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The problem of the relationship between obsession and delusion is dealt with from descriptive, anthropoanalytical and purely phenomenological points of view. The main differential aspects are focused. The phenomenological concept of the progressive fading of the 'feeling of Ego activity' is proposed as the functional bias at the basis of the continuum linking obsessive symbolic awareness to delusional perception.
Prodromal symptoms were investigated in 30 patients with obsessive-compulsive disorder. The large majority of patients (93%) reported at least one prodromal symptom before disease onset. Generalized anxiety, irritability, indecision, phobic and somatic anxiety occurred in about half of patients. Also common were depressive symptoms such as fatigue, lowered self-esteem, depressed mood, pessimism, impaired work, and guilt. The results suggest a close association of obsessions and compulsions with affective symptoms.
Very few cases exist in the literature of maternal obsessional thoughts of child sexual abuse. Two such cases are described of mothers who experienced obsessional thoughts in the puerperium which concerned sexually abusing their own children. Obsessional thoughts of a sexual nature have been shown to occur commonly--in over 25% of those diagnosed with obsessive-compulsive neuroses. These obsessional thoughts concern actions which are usually identified as going against the sufferer's own value systems or involving sexual perversions. Obsessional thoughts of sexually abusing family members are rarely documented; there are no reports of obsessional thoughts experienced by a mother in the puerperium concerning sexual abuse of her own children. We report two cases of mothers suffering from obsessions of this nature at The Mother and Baby Unit (MBU), Queen Elizabeth Psychiatric Hospital, Birmingham.
There is increasing evidence to suggest basal ganglion involvement in the aetiopathogenesis of obsessive-compulsive disorder (OCD). Twenty subjects with rheumatic chorea were assessed for presence of OCD and evaluated on Leyton's Obsessional Inventory. Four subjects had OCD. The study group had markedly higher scores on all the scales of Leyton's Obsessional Inventory. The findings implicate that caudate dysfunction is not sufficient on its own to explain the presence of obsessive-compulsive behaviour and that additional basal ganglion regions/rostral connections also have to be involved to produce co-morbidity.
Memory processes were compared in 26 patients presenting DSM-III-R obsessive-compulsive disorder (OCD) with 20 sex-, age- and education-matched normal controls. A significant between-group difference was found: visual memory was significantly lower in OCD, whereas no significant between-group differences in verbal memory were observed. A subsample of 17 OCD were also compared with the 20 control subjects on an explicit-memory free-recall task and an implicit-memory completion task using neutral, obsessive and guilt-responsibility words to test the effects of an emotional verbal input on memory functioning. No between-group difference was found, suggesting that emotionally laden word processing did not modify implicit and explicit memory performances.
The authors collected clinical diagnostic, neurophysiological, electrophysiological, and biochemical data on 9 adolescents who had primary obsessive-compulsive disorder. The results indicate considerable descriptive validity of the syndrome in childhood and its independence from obsessional traits; however, all of the children had a history of major depressive disorder, and their sleep EEG measures resembled those of young adults with primary depressive disorder. The patients' families did not have a more consistent pattern of anxiety disorder or any other psychiatric disorder than do families of adult obsessive patients. Psycholinguistic test results showed a lack of normal laterality, which has been reported for other psychiatric illness.
The authors reviewed the studies on obsessive-compulsive disorders published from 1953 to 1978. They report on various theories of the etiology of the disorders and provide an overview of the studies based on these theories. The treatment modalities covered include behavioral modification, drug therapy psychotherapy, surgery, and experimental therapies. the authors conclude that, although the obsessive-compulsive disorders are widely present, there is a paucity of new data concerning their treatment. The evidence to date, however, suggests that psychotherapy is an essential ingredient in the treatment process. They recommended that further clinical studies be done to elucidate the etiology and treatment of these disorders.
Obsessive-compulsive patients with symptoms resistant to clomipramine were treated by lithium or L-tryptophan augmentation. The improvement noted supports the hypothesis that increasing serotonergic neurotransmission ameliorates obsessive symptoms.
The authors administered CAT scans and neuropsychological tests to 16 adolescents with obsessive-compulsive disorder (mean age +/- SD = 13.7 +/- 1.6 years) and 16 matched controls. The patients had a mean ventricular-brain ratio (VBR) significantly higher than the controls' and showed spatial-perceptual deficits similar to those found in patients with frontal lobe lesions. Memory, reaction time, and decision time did not differ significantly from controls'. Neurodevelopmental examination of seven patients yielded a high frequency of age-inappropriate synkinesias and left hemibody signs. These results suggest CNS dysfunctioning in children with obsessive-compulsive disorder, with possible right cerebral involvement. However, the patients' neuropsychological test deficits and VBRs were not correlated.
A man with obsessive-compulsive disorder without evidence of depression responded to ECT but not to drug treatments. Further investigation of the utility of ECT in treating drug-refractory obsessive-compulsive disorder is indicated.
The authors describe two cases of obsessive-compulsive disorder with concomitant bipolar affective disorder. Behavior therapy consisting of in vivo exposure plus response prevention controlled the obsessive-compulsive symptoms only after the affective illness was well controlled pharmacologically.
Despite advances in the management of patients with obsessive-compulsive disorder, some remain refractory to treatment. The authors retrospectively examined characteristics of 43 treatment-resistant obsessive-compulsive patients and found that those with concomitant schizotypal personality disorder had an extremely high rate of treatment failure. Of the 29 treated nonschizotypal patients, 26 (90%) improved at least moderately; only one of 14 (7%) schizotypal patients improved. In addition, the number of schizotypal features in each patient was strongly negatively correlated with treatment outcome.
The authors report on four patients with disabling bowel obsessions who responded to tricyclic antidepressant medication despite the absence of depressive symptoms. The relationship of this symptom constellation to DSM-III obsessive-compulsive disorder and social phobia is discussed.
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 evaluated personality dysfunction in 23 patients with primary obsessive-compulsive disorder and an age- and sex-matched group of patients with major depressive disorder. There were no significant differences between the two patient groups with respect to mean personality trait scores or the frequency or type of personality disorder diagnosis. A mixed personality disorder with avoidant, dependent, and passive-aggressive features was most commonly observed in the obsessive-compulsive group. There was a very low frequency of schizoid or compulsive personality disorder.
Eleven obsessive-compulsive patients underwent a prospective open-label trial of fluoxetine monotherapy followed by buspirone augmentation. The combination therapy was statistically superior to fluoxetine monotherapy. The results point to the importance of the 5-HT1a receptor in obsessive-compulsive disorder.
The authors surveyed 34 patients with obsessive-compulsive disorder for a history of seasonal variations in symptoms and behavior and treated six of these patients with bright light. Overall, the patients with obsessive-compulsive disorder did not report a greater degree of seasonal variations than normal and no response was seen to bright light therapy in the small number of patients treated.
Six drug-free obsessive-compulsive patients were given single photon emission computerized tomography scans before and during treatment with fluoxetine. The treatment significantly reduced the patients' "hyperfrontality," as determined by the ratio between medial-frontal and whole cerebral cortex blood flow, and significantly lowered ratings of obsessive-compulsive and anxiety symptoms.