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Treatment of obsessive-compulsive disorder.
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Treatment of an obsessive compulsive disorder by desensitisation.
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Pharmacological characterization of psychosis-like behavior in the MPTP-lesioned nonhuman primate model of Parkinson's disease.
Investigation of the pathophysiology of psychosis in Parkinson's disease (PD), as well as the assessment of potential novel therapeutics, has been limited by the lack of a well-validated animal model. MPTP-lesioned primates exhibit abnormal behaviors that are distinct from dyskinesia and parkinsonism and may represent behavioral correlates of neural processes related to psychosis in PD. Here we assess four types of behavior--agitation, hallucinatory-like responses to nonapparent stimuli, obsessive grooming, and stereotypies that are termed "psychosis-like"--and define their pharmacology using a psychosis-like behavior rating scale. By assessing the actions of drugs known to enhance or attenuate psychosis in PD patients, we find that the pharmacology of these behaviors recapitulates, in several respects, the pharmacology of psychosis in PD. Thus, levodopa and apomorphine elicited psychosis-like behaviors. Amantadine significantly decreased levodopa-induced dyskinesia but exacerbated psychosis-like behaviors. Haloperidol reduced psychosis-like behaviors but at the expense of increased parkinsonian disability while the atypical neuroleptics clozapine and quetiapine reduced psychosis-like behaviors without significant effect on parkinsonian disability. The response of different components of the psychotomimetic behavior suggested the involvement of both dopaminergic and nondopaminergic mechanisms in their expression.
Obsessive relational intrusion: incidence, perceived severity, and coping.
Two studies investigated the phenomenon of obsessive relational intrusion (ORI), defined as repeated and unwanted pursuit and invasion of one's sense of physical or symbolic privacy by another person, either stranger or acquaintance, who desires and/or presumes an intimate relationship. In Study 1, we sought to identify the incidence of a broad range of relationally intrusive behaviors, to identify the coping responses employed by victims of ORI, and to assess the associations between coping responses and ORI behaviors. Study 2 assessed the perceived degree of severity of ORI behaviors. Results revealed that each of 63 ORI behaviors was experienced by 3-78% of respondents in three different samples. Factor analysis revealed four types of ORI behavior: pursuit, violation, threat, and hyper-intimacy. Responses for coping with ORI consisted of interaction, protection, retaliation, and evasion. Virtually all intrusive behaviors were perceived to be annoying. Some types of ORI behaviors were perceived to be relatively more threatening, upsetting and privacy-invading than others. Although sex differences were not observed for the incidence of ORI or coping, women consistently perceived ORI behaviors to be more annoying, upsetting, threatening, and privacy-invading than did men.
[Obsessive-compulsive symptoms in children and pre-adolescents: clinical observation of inpatients].
I investigated the phenomenology of obsessive-compulsive disorder (DSM-IV) in 22 children and pre-adolescents (8 boys and 14 girls, 6-15 years old, mean 12.2 years) admitted to the psychiatric ward of Kanagawa Children's Medical Center between 1989 and 1996. Some patients were concomitantly diagnosed with psychotic disorder, or eating disorder (DSM-IV). Girls dominated boys, and all cases except a girl were over ten years old. Patients were divided into four types according to their obsessive-compulsive symptoms. Type I (7 cases, 31.8%): Recurrent idea and repetitive behavior were painful. The patients recognized these ideas and behaviors to be a product of their own mind. They also recognized the behavior to be excessive or unreasonable, and tried to resist at least while the symptoms were mild. Four patients showed good courses, but in three patients showed severe obsessive-compulsive symptoms that persisted for a long time after admission. Type II (13 cases, 59.1%) consisted of 2 subtypes. Type IIa (10 cases, 45.5%): The obsession or compulsion was recurrent and distressful, but insight into the problem was unclear or poor. We noted 4 Type IIa patients with this type resisted their symptoms, but the others' did not. This type was the most prevalent of the four types, and seemed to be the main type of obsessive-compulsive disorder among children and pre-adolescents. Type IIb (3 cases, 13.6%): Compulsion dominated obsession. The subjects experienced distress from their severe compulsion, but seldom complained of it. Furthermore, patients could hardly discern and resist their symptoms. So it resembled obsessive desire for the maintenance of sameness, or stereotypy in developmental disorders. Patients recognized the idea or the behavior to be the product of their own mind. Severe symptoms persisted for a long time after admission. Type III (2 cases, 9.1%): The patients experienced their recurrent idea and repetitive behavior as agonizing. They had insights that their obsession or compulsion was excessive or unreasonable, and tried to resist it. The symptoms were similar to those of psychoses, but patients did not have definite psychotic symptoms. Severe symptoms persisted for a long time after admission. Categorization according to obsession and compulsion supported the criteria for obsessive-compulsive disorder in DSM-IV. It showed concretely that a number of children and adolescents with severe obsessive-compulsive symptoms had marginal features of the symptoms. Of 20 cases excluding 2 cases classified as atypical type III, seven patients (35.0%) understood that their symptoms were excessive or unreasonable, and 10 cases (50.0%) showed objective resistance to their symptoms. However, insight or resistance to the obsessive-compulsive symptom was not as stable as that in adult patients with such symptoms, and vacillated during the course of the disease.
