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PubMed1989

Obsessive-compulsive symptoms in childhood and adolescence.

We investigated 61 patients (38 boys and 23 girls) under 18 years of age with obsessive-compulsive symptoms seen in the Department of Psychiatry, Nagoya University Hospital, from 1982 until 1986. In this period, a total of 1293 patients under 18 years of age visited the clinic. The percentage of patients with obsessive-compulsive symptoms was 5%. The earliest onset of symptoms was at age 3 years, and the average age of onset was 11.6 years. We found no particular tendency in terms of the number of siblings and the birth order of the patients. Obsessive traits were the fundamental personality traits of patients. Moreover, according to the other characteristics of personality, the patients were subdivided into schizothymic, viscous temperament, and cyclothymic. Parents of the patients were more apt than usual to have obsessive-compulsive personalities. Psychiatric disturbances and occupations were also investigated. Incidents related to school situations commonly triggered obsessive-compulsive symptoms. The most frequently noted obsessive thought was dirt phobia, and the most common compulsive behavior was washing. School refusal and violence at home were especially common as associated symptoms of obsessive-compulsive symptoms. We also describe the treatment regimen and the outcomes of the patients.

Adolescent↗
PubMed2006

Effects of perceived criticism on anxiety and depression during behavioral treatment of anxiety disorders.

The present study explored the effect of perceived criticism (PC) on levels of anxiety and depression during behavioral treatment among patients diagnosed with obsessive-compulsive disorder (OCD) or panic disorder with agoraphobia (PDA). We posited that patients' perceptions of relatives' criticism and the degree to which they were upset by the criticism (UC) would be related to negative affect and discomfort during exposure. The sample included 75 patients with a primary diagnosis of OCD (n=43) or PDA (n=32) and their participating relatives. Measures of patients' weekly ratings of PC and upset about the criticism, anxious and depressed mood, and subjective discomfort during exposure treatment were analyzed using a mixed model regression approach (SAS Proc Mixed). Patients' anxious and depressed mood predicted greater discomfort during exposure. Patients who were more UC also had higher weekly ratings of anxiety and depression, and more discomfort during exposure sessions. Findings suggest that treatment outcome may be improved by attention to patients' reactions to their interpersonal environment.

Adolescent↗
PubMedDate not supplied

[Tic syndrome].

A tic is an involuntary, sudden, rapid, recurrent, nonrrhythmic, stereotyped, motor movement or vocalization. This paper reviews clinical, pathophysiological, epidemiological and treatment issues of tic disorders. The clinical presentation of tic disorders with simple and complex motor or vocal tics is reviewed in detail. The most common psychiatric comorbid conditions, such as personality disorder (PD), Obsessive-Compulsive Disorder (OCD), Self-Destructive Behavior (SDB) and Attention Deficit Hyperactivity Disorder (ADHD) are presented too. All forms of tics may be exacerbated by anger or stress, but they are usually markedly diminished during sleep. Premonitory feelings or "sensory experiences", which are distinct from the actual motor or phonic tics and precede the tics, occur in over 80% of tic-patients and in 95% of patients with Gilles de la Tourette Syndrome (GTS). The American Psychiatric Association recognizes three types of tic disorders on the basis of clinical criteria: Transient Tic Disorder, Chronic Motor or Vocal Tic Disorder and GTS. The diagnostic criteria for these types are described. According to epidemiological data, up to 10% of children have at least somewhere a transient tic disorder. The onset of tics, whether simple or multiple, occurs at approximately 7 years of age. The accepted prevalence figure for GTS is 0.05-3%. Although tics can appear as the result of brain injury, Huntington chorea or encephalitis, they are most commonly idiopathic. Genetic factors appear to be present in many but not in all cases of tic disorders. Autosomal dominant, sex-linked models or semirecessive-semidominant-oligogenic models have been considered. Based on the review of the literature we believe that tic disorders are related to altered neurotransmitter function within the CNS, especially that the functional abnormality is somehow related to dopaminergic mechanism. Several authors have recently investigated the possible role of autoimmune response to streptococcal infection in the pathogenesis of tics. The differential diagnosis of tics is reviewed in detail. Above all tics represent a social disability. The ability to tolerate tics varies greatly from one individual to another, and the need for treatment is better defined by the patient than by the physician. Mild cases do not need be treated. Ideally, management should be multidisciplinary and can range from educative to supportive means or to intricate pharmacological interventions. The major form of treatment of the motor or vocal symptoms continues to be based on high-potency "typical" neuroleptics (tiaprid, pimozide, haloperidol), which induce a wide range of potentially serious side effects. In everyday practice we prefer to start with an "atypical" neuroleptic drug--for example, olanzapin (5-10 mg/day), risperidone or clozapine. Other drugs, such as clonidin or pergolid are widely used but their efficiency is still questionable. SSRIs (sertaline, citalopram, fluoxetin, fluvoxamine) or other antidepressants (clomipramine) have been used in treatment of psychiatric comorbid conditions, too. Botulinum toxin injections have proved useful in tics, targeting at the symptoms of blepharospasm, in neck and facial muscles.

