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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↗
PubMed1993

Elevated growth hormone responses to pyridostigmine in obsessive-compulsive disorder: evidence of cholinergic supersensitivity.

The growth hormone response to the acetylcholinesterase inhibitor pyridostigmine was measured in nine normothymic outpatients who met DSM-III-R criteria for obsessive-compulsive disorder. The responses were significantly elevated when compared to those found in a healthy comparison group (N = 9). The data suggest that cholinergic supersensitivity is present in obsessive-compulsive disorder.

Adult↗
PubMed1994

Long-term follow-up of 85 patients with obsessive-compulsive disorder.

In this study, long-term outcome for patients with obsessive-compulsive disorder treated with serotonin reuptake inhibitor medications was examined. The records of 85 patients who had first been evaluated at least 1 year previously (the mean follow-up period was 773 days) were reviewed. Information was collected on age at onset of symptoms, time since first evaluation, and scores on several scales measuring symptom severity, including the Yale-Brown Obsessive Compulsive Scale. Comparison of these baseline data with Yale-Brown scale scores at the most recent follow-up visit showed that 74 (87%) of the patients had responded to treatment. No predictors of improvement were found.

Adult↗
PubMed1995

Pilot studies of telemedicine for patients with obsessive-compulsive disorder.

OBJECTIVE: Remote video psychiatric assessment holds promise for providing expert consultation to underserved areas. The authors assessed the reliability of rating scales administered in person and over video to patients with obsessive-compulsive disorder. METHOD: Rating scales for obsessive-compulsive, depressive, and anxiety symptoms were administered in person (N = 16) and by means of narrow-bandwidth video transmission over one digital telephone line (N = 10). Interrater reliability was determined for each condition; for the video interviews one rater sat at the local site in front of the videoconsulting apparatus and asked the questions, and the patient and the second rater sat at the remote site. RESULTS: Reliability was excellent in both conditions, and there was no degradation in reliability when the assessment was conducted over video. CONCLUSIONS: Telemedicine resulted in near-perfect interrater agreement on rating scale scores. Its use for other disorders and for more in-depth assessments should be explored.

Anxiety Disorders↗
PubMed1996

Reduced benzodiazepine sensitivity in patients with panic disorder: comparison with patients with obsessive-compulsive disorder and normal subjects.

OBJECTIVE: The authors sought to replicate their previous finding of reduced response to diazepam in patients with panic disorder, to test whether this effect was specific for panic disorder, and to determine whether this reduced response was merely an artifact of resistance to sedation from anxiety-related overarousal. METHOD: The effects of four increasing intravenous doses of diazepam on saccadic eye movement velocity and accuracy (the latter being a saccadic variable that is unaffected by sedation), short-term memory, and self- and observer-rated sedation were assessed in 18 patients with panic disorder, 15 patients with obsessive-compulsive disorder, and 14 normal comparison subjects. The ratios of effect to blood level areas under the curve for both ascending and descending limbs of the effect/blood level curves were compared for each variable. RESULTS: Patients with panic disorder showed significantly less diazepam effect on saccadic velocity and accuracy for the ascending limb of the blood level curve than comparison subjects. Patients with obsessive-compulsive disorder showed similar differences from comparison subjects but only for saccadic velocity. There were no group differences in diazepam effects on memory and sedation. CONCLUSIONS: Patients with panic disorder are less sensitive than comparison subjects to diazepam. Although this difference is not an artifact of resistance to sedation, it may not be specific for panic disorder but rather may reflect a more nonspecific aspect of anxiety disorders.

Adult↗
PubMed1999

Obsessive-compulsive disorder in patients with first-episode schizophrenia.

OBJECTIVE: The aim of the present study was to determine the rate of obsessive-compulsive disorder (OCD) in patients with first-episode schizophrenia. METHOD: Fifty patients consecutively hospitalized with first-episode psychosis who met DSM-IV criteria for schizophrenia spectrum disorders were assessed for OCD. The instruments used were the Structured Clinical Interview for DSM-IV, Schedule for the Assessment of Positive Symptoms (SAPS), Schedule for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Seven (14%) of the 50 schizophrenic patients met DSM-IV criteria for OCD and scored significantly lower than schizophrenic patients without OCD on the formal thought disorder subscale of the SAPS and the flattened affect subscale of the SANS. CONCLUSIONS: OCD is relatively frequent in patients with first-episode schizophrenia and may have a "protective" effect on some schizophrenic symptoms, at least in the early stages of the disease.

