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PubMed2000

A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder.

BACKGROUND: To date, only 1 controlled study has found a drug (haloperidol) to be efficacious in augmenting response in patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitor (SRI) monotherapy; patients with comorbid chronic tic disorders showed a preferential response. This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone. METHODS: Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an SRI. Thirty-six patients were refractory to the SRI and were randomized in a double-blind manner to 6 weeks of risperidone (n = 20) or placebo (n = 16) addition. Behavioral ratings, including the Yale-Brown Obsessive Compulsive Scale, were obtained at baseline and throughout the trial. Placebo-treated patients subsequently received an identical open-label trial of risperidone addition. RESULTS: For study completers, 9 (50%) of 18 risperidone-treated patients were responders (mean daily dose, 2.2 +/-0.7 mg/d) compared with 0 of 15 in the placebo addition group (P<. 005). Seven (50%) of 14 patients who received open-label risperidone addition responded. Risperidone addition was superior to placebo in reducing OCD (P<.001), depressive (P<.001), and anxiety (P =.003) symptoms. There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder. Other than mild, transient sedation, risperidone was well tolerated. CONCLUSION: These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy.

Adult↗
PubMed1995

The functional neuroanatomy of Tourette's syndrome: an FDG-PET Study. II: Relationships between regional cerebral metabolism and associated behavioral and cognitive features of the illness.

We analyzed F-18 fluoro-deoxyglucose PET scans carried out in 18 drug-free patients with Tourette's syndrome (TS) in order to evaluate relationships between cerebral metabolism and complex cognitive and behavioural features commonly associated with this disorder. These features (obsessions and compulsions, impulsivity, coprolalia, self-injurious behavior, echophenomena, depression, and measures of attentional and visuospatial dysfunction) were associated with significant increases in metabolic activity in the orbitofrontal cortices. Similar increases, although less robust, were observed in the putamen and, in the case of attentional and visuospatial measures, in the inferior portions of the insula. On the other hand, behavioral and cognitive features were not associated with metabolic rates in other subcortical (midbrain, ventral striatum), paralimbic (parahippocampal gyrus), or sensorimotor regions (supplementary motor area, lateral premotor or Rolandic cortices), in which metabolism had, in some cases more robustly, distinguished these TS patients from controls (Braun et al., 1993). These results suggest that a subset of regions in which metabolic activity appears to be associated with the diagnosis of TS per se, may be explicitly associated with the emergence of complex behavioral and cognitive features of the illness. This is most conspicuous in the orbitofrontal cortices, and it is consistent with the observation that these features resemble the elements of a behavioral syndrome typically seen in patients with lesions of the orbitofrontal cortex.

Adult↗
PubMed1978

Severe depersonalization treated by behavior therapy.

The author reports the use of behavior therapy in the treatment of two cases of severe intractable depersonalization. Outcome criteria included full psychiatric assessment, patients' self-ratings, and psychometric test scores. Treatment by flooding was highly effective in one case, and associated obsessive symptoms and anticipatory anxiety were substantially decreased in the other. Behavioral techniques may prove especially helpful in cases in which anticipatory anxiety, phobic avoidance, and obsessive perseveration are exacerbating features.

Adult↗
PubMed1991

Childhood obsessive-compulsive disorder and cingulate epilepsy.

There are no reports of an association between obsessive-compulsive disorder and cingulate epilepsy in childhood. We report the behavioral, cognitive, and EEG findings in a young girl with medically resistant seizures and severe obsessive-compulsive symptomatology. Her scalp EEG and neuropsychological test scores suggested right frontal lobe dysfunction. The intractability of her seizures and progressive intellectual and psychosocial deterioration prompted evaluation for excisional surgery. Intracranial EEG recording demonstrated a focal seizure origin in the right anterior cingulate gyrus. Cingulotomy resulted in freedom from seizures and significant improvement in her obsessive-compulsive symptoms.

Brain Mapping↗
PubMedDate not supplied

Stereotypies: prevalence and association with compulsive and impulsive symptoms in college students.

BACKGROUND: Although stereotypic behaviors have been well described in patients with mental retardation, there has been relatively little work on the prevalence and nature of these phenomena in intellectually normal subjects. Stereotypies may conceivably be related to obsessive-compulsive disorder, to perfectionism, or to impulse dyscontrol. METHODS: This study attempted to assess the prevalence of stereotypic behaviors in a college population and to determine their relationship to compulsive and impulsive symptoms and traits by means of self-rated questionnaires. Questionnaires assessed stereotypies as well as obsessive-compulsive symptoms, perfectionism, and impulsive-aggressive traits. RESULTS: Stereotypic behaviors were common in this population, and they were time-consuming or problematic in a subgroup of subjects. The total number of stereotypic behaviors was significantly associated with increased scores of obsessive-compulsive symptoms, of perfectionism, and of impulsive-aggressive traits. Other measures of the severity of stereotypic behavior were also associated with obsessive-compulsive symptoms and perfectionism. CONCLUSIONS: Although the nature of stereotypic behaviors is not well understood, these phenomena can be clinically important in intellectually normal subjects. Stereotypic behaviors deserve further attention from researchers and clinicians.

