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PubMed2005

Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the results of cognitive-behavioral group therapy (CBGT) for obsessive-compulsive disorder (OCD) over a 1-year follow-up period. METHOD: Forty-two OCD patients, who completed 12 sessions of CBGT, were followed for 1 year. Measures of the severity of symptoms were obtained at the end of the acute treatment and at 3, 6, and 12 months post-treatment using the Yale-Brown obsessive-compulsive scale (Y-BOCS) and the clinical global impression (CGI). RESULTS: The reduction in the severity of symptoms observed at the end of the treatment was maintained during 1 year (F2,41=1.1; P=0.342). Eleven patients (35.5%) relapsed in the follow-up period. The intensity of improvement (log rank=12.97, GL=1, P=0.0003) and full remission (log rank=6.17; GL=1; P=0.001) were strong predictors for non-relapsing. CONCLUSION: The CBGT is an effective treatment for OCD and its results are maintained for 1 year. However, further long-term randomized controlled trials are needed in order to confirm this finding.

Adult↗
PubMed2007

Diagnosis and treatment of obsessive-compulsive disorder and related disorders.

Obsessive-compulsive disorder (OCD) is currently recognised as one of the most common psychiatric disorders as well as one of the most disabling of all medical disorders. Obsessive-compulsive related disorders (OCRDs), often comorbid with OCD, include many distinct psychiatric conditions (i.e. some somatoform disorders, eating disorders, impulse control disorders and some neurological conditions) which have overlapping symptoms and compulsive qualities with OCD. Although effective treatments exist, OCD and related disorders are often underdiagnosed and undertreated. Serotonin reuptake inhibitors (SRIs) and cognitive behavioural therapy (CBT) represent the first-line treatment for OCD and related disorders. However, the time and the doses of the medications used in the treatment of OCD and related disorders differ from those recommended in depressive disorders. In addition, remission is not common for patients with OCD and related disorders in clinical practice, and poor responders as well as refractory cases may benefit from different treatment strategies including integrated treatment, pharmacological augmentation and brain stimulation techniques.

Chronic Disease↗
PubMedDate not supplied

Contemporary approaches to pharmacotherapy in Tourette's syndrome and obsessive-compulsive disorder.

TOPIC: Contemporary approaches used in the pharmacological treatment of children and adolescents with Tourette's syndrome or obsessive-compulsive disorder. BACKGROUND: Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD) now are recognized as more common than previously believed. Moreover, there is accumulating evidence that these two disorders may share common neurobiological underpinnings. Nonetheless, pharmacologic approaches to treatment may be quite different. SOURCES: Using recently published information, this paper reviews current treatment for TS and OCD. CONCLUSION: There have been major advances in the understanding of the pathophysiology of OCD and TS. These advances provides guidance for the treatment of children and adolescents with these disorders. However, additional research is needed to refine current treatment approaches.

Adolescent↗
PubMed1995

Changes in metabolism of cerebral glucose after stereotactic leukotomy for refractory obsessive-compulsive disorder: a case report.

Brain glucose metabolism was investigated with PET and [18F]fluorodeoxyglucose, before and after a bifrontal stereotactic leukotomy in a 37 year old woman with refractory obsessive-compulsive disorder. A bilateral decrease in glucose metabolism was found in the orbital frontal cortex after psychosurgery. Glucose metabolism was decreased to a lesser degree in Brodmann's area 25, in the thalamus, and in the caudate nucleus. Clinical improvement in obsessive-compulsive disorder after stereotactic tractotomy seems to be associated with metabolic changes in the brain, in particular, in the orbital part of the frontal lobe.

Adult↗
PubMed2001

Kinematic analysis of handwriting movements in patients with obsessive-compulsive disorder.

OBJECTIVES: Basal ganglia dysfunction is supposed to play a part in the pathophysiology of obsessive-compulsive disorder (OCD). A new computer aided technique for the analysis of hand movements, allowing the detection of subtle motor performance abnormalities, was applied in this study of patients with OCD and healthy controls. METHODS: Using a digitising graphic tablet, hand motor performance was studied in 22 unmedicated patients with OCD and compared with 22 healthy controls. All subjects drew superimposed concentric circles with both the right and the left hand, in addition to writing a given sentence, their personal signature, and letter sequences in four different sizes. Kinematic parameters were calculated to quantify hand motion. RESULTS: Patients with OCD had significant impairments of handwriting performance, reflected by lower peak velocity (sentence t=3.6; p=0.001; signature t=2.8; p=0.01) and micrographia (sentence t=3.4; p=0.002; signature t=2.5; p=0.02), compared with controls and shortened acceleration phases per stroke (sentence t=2.4; p=0.02; signature t=4.1; p=0.000). By contrast, in repetitive drawing, patients with OCD had higher peak velocity than healthy controls (group x task interaction p<0.01). There were no significant differences in left and right hand performance between groups. Patients with early versus late age of onset differed in handwriting parameters, such as handwriting consistency. Greater severity of obsessions and compulsions correlated with increasingly poor handwriting performance in patients with OCD. CONCLUSIONS: A subtle motor dysfunction in OCD can be detected with a digitising tablet. The findings show handwriting impairments in patients with OCD, in line with the assumption that basal ganglia dysfunction is part of OCD pathophysiology. Repetitive motor pattern performance was not impaired, but rather tended to be even better in patients with OCD than in controls. The findings also support the concept that patients with OCD with early versus late age of onset differ in pathophysiological mechanisms and basal ganglia dysfunction.