Adult↗
PubMed2001

Adults with early-onset obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder with a bimodal age at onset and range of treatment outcomes. This study attempted to ascertain the importance of the age at OCD symptom onset for a better phenotypic precision. Therefore, the authors compared adult OCD patients with an early symptom onset to OCD patients with a later symptom onset. METHOD: Forty-two adult outpatients with OCD were evaluated with semistructured interviews: 21 with symptom onset before the age of 10 (early-onset group) and 21 with symptom onset after the age of 17 (late-onset group). RESULTS: Early onset was associated with higher scores on the Yale-Brown Obsessive Compulsive Scale, higher frequencies of tic-like compulsions, higher frequency of sensory phenomena, and a higher rate of comorbid tic disorders. The early-onset group also responded less well to treatment with clomipramine and selective serotonin reuptake inhibitors. CONCLUSIONS: The results indicate that age at onset may be an important factor in subtyping OCD and that the phenotypic differences found were not restricted to childhood.

Adolescent↗
PubMed2001

Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study.

OBJECTIVE: The efficacy of repetitive transcranial magnetic stimulation (rTMS) of the right prefrontal cortex for patients with obsessive-compulsive disorder (OCD) was studied under double-blind, placebo-controlled conditions. METHOD: Patients were randomly assigned to 18 sessions of real (N=10) or sham (N=8) rTMS. Treatments lasted 20 minutes, and the frequency was 1 Hz for both conditions, but the intensity was 110% of motor threshold for real rTMS and 20% for the sham condition. RESULTS: No significant changes in OCD were detected in either group after treatment. Two patients who received real rTMS, with checking compulsions, and one receiving sham treatment, with sexual/religious obsessions, were considered responders. CONCLUSIONS: Low-frequency rTMS of the right prefrontal cortex failed to produce significant improvement of OCD and was not significantly different from sham treatment. Further studies are indicated to assess the efficacy of rTMS in OCD and to clarify the optimal stimulation characteristics.

Adult↗
PubMed2002

Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study.

OBJECTIVE: Little is known about the longitudinal course of symptoms in adult patients with obsessive-compulsive disorder (OCD), although some evidence exists regarding symptom stability in children and adolescents. This study systematically investigated the temporal stability of individual symptoms and symptom dimensions of OCD in adult patients who were followed prospectively for 2 years. METHOD: One hundred seventeen adult outpatients with OCD from three U.S. sites were administered the Yale-Brown Obsessive Compulsive Scale symptom checklist four times over a period of 2 years. Eighty-one (69%), 83 (71%), and 67 (57%) patients were available 6 months, 1 year, and 2 years after initial screening, respectively. Different analytic methods assessed the stability of OCD symptoms within and between previously identified symptom dimensions. RESULTS: For the most part, patients maintained their symptoms throughout follow-up, although some symptoms were more stable than others. For the symptoms that changed, changes occurred within rather than between symptom dimensions; qualitative shifts from one dimension to another were rare. The strongest predictor of the presence of a particular symptom was having had that symptom in the past. Although most patients had received pharmacological and behavioral treatment during the follow-up period, changes within symptom dimensions could not be explained by overall clinical improvement over time. CONCLUSIONS: Symptoms of adult patients with OCD might be more stable across time than previously thought, with some symptoms waxing and waning within symptom dimensions and rarely involving shifts between dimensions. Longer follow-up studies involving larger samples are needed to better understand the fluctuations of OCD symptoms across time.

Adult↗
PubMed2002

Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder.

OBJECTIVE: Long-term outcome associated with cingulotomy for obsessive-compulsive disorder (OCD) was prospectively assessed. Findings are reported for 18 patients previously described in 1995 and for 26 new patients. METHOD: An open preoperative and follow-up assessment was conducted at multiple time points for 44 patients undergoing one or more cingulotomies for treatment-refractory OCD. The patients were assessed by using the Structured Clinical Interview for DSM-III-R preoperatively and with the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, and the Sickness Impact Profile both preoperatively and at all follow-up assessments. The patients completed clinical global improvement scales at all follow-up assessments. RESULTS: At mean follow-up of 32 months after one or more cingulotomies, 14 patients (32%) met criteria for treatment response and six others (14%) were partial responders. Thus, 20 patients (45%) were at least partial responders at long-term follow-up after one or more cingulotomies. Few adverse effects were reported. CONCLUSIONS: Thirty-two percent to 45% of patients previously unresponsive to medication and behavioral treatments for OCD were at least partly improved after cingulotomy. Cingulotomy remains a viable treatment option for patients with severe treatment-refractory OCD.

Adolescent↗
PubMed2004

Enhanced dopamine transporter density in psychotropic-naive patients with obsessive-compulsive disorder shown by [123I]{beta}-CIT SPECT.

