and anger, were most strongly associated with laxative abuse. CONCLUSIONS: The function of laxative abuse may differ across individuals with eating disorders, alternatively serving as a method of purging and a form of self-harm.
Obsessive-compulsive symptoms (OCS) frequently occur in patients with Tourette syndrome (TS) and autism spectrum disorders (ASD). It has been suggested that genetic factors play a role in the transmission of both TS and ASD and that obsessive-compulsive disorder (OCD) may have some genetic relationship with these disorders. The objective of this study was to explore whether the OCS associated with TS and ASD were found in the parents of TS and ASD probands by comparing them with normal controls. The subjects were parents of 13 TS and 16 ASD probands. All parents underwent an examination for tic symptoms and OCD, and completed the Maudsley Obsessional Compulsive Inventory (MOCI) and State-Trait Anxiety Inventory (STAI). No significant differences were observed in the MOCI and STAI scores among all three groups. However, the MOCI total score was higher in fathers of ASD probands than in male normal controls with a marginal significance. There was a significant tendency for the mean cleaning score of MOCI in fathers of ASD probands to be higher than that in male normal controls, and the mean checking score in fathers of ASD probands was fourfold higher than that in male normal controls, although there was no significant difference. No significant relationship was observed between OCS in TS or ASD probands and OCS of their parents. Further studies on OCD and OCS including a dimensional approach within ASD families are needed.
The efficacy of paroxetine in the treatment of obsessive-compulsive disorder in Western populations is well established. The present study compares the efficacy and safety of paroxetine with placebo in the treatment of obsessive-compulsive disorder in Japanese patients. Patients aged 16 years or older who met Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for obsessive-compulsive disorder and had a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of >/=16 were randomized to receive 12 weeks' therapy in a double-blind manner. Paroxetine 20-50 mg/day or placebo was administered following a 1 week, placebo run-in phase. One hundred and ninety-one patients were randomized to either paroxetine or placebo, 188 patients were assessed as the full analysis set (FAS) and 144 patients completed the 12 week study. After adjustment for the Y-BOCS total score at baseline, reductions in obsessive-compulsive total score at week 6 and at the end of therapy were significantly greater in the paroxetine group than the placebo group. Most of the adverse events that occurred during the study were of mild to moderate intensity. Paroxetine is effective and well tolerated in Japanese adult patients with obsessive-compulsive disorder.
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In this study of erotic transference the phenomenon is defined in the manner of Freud (1915) and Blum (1973). It involves a circumscribed behaviour which consists of an erotic preoccupation with the therapist which often has the quality of an obsession. It is prolonged, usually for months or years, is relatively immutable, and can be seen as a milder variant of de Clerembault's syndrome. It is suggested that the psychic purpose of the preoccupation is to maintain a threatened sense of self. The erotic content of the preoccupation is likely to be a consequence of the sexualization of the early relationship with caregivers, which was impingeing and disruptive of self-development. In an illustrative case, the disturbance of this development was considered to include an impediment to the development of the transitional field, the mother herself replacing the transitional object.
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To investigate the dose-effect relationship, 106 patients received for 6 weeks under double-blind conditions randomly either 0.5 (n = 35), 1.0 (n = 35) or 1.5 mg (n = 36) fluspirilene per per week. Two patients dropped out. The main result of this study was the verification of a clear dose-effect relationship. There is a difference between all three dosage groups after 6 weeks. Improvement with 0.5 mg fluspirilene was far more seldom (17 of 35) than with 1.0 mg (25 of 33) and very much more frequent with 1.5 mg (30 of 36). This was confirmed with the three scales of the Hamilton Anxiety Scale. The clear dose-effect relationship was also shown on the subjective 'Eigenschaftswörterliste' scales of elation, self-confidence, introversion, anxiety, vulnerability and depression. The tolerance of all doses in this study was good and did not differ. Nevertheless, the findings from earlier studies were reproduced, according to which a poorer tolerance is combined with a poorer therapeutic efficacy. It was worked out in the discussion that patients who improved subjectively and according to the physician's assessment after 14 days of treatment also showed a good response after a longer period of treatment.