Antidepressive Agents↗
PubMed2007

Motor inhibition in trichotillomania and obsessive-compulsive disorder.

We investigated motor inhibition abilities in trichotillomania (TTM) and obsessive-compulsive disorder (OCD), two disorders characterized by repetitive, intentionally performed behaviors. Performance in a GoNogo experiment of 25 TTM and 21 OCD participants was compared to the performance of 26 HC participants. In contrast to OCD and HC participants, TTM participants tended to perform either 'fast and inaccurate' (indicating poor motor inhibition) or 'slow and accurate'. TTM participants with poor motor inhibition reported a significantly earlier age of TTM onset than those TTM participants who performed well. There was no evidence for motor inhibition deficits in OCD. Based on our data, a subgroup of TTM sufferers seems to be characterized by motor inhibition deficits.

Adult↗
PubMed1976

Obsessive-compulsive neurosis after viewing the fetus during therapeutic abortion.

A case of obsessive-compulsive neurosis which developed in a young woman after she had viewed the fetus expelled during a therapeutic abortion with hypertonic saline is reported. The treatment, involving both psychodynamic psychotherapy and behavior therapy, illustrates the use and possible interaction of these therapies in the same patient.

Abortion, Therapeutic↗
PubMed1990

Approaches to the patient with treatment-refractory obsessive compulsive disorder.

Modern therapies have dramatically improved the treatment outcome for patients with obsessive compulsive disorder (OCD), but many clinicians are not aware of what is presently available in terms of effective treatments. Clinicians now know that if patients receive appropriate treatment, usually consisting of behavior therapy and/or psychotropic medication, the majority will improve substantially, and occasionally completely, within a few months. This article reviews some of the treatment options for managing refractory patients with OCD.

Behavior Therapy↗
PubMed1991

Tourette syndrome and other tic disorders. Diagnosis, pathophysiology, and treatment.

In this report, we discuss the definition, characteristics, pathophysiology, and treatment of tic disorders with a major emphasis on Tourette syndrome. Although the diagnosis of a tic disorder depends on the presence of motor and/or phonic tic(s), patients with these problems also have a variety of co-morbid features including obsessive-compulsive symptoms, attention-deficit hyperactivity disorder, behavioral difficulties, and learning disabilities. Conservative estimates for Tourette syndrome suggest a prevalence rate of 0.1-1.0 per 1000. This syndrome is inherited in a sex-influenced autosomal dominant pattern with either chronic multiple tic disorder or obsessive-compulsive disorder as alternative phenotypes of the putative gene. Current evidence continues to support a pathophysiologic mechanism involving synaptic neurotransmission, with the dopaminergic system as a primary candidate. Therapeutically, it is essential to clarify whether a patient's problems are related to tics or associated behavioral difficulties. Pharmacotherapy for motor and phonic tics is strictly symptomatic and should be reserved for those with functionally disabling symptoms. A comprehensive individualized treatment program is often required in the care of individuals with tic disorders.

Behavior↗
PubMed2002

Asperger syndrome: a proton magnetic resonance spectroscopy study of brain.

BACKGROUND: Asperger syndrome (AS; an autistic disorder) is associated with impaired social skills and obsessional/repetitive behavior. Patients with autism have significant abnormalities in the frontal lobe and frontoparietal connectivity. Nobody has examined the relationship between abnormalities in the frontal and parietal lobes and clinical symptoms in people with AS. METHODS: We used in vivo proton magnetic resonance spectroscopy to examine neuronal integrity of the medial prefrontal and parietal lobes in 14 non-learning-disabled adults with AS and 18 control subjects (of similar sex, age, and IQ). We obtained measures of the prefrontal lobe in 11, the parietal lobe in 13, and both lobes in 10 subjects with AS. We measured concentrations and ratios of N-acetylaspartate (NAA), creatine and phosphocreatine (Cr + PCr), and choline (Cho). Levels of NAA, Cr + PCr, and Cho are indicators of neuronal density and mitochondrial metabolism, phosphate metabolism, and membrane turnover. Frontal metabolite levels were correlated with scores on the Yale-Brown Obsessive Compulsive Scale and the Autism Diagnostic Interview. RESULTS: Subjects with AS had a significantly higher prefrontal lobe concentration of NAA (z = -3.1; P =.002), Cr + PCr (z = -2.2; P =.03), and Cho (z = -2.9; P =.003). Increased prefrontal NAA concentration was significantly correlated with obsessional behavior (tau = 0.67; P =.005); increased prefrontal concentration of Cho, with social function (tau = 0.72; P =.02). We found no significant differences in parietal lobe metabolite concentrations. CONCLUSION: Subjects with AS have abnormalities in neuronal integrity of the prefrontal lobe, which is related to severity of clinical symptoms.