Adolescent↗
PubMed1998

Decreased blood levels of tumor necrosis factor-alpha in patients with obsessive-compulsive disorder.

To investigate immune system function in obsessive-compulsive disorder (OCD) we measured plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta) and interleukin-6 (IL-6) in 14 drug-free obsessive-compulsive patients and 14 matched healthy controls. No significant differences were observed between patients and controls in plasma levels of IL-1 beta and IL-6, whereas plasma levels of TNF-alpha were significantly lower (p = 0.001) in the former. Blood levels of prolactin did not differ between the two groups, whereas plasma cortisol concentrations were significantly higher in patients than in healthy subjects (p = 0.02). No significant correlation was found between immune parameters, on the one hand, and endocrine or psychopathological measures on the other. These results suggest that OCD is associated with a decreased production in TNF-alpha, but normal synthesis of IL-1 beta and IL-6.

Adult↗
PubMedDate not supplied

Obsessive-compulsive disorder with delusions.

Obsessive-compulsive (OCD) and delusional disorders (DD) have been recognised with increased frequency in recent years, and the propensity of some OCD subjects to become deluded has become a focus of interest. This study reports illness-specific demography along with measures of symptom severity and tests to assess schizotypal ideation, dysfunctional attitudes, attributional and attention bias in 30 patients with OCD, 29 with DD, 16 with OCD with delusions (OC-DD) and a 30-subject control group (CG). Obsessional features appeared before delusions in the OC-DD group, suggesting that OCD was the primary pathology. Delusions were more likely in subjects obsessional about one rather than multiple themes. There was some support for proposals that depression and schizotypy may bring out delusions in OCD and some evidence for the utility of categorising OCD according to the number of obsessions a subject has.

Adult↗
PubMedDate not supplied

Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients.

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Adolescent↗
PubMedDate not supplied

Memory deficits in patients with DSM-IV obsessive-compulsive disorder.

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers' rituals. Another account of doubting implicates meta-cognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to meta-cognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

Adolescent↗
PubMed2005

Increased maintenance of obsessive-compulsive disorder remission after integrated serotonergic treatment and cognitive psychotherapy compared with medication alone.

BACKGROUND: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone. METHODS: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score < or =10 and Global Assessment of Functioning (GAF) scale score > or =70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12-24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients' preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAF scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse. RESULTS: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p < 0.001) in the integrated treatment group (132 months, 95% CI 107-157) than in the medication group (25 months, 95% CI 12-38). CONCLUSIONS: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment.

Adult↗
PubMed2006

Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.

BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.

Adult↗
PubMed2005

Delusions or obsessions: the same only different? A case report.

The phenomenological distinction between delusions and obsessions has been the subject of much debate in psychiatry. Some authors feel these symptoms are distinct nosological entities, while others argue that they reflect manifestations of the same symptom and are distinguishable on the basis of the level of insight a patient displays. In this report we describe the case history of a lady who presented with an obsessional disorder. The symptom was resistant to standard treatments and subsequently became more delusional in nature. We review the literature in terms of the classification of obsessions and delusions and offer assistance to clinicians in terms of the diagnosis and treatment of cases where the distinction between these phenomena is not clear and offer alternative means of classifying these symptoms based on insight.

Adult↗
PubMed2006

Serotonin transporter imaging with [123I]beta-CIT SPECT before and after one year of citalopram treatment of obsessive-compulsive disorder.

BACKGROUND: Two thirds of patients with obsessive-compulsive disorder (OCD) respond to treatment with selective serotonin reuptake inhibitors (SSRIs). The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be elucidated. OBJECTIVES: The aim of this pilot study was to quantify changes in the availability of serotonin transporter (SERT) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms. METHODS: Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]beta-CIT. Specific-to-nondisplaceable [123I]beta-CIT binding ratios (V3'') were calculated in SERT-rich brainstem, midbrain and thalamus using a magnetic resonance imaging-based region of interest (ROI) analysis. Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS: V3'' differed significantly between pretreatment and follow-up scans in all three brain regions, thalamus, midbrain as well as in brainstem. In thalamic ROI, differ ences in SERT availability and Y-BOCS ratings correlated. In midbrain, a trend toward a significant association was found. In brainstem, no relationship was revealed. CONCLUSIONS: Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD.