Relapse prevention program for treatment of obsessive-compulsive disorder.
Eighteen participants with obsessive-compulsive disorder received 3 weeks of intensive treatment by exposure and response prevention, which were followed by either a relapse prevention (RP) program or associative therapy (AT; an attention-control program). Independent evaluators conducted assessments of obsessive-compulsive symptoms, anxiety, and depression, before and after intensive behavior therapy, after the week of intensive RP or AT and at a 6-month follow-up. Results indicated that the RP program was effective in preventing relapse: Both treatment groups improved immediately after the intensive treatment, but the RP group remained improved at follow-up, whereas the AT group showed some return of symptoms.
Effects of September 11 on patients with obsessive compulsive disorder.
Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4-6 months after the attacks. Participants completed a 15-item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.
Autistic-like behavior in CHARGE syndrome.
Children with CHARGE syndrome frequently exhibit moderate to severe behavior difficulties, and are often diagnosed with obsessive-compulsive disorder, attention deficit disorder, Tourette syndrome, and autism. Hartshorne and Cypher (2004) surveyed parents of 100 children with CHARGE worldwide and confirmed the prevalence of behaviors that are associated with these disorders. They also found behaviors that could be described as typical of persons who are deafblind. The present study examined whether the autistic-like behaviors of children with CHARGE are more similar to those of children who are deafblind, to those of children who are autistic or are unique to CHARGE. Surveys including the Autism Behavior Checklist (ABC) were mailed to families of 204 children with CHARGE, and 160 usable surveys were returned (78%). Total scores on the ABC for children with CHARGE were significantly different from the norms for those with autism, and those who were deafblind. However, the variance for CHARGE was larger than for the normative groups, and 27.5% of those with CHARGE could be classified as autistic. The pattern of subscale scores for those with CHARGE differed from the other normative groups.
Clinical outcome in patients with obsessive-compulsive disorder after discontinuation of SRI treatment: results from a two-year follow-up.
BACKGROUND: Combined treatment with serotonin-reuptake inhibitors (SRI) and cognitive-behavioral therapy (CBT) is a common therapy approach for obsessive-compulsive disorder (OCD). However, it is a matter of debate whether discontinuation of SRI after combined treatment leads to relapse. METHOD: Seventy-four consecutively admitted patients suffering from OCD were included in the study. Thirty-seven patients were treated with CBT alone, and 37 patients received combined CBT and SRI treatment. Of these latter patients, seventeen discontinued SRI treatment during the follow-up period (1 and 2 years after inpatient treatment). OCD symptom severity was determined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and mood was assessed by Hamilton Depression Rating Scale (HDRS). RESULTS: During the initial treatment, scores for Y-BOCS (p < 0.001), HDRS (p < 0.001) and the Global Assessment of Functioning Scale (GAF) (p < 0.001) improved significantly in all groups. Reassessment two years later revealed that a) OCD symptom severity and depression scores were similar between the groups and b) discontinuation of SRI did not prompt by a recurrence of symptoms. CONCLUSIONS: We interpret our results as suggesting that discontinuation of SRI treatment may be considered in formerly combined treated OCD patients after stable remission.
A comparative study of psychotic and nonpsychotic stalking.
A comparative analysis of psychotic versus nonpsychotic stalking is presented. Archival files of 25 forensic subjects whose alleged criminal offenses met a legal definition of stalking behavior were studied for demographic characteristics, stalking dynamics, psychosocial history, and current psychological variables. Although nearly one-third of all subjects had an Axis I psychotic disorder and were delusional, only one of these subjects had erotomanic delusions. The psychotic subjects' pursuit of victims was associated with other delusions and symptoms of psychosis. Nonpsychotic subjects tended to exhibit an Axis I disorder (usually major depression, adjustment disorder, or substance dependence) as well as a variety of Axis II personality disorders. The nonpsychotic subjects' pursuit of victims was influenced by various psychological factors, including anger and hostility, projection of blame, obsession, dependency, minimization and denial, and jealousy. Psychotic subjects visited the victims' homes significantly more often than nonpsychotic subjects. Nonpsychotic subjects made more verbal threats and "acted out" violently more often than psychotic subjects. While all subjects exhibited some similarities in stalking behaviors and demographic variables, including childhood attachment disruptions, no single profile of a "stalker" emerged. These findings provide information about factors contributing to stalking violence, as well as diagnostic issues that should be considered in the assessment and treatment of this criminal population.