Adult↗
PubMed1998

Faith-assisted cognitive therapy of obsessive-compulsive disorder.

OBJECTIVE: The aim of this paper is to report the rapid resolution of obsessions when the patient invoked Christ to treat her obsessions. CLINICAL PICTURE: A 25-year-old female presented with obsessions (doubts) that: (i) while driving she will knock down a pedestrian; and (ii) she will be charged with sex abuse. TREATMENT AND OUTCOME: Cognitive therapy (cognitive restructuring and thought-stopping) was offered. After a single session a complete remission was reported when she replaced her doubts with firm convictions that 'Christ will help me drive safely' and 'Christ will not let me do anything wrong'. She was reported to have remained well at the end of 5 months at which time she relocated and was then lost to follow-up. CONCLUSION: Religious faith can have a healing effect, and cognitive therapy is not incompatible with religion. Although unusual in standard clinical practice, rapid resolution of obsessions is possible.

Adult↗
PubMed1989

Anxiety and cerebral blood flow during behavioral challenge. Dissociation of central from peripheral and subjective measures.

To investigate the relationship between anxiety and regional cerebral blood flow, we administered behavioral challenges to 10 patients with obsessive-compulsive disorder while measuring regional cerebral blood flow with the xenon 133 inhalation technique. Each patient was studied under three conditions: relaxation, imaginal flooding, and in vivo (actual) exposure to the phobic stimulus. Subjective anxiety, obsessive-compulsive ratings, and autonomic measures (heart rate, blood pressure) increased significantly, but respiratory rate and PCO2 did not change across the three conditions. Regional cerebral blood flow increased slightly (in the temporal region) during imaginal flooding, but decreased markedly in several cortical regions during in vivo exposure, when anxiety was highest by subjective and peripheral autonomic measures. These results demonstrate that intense anxiety can be associated with decreased rather than increased cortical perfusion and that ostensibly related states of anxiety (eg, anticipatory and obsessional anxiety) may be associated with opposite effects on regional cerebral blood flow.

Adult↗
PubMed2004

Differential response to placebo among patients with social phobia, panic disorder, and obsessive-compulsive disorder.

OBJECTIVE: Placebo effects in treatment of three anxiety disorders were compared. METHOD: Treatment response and patients' treatment expectancy were examined by using data from 70 patients with obsessive-compulsive disorder, social phobia, or panic disorder who received placebo in three randomized, controlled trials comparing cognitive behavior therapy, medication, and their combination to placebo. RESULTS: Patients with obsessive-compulsive disorder were less likely to respond to placebo than patients with generalized social phobia or panic disorder. Differential expectancy did not account for these findings. CONCLUSIONS: Further examination of the placebo effect across the anxiety disorders may elucidate maintenance mechanisms of these disorders and have implications for development of more effective treatments.

Adult↗
PubMed1997

Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa.

OBJECTIVE: Depression, anxiety, and obsessionality frequently are present in underweight, malnourished patients with anorexia nervosa. It is less certain if these symptoms persist after recovery. Thus, we assessed these symptoms in anorexic women at three states of illness (underweight, short-term weight restored, and long-term weight restored) in comparison to a group of healthy women. METHOD: We used standardized self- and trained rater instruments to assess depression (Hamilton Depression Rating Scale and Beck Depression Inventory), anxiety (Spielberger State-Trait Anxiety Inventory and Hamilton Anxiety Rating Scale), and obsessions and compulsions (Yale-Brown Obsessive Compulsive Scale). RESULTS: A similar pattern was found for all symptoms. That is; scores for depression, anxiety, and obsessionality were most elevated in the underweight state. These symptoms improved with weight restoration. However, milder but significantly elevated symptoms persisted in long-term weight-restored anorexic women compared to healthy control women. DISCUSSION: These data suggest that malnutrition intensifies the severity of depression, anxiety, and obsessionality in anorexia nervosa. However, the fact that mild to moderate symptoms persisted after long-term weight restoration raises the possibility that such behaviors are related to the pathogenesis of this illness.

Adolescent↗
PubMed1992

Changes in DSM-III-R axis II diagnoses following treatment of obsessive-compulsive disorder.

Seventeen patients with obsessive-compulsive disorder and concomitant personality disorders were treated with pharmacologic and/or behavioral therapy and reassessed after 4 months. Nine of the 10 patients who responded to treatment for obsessive-compulsive disorder no longer met criteria for a personality disorder. Of the seven nonresponders, five continued to meet criteria for a personality disorder.

Adult↗