Adult↗
PubMed2006

Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results.

OBJECTIVE: To investigate the long-term efficacy and adverse cognitive effects of stereotactic bilateral anterior cingulotomy as a treatment for refractory obsessive-compulsive disorder (OCD) patients. MATERIALS AND METHODS: Seventeen patients suffering from refractory OCD underwent stereotactic bilateral anterior cingulotomies and were followed for 24 months. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Clinical Global Impression and other neuropsychological tests were used to assess the efficacy and cognitive changes of cingulotomy. The tests were taken before and 12 and 24 months after surgery. RESULTS: The mean improvement rate of the Y-BOCS score achieved from the baseline was 48%. Eight patients out of 17 met the responder criteria. During the 24-month follow-up, there were no significant adverse effects observed after surgery. CONCLUSIONS: Bilateral anterior cingulotomy was effective for the treatment of refractory OCD, and no other significant adverse cognitive effects on long-term follow-up were found.

Adult↗
PubMed1988

Intraoperative electrical stimulation of the brain in patients with obsessive-compulsive neurosis.

Twenty patients with intractable obsessive-compulsive neurosis were operated under local anesthesia. Each patient had a lesion produced in 1 of the 4 brain targets: anterior internal capsule, rostral cingulum, middle cingulum, and genu of the corpus callosum. Before destructive permanent lesions were produced, the target area was stimulated electrically. Stimulation gave subjective or objective reactions in 30% of the patients: diminished anxiety, 3 patients; increased anxiety, 1 patient, and motor responses, 2 patients. None experienced an obsessive reaction to stimulation. The clinical effect of surgery was usually good.

Adult↗
PubMed1994

Psychoimmune investigation in obsessive-compulsive disorder: assays of plasma transferrin, IL-2 and IL-6 receptor, and IL-1 beta and IL-6 concentrations.

This study was carried out to investigate the immune function in obsessive-compulsive disorder (OCD). Plasma levels of interleukin (IL)-1 beta, IL-6, soluble IL-6 receptor (sIL-6R), sIL-2R, and transferrin receptor (TfR), and baseline plasma cortisol levels were measured in 19 OCD patients and 19 normal controls. No significant differences in any of the above immune variables were found between subjects with OCD and normal controls. There was a significant positive correlation between IL-6 or sIL-6R concentrations and severity of compulsive--but not obsessive--symptoms. In subjects with OCD, there was a significant negative relationship between sIL-2R concentrations and plasma cortisol values. In subjects with OCD and in the study group as a whole, there were significant positive relationships between sIL-2R and TfR concentrations.

Adult↗
PubMed1995

Cerebral perfusion, electrical activity and effects of serotonergic treatment in obsessive-compulsive disorder. A preliminary study.

An abnormally increased glucose metabolism has been described with positron emission tomography (PET) in frontal and caudate regions of obsessive-compulsive patients. Perfusion and electroencephalographic studies have been less conclusive. However, these techniques are, currently, more available than PET and, therefore, deserve further study because of their possible clinical applications. In this article, 13 obsessive-compulsive patients were studied with quantitative EEG and auditory and visual evoked potentials. Six of them were studied also with perfusion single photon emission tomography. A group of 4 patients was studied with both techniques before and after a serotonergic treatment. Increased global, beta, and theta electrical power together with an increased perfusion in frontal regions was observed. The patients also showed a delta power increase over right temporal and frontal regions, together with increased perfusion in the right basal ganglia region as well as a decreased amplitude of the P50 and N100 waves of the auditory evoked potentials over temporal electrodes; these alterations were reduced with treatment. These results are discussed in the context of current data about serotonergic neurotransmission.

Adult↗
PubMed1996

Decreased platelet 3H-paroxetine binding in obsessive-compulsive patients.

The similarities between the serotonin (5-HT) transporter in both human platelets and human brain permit us to investigate this structure in patients with different psychiatric disorders. Several reports have shown abnormalities of the 5-HT transporter, by means of the measurement of the 5-HT uptake or of the 3H-imipramine binding, in platelets of patients with obsessive-compulsive disorder (OCD). The availability of the ligand 3H-paroxetine, a selective 5-HT reuptake inhibitor, to label the 5-HT transporter, promoted us to evaluate the binding of 3H-paroxetine in platelets of 18 drug-free patients with OCD. The results, showing that the patients had a lower number of 3H-paroxetine sites, which is inversely correlated with the Yale Brown Obsessive-Compulsive Scale total score, than a similar group of controls, add supporting evidence to the involvement of 5-HT in OCD. In addition, the decreased functionality of the 5-HT transporter seems to be linked to the severity of OC symptoms.

Adolescent↗