Using objects of obsession as token reinforcers for children with autism.
We assessed the effectiveness of using objects of obsession as token reinforcers to increase task performance for children with autism. The use of obsessions as tokens (e.g., letter "A", a picture of a train) was compared with the use of typical tokens (e.g., stars, happy faces). A multiple baseline design across children with a reversal within child was used. Data were collected on percentage correct of task responses and on the occurrence of inappropriate behaviors during work sessions. Results indicated that percentage correct on task performance was higher when objects of obsession were used as tokens as opposed to when typical tokens were used. Concomitant decreases in inappropriate behaviors during work sessions were also noted. Results are discussed in terms of primary versus secondary reinforcement and the effects of saliency and novelty of the reinforcing stimuli.
Polygenic inheritance of Tourette syndrome, stuttering, attention deficit hyperactivity, conduct, and oppositional defiant disorder: the additive and subtractive effect of the three dopaminergic genes--DRD2, D beta H, and DAT1.
Polymorphisms of three different dopaminergic genes, dopamine D2 receptor (DRD2), dopamine beta-hydroxylase (D beta H), and dopamine transporter (DAT1), were examined in Tourette syndrome (TS) probands, their relatives, and controls. Each gene individually showed a significant correlation with various behavioral variables in these subjects. The additive and substractive effects of the three genes were examined by genotyping all three genes in the same set of subjects. For 9 of 20 TS associated comorbid behaviors there was a significant linear association between the degree of loading for markers of three genes and the mean behavior scores. The behavior variables showing the significant associations were, in order attention deficit hyperactivity disorder (ADHD), stuttering oppositional defiant, tics, conduct, obsessive-compulsive, mania, alcohol abuse and general anxiety-behaviors that constitute the most overt clinical aspects of TS. For 16 of the 20 behavior scores there was a linear progressive decrease in the mean score with progressively lesser loading for the three gene markers. These results suggest that TS, ADHD, stuttering oppositional defiant and conduct disorder, and other behaviors associated with TS, are polygenic, due in part to these three dopaminergic genes, and that the genetics of other polygenic psychiatric disorders may be deciphered using this technique.
Intractable seizures, compulsions, and coprolalia: a pediatric case study.
A 10-year-old girl with intractable complex partial seizures developed aphasia, coprolalia, and repetitive motor behaviors involving touching, sexual touching, and aggressive acts. Her symptoms subsided following surgical resection of a left anterior temporal lobe ganglioglioma and control of seizures. Possible neurobehavioral implications of the reversibility of this patient's symptoms are discussed.
Neuropsychiatric aspects of stroke.
Neuropsychiatric disorders following stroke are common, and pathologic involvement of specific regions or functional systems results in behavioral syndromes similar to idiopathic psychiatric syndromes. Depression occurs in up to half of all stroke patients and is most frequently associated with left anterior cortical and subcortical infarctions. Mood changes interfere with cognitive, functional and social recovery. Treatment with heterocyclic antidepressants, stimulants, and electroconvulsive therapy is efficacious in most patients. Mania, delusions, hallucinations, personality alterations, obsessive-compulsive disorder, and changes in sexual behavior are less common but have also been described in post-stroke patients. Each behavioral syndrome is associated with a specific pattern of brain involvement. Investigation of these phenomena contributes to understanding the cerebral basis of psychiatric disorders.
Eating Attitudes Test scores of patients with obsessive-compulsive disorder.
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Obsessive-compulsive disorder: Part II. Treating the symptoms and studying the brain.
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Defense mechanism changes in successfully treated patients with obsessive-compulsive disorder.
OBJECTIVE: Changes in defense mechanisms after treatment of patients with obsessive-compulsive disorder (OCD) were measured by using an established rating scale. METHOD: Before and after 7-week group behavior therapy, 17 patients with DSM-III-R OCD were assessed with the Defense Style Questionnaire, Yale-Brown Obsessive Compulsive Scale, and Beck Depression Inventory. RESULTS: After behavior therapy the patients evidenced significant decreases in Yale-Brown Obsessive Compulsive Scale scores and significant increases in the use of more adaptive defense mechanisms. There were no significant changes in three maladaptive defense mechanism categories. The improvement in adaptive defenses was independently linked to improvement both in OCD and in depression. CONCLUSIONS: Personality as defined by defense mechanisms may be more amenable to brief behavioral treatment than previously thought. The permanence of these changes must be further assessed.