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Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.
This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psychotherapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders "cross over" and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.
OBJECTIVE: This study examined the relationship between behavioural inhibition, insecure mother-child attachment and evidence of anxiety in the offspring of mothers with anxiety disorders. METHOD: Twenty children aged 18 to 59 months who were born to 18 mothers with diagnosed anxiety disorders were examined for behavioural inhibition (Kagan's measures) and mother-child attachment (Strange Situation Procedure). Child anxiety was assessed using DSM-III-R criteria and the Child Behavior Checklist (CBCL). RESULTS: Sixty-five percent of the children were behaviourally inhibited. They showed more somatic problems and fewer destructive behaviours than those who were not inhibited. Eighty percent of the children were insecurely attached. They had higher CBCL internalizing scores than secure children and three of them met diagnostic criteria for anxiety disorders. CONCLUSION: Though preliminary, this work suggests a need to identify children of anxious mothers as being at risk for anxiety, especially in the presence of inhibited temperament or attachment difficulties.
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The present investigation was intended principally as a concurrent validation study for a new self-report symptom inventory: the SCL-90. A sample of 209 'symptomatic volunteers' served as subjects and were administered both the SCL-90 and the MMPI prior to participation in clinical therapeutic drug trials. The MMPI was scored for the Wiggins content scales and the Tryon cluster scales in addition to the standard clinical scales. Comparisons of the nine primary symptom dimensions of the SCL-90 with the set of MMPI scales reflected very high convergent validity for the SCL-90. Peak correlations were observed with like constructs on eight of the nine scales, with secondary patterns of correlations showing high interpretative consistency.
Psychiatric descriptions of bodily symptoms have usually been derived from narrowly restricted clinical experience. It is argued that it is more useful to review evidence from all medical settings and occurrence, nature, disability and presentation are here discussed. Syndromes of hypochondriacal reactions appear to be extreme and uncommon manifestations of a universal potential.
Analyses were undertaken to examine whether a wide range of psychiatric disorders, including anxiety, affective, substance abuse and psychotic disorders, represent variant manifestations of Tourette's syndrome (TS). Previous studies have suggested that chronic tics (CT) and obsessive-compulsive disorder (OCD) are variant expressions of TS since both CT and OCD are elevated among relatives of TS probands. In the current study, no other psychiatric disorder was significantly elevated among the relatives who did not have TS, CT or OCD when compared with a control sample. These findings are not consistent with the hypothesis that a wide range of psychiatric and behavioural disorders are variant expressions of TS.
OBJECTIVE: The relationship between alcohol dependence and lifelong major anxiety disorders is complex. The literature indicates a close association between anxiety symptoms and drinking behavior. However, it is difficult to determine whether the anxiety conditions are lifelong disorders or if they represent temporary organic conditions related to alcohol intoxication and withdrawal. One approach to understanding more about the relationships between alcohol dependence and major anxiety disorders is to observe the rate of anxiety-related diagnoses in close relatives of alcoholics. This approach evaluates whether alcoholism and major anxiety disorders might share a common genetic basis. METHOD: The data presented here describe the rates of four major anxiety disorders in 591 interviewed first-degree relatives of alcohol dependent men and women. The data were gathered through face-to-face structured standardized interviews. RESULTS: The analyses reveal that after focusing on DSM-III-R anxiety disorders, controlling for the potential presence of temporary organic conditions in the subject and considering the impact of assortative mating in their parents, the life-time risk for panic disorder in close biological family members of alcoholics is 3.4%; for agoraphobia, 1.4%; for social phobia, 2.3%; and for obsessive-compulsive disease, 1.4%. CONCLUSIONS: These data do not indicate an exceptionally high rate of anxiety disorders among close relatives of alcoholics. While other mechanisms might contribute to relationship between alcoholism and major anxiety disorders, the results do not support evidence of a common genotype for the two disorders.
OBJECTIVE: The co-occurrence of mania with other medical and psychiatric disorders has been little studied. The authors reviewed the literature in order to clarify the current state of knowledge of this subject and to identify possible areas of future research. METHODS: Published articles which specifically addressed associations of mania with medical disorders and other psychiatric syndromes were identified using the Paperchase medical literature search system and by cross-referencing from other published work. The articles were then organized into three categories: 1) medical disorders associated with secondary mania; 2) medical comorbidity in bipolar disorder; and 3) psychiatric comorbidity in bipolar disorder. RESULTS: The review of medical illness and secondary mania supports the hypothesis that injuries involving right-side and mid-line brain structures are associated with so-called secondary mania. Additionally, an association between bipolar disorder and migraine is identified. Several psychiatric disorders appear to occur with mania at rates higher than expected including obsessive-compulsive disorder, bulimia nervosa, panic disorder, impulse control disorders, and substance abuse. CONCLUSIONS: The authors discuss the potential implications of these findings and suggest research approaches to further examine the relationships between mania and other medical and psychiatric syndromes.