The authors used symptom profiles, demographic data, and other variables to compare 316 patients representing all specific DSM-III anxiety disorders except posttraumatic stress disorder to each other and to published norms for both an unselected psychiatric outpatient population and normal subjects. The results support the grouping of these disorders, with the possible exception of obsessive-compulsive disorder, into one general diagnostic category of "anxiety disorders." The distinction between the specific diagnoses of simple phobia and social phobia was also supported; however, the differentiation between panic disorder, agoraphobia, and generalized anxiety was only weakly supported.
Sixteen outpatients who met DSM-III criteria for obsessive-compulsive disorder completed a 20-week double-blind, crossover trial with fluvoxamine and placebo. Thirteen (81%) improved with fluvoxamine, while three (19%) improved with placebo. Fluvoxamine treatment was associated with significant improvement on measures of obsessive-compulsive symptoms, anxiety, and depression. Depressed subjects' improvement on obsessive-compulsive measures correlated with improvement in symptoms of depression. Nondepressed subjects also showed improvement on measures of obsessive-compulsive symptoms. In this trial, fluvoxamine was an effective and safe treatment for obsessive-compulsive disorder.
Ten obsessive-compulsive patients received single-blind treatment with fluvoxamine, a selective serotonin reuptake inhibitor, for several weeks following at least 2 weeks of placebo. The group showed significant improvement, as measured by several clinical scales and self-ratings; six patients were judged responders. Fluvoxamine appears effective in treating severe obsessive-compulsive disorder.
The authors compared scores on the Toronto Alexithymia Scale and the Anxiety Sensitivity Index of 27 patients with panic disorder and 31 patients with obsessive-compulsive disorder. Results suggest that patients with panic disorder constrict emotional experience, thereby reducing the likelihood of their experiencing physiological symptoms that accompany affect.
OBJECTIVE: Tourette's syndrome is a chronic disorder of childhood onset that is characterized by motor and phonic tics and a broad range of associated behavior including obsessive-compulsive symptoms. Less well appreciated are the sensory and other perceptually tinged mental phenomena associated with both tic and compulsive behavior. This cross-sectional study evaluated the "just-right" phenomena commonly associated with compulsive behavior in subjects with tic disorders. METHOD: A total of 134 subjects with tic disorders, aged 9 to 71 years, completed a questionnaire concerning their current and past tic symptoms. Subjects were also asked to describe their "just right" perceptions. The Yale-Brown Obsessive Compulsive Scale was used to assess severity of current obsessive-compulsive symptoms. RESULTS: Eight-one percent of the subjects with both Tourette's syndrome and obsessive-compulsive disorder (N = 31) and 56% of the subjects with Tourette's syndrome and obsessive-compulsive symptoms (N = 61) reported being aware of a need to perform compulsions until they were "just right." This awareness most commonly referred to visual or tactile (as opposed to auditory) features of the compulsive act or its consequences. Three-quarters of the subjects with these perceptions reported that they usually were aware of them immediately before or concurrently with the initiation of compulsions. CONCLUSIONS: While epidemiological studies of tic disorders and obsessive-compulsive disorder have yet to incorporate questions concerning "just right" perceptions, these results suggest that such perceptions may be commonplace in adolescent and adult subjects with both obsessive-compulsive disorder and tic disorders. They also implicate brain regions involved in the processing of sensorimotor information in the pathobiology of tic disorders.
OBJECTIVE: This study evaluates the clinical response to olanzapine used in association with selective serotonin reuptake inhibitors (SSRIs) or clomipramine in treatment-resistant obsessive-compulsive disorder (OCD). METHODS: We describe the cases of 9 patients with serotonin uptake inhibitor-resistant OCD who were given an open-label adjunctive treatment of olanzapine for a minimum of 6 weeks. The response was assessed by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale (CGI). RESULTS: Six patients showed improvement of symptoms after the augmentation with olanzapine. One patient (treated with clomipramine) discontinued olanzapine due to side effects, and another 2 did not respond. CONCLUSION: Olanzapine augmentation of SSRIs in treating OCD showed a good (two-thirds) response rate, and it could therefore be considered as a treatment option when conventional therapies have failed.