OBJECTIVE: The authors examine the functional anatomy of serotonergic and dopaminergic systems in obsessive-compulsive disorder in psychotropic-naive patients without comorbidity. METHOD: [(123)I]beta-CIT binding patterns for dopamine and serotonin transporters in the brain were measured in 15 psychotropic-naive adult outpatients with OCD (no comorbidity) and in 15 pairwise-matched healthy subjects. Volumes of interest were constructed on magnetic resonance imaging scans and coregistered with single photon emission computed tomography scans. Binding ratios were compared, and possible correlations between binding patterns and obsessive-compulsive symptoms were assessed. RESULTS: There were significant differences between patients and healthy subjects in the [(123)I]beta-CIT binding pattern for dopamine transporter in the left caudate and left putamen. Patients had higher binding ratios than healthy subjects. No differences were found in the less specific [(123)I]beta-CIT binding pattern for serotonin transporters in the selected volumes of interest. Hemispheric within-group comparisons revealed no asymmetry effects. CONCLUSIONS: The results of our study provide direct evidence for an involvement of the dopaminergic system in the pathophysiology of OCD.

Adult↗
PubMed2004

Cerebral glucose metabolism in obsessive-compulsive hoarding.

OBJECTIVE: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a discrete clinical syndrome that includes indecisiveness, disorganization, perfectionism, procrastination, and avoidance and has been associated with poor response to medications and cognitive behavior therapy. The authors sought to identify cerebral metabolic patterns specifically associated with the compulsive hoarding syndrome using positron emission tomography (PET). METHOD: [(18)F]Fluorodeoxyglucose PET scans were obtained for 45 adult subjects who met DSM-IV criteria for OCD (12 of whom had compulsive hoarding as their most prominent OCD symptom factor) and 17 normal comparison subjects. All subjects had been free of psychotropic medication for at least 4 weeks. Regional cerebral glucose metabolism was compared between the groups. RESULTS: In relation to the comparison subjects, the patients with compulsive hoarding syndrome had significantly lower glucose metabolism in the posterior cingulate gyrus and cuneus, whereas the nonhoarding OCD patients had significantly higher glucose metabolism in the bilateral thalamus and caudate. In relation to nonhoarding OCD patients, compulsive hoarders had significantly lower metabolism in the dorsal anterior cingulate gyrus. Across all OCD patients, hoarding severity was negatively correlated with glucose metabolism in the dorsal anterior cingulate gyrus. CONCLUSIONS: OCD patients with the compulsive hoarding syndrome had a different pattern of cerebral glucose metabolism than nonhoarding OCD patients and comparison subjects. Obsessive-compulsive hoarding may be a neurobiologically distinct subgroup or variant of OCD whose symptoms and poor response to anti-obsessional treatment are mediated by lower activity in the cingulate cortex.

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↗
PubMed2005

Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.

OBJECTIVE: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet their relative and combined efficacy have not been demonstrated conclusively. METHOD: A double-blind, randomized, placebo-controlled trial comparing exposure and ritual prevention, clomipramine, their combination (exposure and ritual prevention plus clomipramine), and pill placebo was conducted at one center expert in pharmacotherapy, another with expertise in exposure and ritual prevention, and a third with expertise in both modalities. Participants were adult outpatients (N=122 entrants) with OCD. Interventions included intensive exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance sessions, and/or clomipramine administered for 12 weeks, with a maximum dose of 250 mg/day. The main outcome measures were the Yale-Brown Obsessive Compulsive Scale total score and response rates determined by the Clinical Global Impression improvement scale. RESULTS: At week 12, the effects of all active treatments were superior to placebo. The effect of exposure and ritual prevention did not differ from that of exposure and ritual prevention plus clomipramine, and both were superior to clomipramine only. Treated and completer response rates were, respectively, 62% and 86% for exposure and ritual prevention, 42% and 48% for clomipramine, 70% and 79% for exposure and ritual prevention plus clomipramine, and 8% and 10% for placebo. CONCLUSIONS: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.

Adolescent↗
PubMedDate not supplied

Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression.

The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.

Adult↗
PubMedDate not supplied

Acute onset of obsessive-compulsive disorder in males following childbirth.

Research on postpartum onset obsessive-compulsive disorder (OCD) has focused exclusively on females. However, the authors present four cases of males with OCD onset that coincide with a spouse's pregnancy or delivery. The rapid onset and content of obsessions and compulsions are remarkably similar to those reported in previous studies of postpartum OCD in females. Each patient also responded to cognitive-behavioral therapy using exposure procedures. The implications of these cases for etiological models of postpartum OCD and future research directions are discussed.

Acute Disease↗
PubMed1985

Short-term dynamic psychotherapy of phobic and mildly obsessive-compulsive patients.

This paper reviews the psychodynamics of phobic and obsessive-compulsive symptoms of mild severity and describes the techniques of short-term anxiety-provoking psychotherapy which are used to treat phobic and mildly obsessive-compulsive patients. Academic phobias, a common difficulty encountered in college students, are also discussed.

Follow-Up Studies↗