Comorbidity is defined as the presence of two or more independent diseases in the same subject. This paper reviews the comorbidity of affective disorders with other mental disorders. We focus on the disorders of anxiety, schizophrenia, dependence on psychoactive substances, eating disorders, personality disorders and obsessive-compulsive disorder. To this end, we have carried out an extensive review that has taken account of numerous studies, as well as of different diagnostic orientations (categorical or dimensional). In general the presence of affective symptoms and/or disorders in the context of other mental pathologies is high. Moreover, comorbidity has a high transcendence with respect to clinical prognosis (worse response to treatments, greater symptomatic persistence, greater tendency to chronicity and greater risk of mortality) and the social consequences (decline in work performance and greater use of resources). Nonetheless, we must bear in mind that the analysis of the comorbidity of affective disorders in other mental disorders is complex and controversial, not only because of its high frequency, but also because of the existence of symptomatic overlap, scarcity of signs and pathognomonic symptoms, variability of diagnostic criteria, applied methodological differences, as well as a scarcity of longitudinal and prospective studies.
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OBJECTIVE: To describe the characteristics of a series of children and adolescents with obsessive-compulsive disorder (OCD) and evaluate the outcome of treatment. METHOD: Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment. RESULTS: Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome. CONCLUSIONS: Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive-behaviour therapy alone.
OBJECTIVE: The authors studied factors associated with short-term treatment response in 38 nondepressed subjects with DSM-III-R obsessive-compulsive disorder (OCD). METHOD: The subjects completed 12 weeks of treatment with paroxetine (N = 20), placebo (N = 8), or cognitive-behavioral therapy (N = 10). Clinician and self-rated measures were gathered at baseline, during treatment, and after treatment. RESULTS: Seventeen (45%) subjects had "much" or "very much" improvement and achieved at least a 40% decrease in their total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Responders had lower obsessive-compulsive scores on the Symptom Checklist 90-Revised, had a lower checking score on the Maudsley Obsessive-Compulsive Inventory, were less likely to have had prior drug therapy, and in general suffered more obsessive-compulsive symptoms. They were significantly less likely to have hoarding obsessions and corresponding compulsions. The latter finding was confirmed using multiple regression analysis. CONCLUSION: Hoarding is an important symptom that predicts poor treatment response in patients with OCD.
BACKGROUND: Musical hallucinations have been considered a rare manifestation of psychotic states or brain and hearing abnormalities. However, an obsessive-compulsive disorder (OCD) assessment tool refers to musical hallucinations and our preliminary study showed that about one third of OCD patients experienced musical hallucinations. AIMS: To elucidate the lifetime prevalence of musical hallucinations among psychotic and nonpsychotic psychiatric outpatients. METHODS: Lifetime experience of musical hallucinations was examined with a specially designed structured interview in 190 consecutive outpatients with diagnoses of anxiety, affective, and schizophrenia disorders. RESULTS: Musical hallucinations occurred in more than one fifth of all diagnoses. The prevalence of musical hallucinations was highest in OCD patients (41%). Musical hallucinations were significantly more frequent with more comorbid disorders, and logistic regression revealed that this finding was mainly due to OCD combined with either social phobia or schizophrenia. CONCLUSION: Musical hallucinations are more common among psychiatric patients than previously reported and are more suggestive of OCD than of other mental disorders.
One hundred and fifty four consecutively evaluated new and return psychiatric outpatients were examined by the same interviewer using a detailed, precoded questionnaire based on the diagnostic criteria for psychiatric research proposed by Feighner et al. Affective disorders were present for 75% of the patients and were associated with older age, divorce and a shorter duration of marital status. Race, sex, education and income levels were not related to the presence of affective disorders. Sixty patients with diagnoses of primary affective disorders and 56 patients with diagnoses of secondary affective disorders were identified and studied. Secondary affective disorders were found to be associated with males, younger age (under 34), unmarried marital status, and lower income levels. Primary affective disorders were associated with higher annual incomes (over +4,000) and fewer individuals with a "some high school only" education. Forty one patients with diagnoses of unipolar primary affective disorders were examined. Sex, race, age, marital status and duration of marital status did not vary for the two groups and were not associated with polarity of affective disorders. Lower education and annual income levels both were demonstrated for patients with bipolar primary affective disorders.