Adolescent↗
PubMed2000

Recurrent detoxification may elevate alcohol craving as measured by the Obsessive Compulsive Drinking scale.

Research has demonstrated a relationship between the number of previous alcohol detoxifications and increased severity of the alcohol withdrawal syndrome (AWS) that is hypothesized to be similar to an electrophysiologic "kindling process." Application of a "kindling" model to AWS suggests that neuroadaptation of the central nervous system to repeated detoxifications may also cause neurobehavioral alterations that may affect "craving." This study examined craving as assessed by the Obsessive Compulsive Drinking Scale (OCDS) in 67 adult outpatients meeting DSM-IV criteria (American Psychiatric Association, 1994) for alcohol dependence and AWS having either < 2 and > or = 2 previous detoxifications. Results of ANCOVA revealed that patients with > or = 2 previous detoxifications had higher scores on a scale that measures obsessive thoughts about alcohol, drinking urges and behaviors, and a composite of these scores after controlling for alcohol dependence severity, depressive symptoms and number of drinks 2 weeks prior to the study. Findings emphasize the need to address craving and other psychological variables with respect to treatment of AWS.

Adult↗
PubMed1992

Obsessive-compulsive disorder.

Obsessive-compulsive disorder is a well-defined clinical syndrome that has been difficult to treat with standard psychotherapies and medications. Data accumulated over the last decade have demonstrated that the disorder is relatively common and frequently coexists with phobia, depression, and alcohol abuse. The authors review current studies of the spectrum of obsessive-compulsive disorder and related disorders that respond to the new serotonergic antidepressants and behavioral therapy. Differential diagnosis, epidemiology and comorbidity, etiology, evaluation, and psychologic and pharmacologic treatments are discussed. Most patients with obsessive-compulsive disorder require long-term treatment with drugs, but behavioral therapy has also been used successfully. Serotonin reuptake inhibitors used in the treatment of depression have been found effective; clomipramine has produced the best results in large-scale tests. The fact that serotonin reuptake inhibitors are effective as both antidepressants and antiobsessional agents suggests common biological factors in disorders that respond to these drugs.

Antidepressive Agents↗
PubMed2000

Appetitive behavior, compulsivity, and neurochemistry in Prader-Willi syndrome.

Advances in genetic research have led to an increased understanding of genotype-phenotype relationships. Excessive eating and weight gain characteristic of Prader-Willi syndrome (PWS) have been the understandable focus of much of the research. The intense preoccupation with food, lack of satiation, and incessant food seeking are among the most striking features of PWS. It has become increasingly clear that the behavioral phenotype of PWS also includes symptoms similar to obsessive compulsive disorder, which in all probability interact with the incessant hunger and lack of satiation to engender the intense preoccupation and food seeking behavior that is characteristic of this disorder. Several lines of evidence suggest that genetic material on chromosome 15 may alter synthesis, release, metabolism, binding, intrinsic activity, or reuptake of specific neurotransmitters, or alter the receptor numbers and/or distribution involved in modulating feeding. Among the likely candidates are GABAnergic, serotonergic, and neuropeptidergic mechanisms. This review summarizes what is known about the appetitive behavior and compulsivity in PWS and discusses the possible mechanisms underlying these behaviors. MRDD Research Reviews 2000;6:125-130.

Brain↗
PubMed1988

Obsessive-compulsive symptoms in agoraphobia: changes with treatment.

Ten patients suffering from agoraphobia with panic attacks reported significantly more obsessive-compulsive symptoms on the Comprehensive Psychopathological Rating Scale and Marks' Compulsion Checklist than healthy control subjects matched to the patients on sociodemographic variables. Behavioral treatment directed toward agoraphobia was associated with significant improvement in obsessive-compulsive complaints. On retesting, there were no significant differences in such symptoms between patients and controls. The results should alert the physician to inquire about the presence of agoraphobia in patients complaining of obsessive-compulsive disturbances.

Adult↗
PubMed1992

Neurosurgical treatment of malignant obsessive compulsive disorder.

Although the majority of patients with obsessive compulsive disorder (OCD) respond well to behavioral techniques, pharmacotherapy, or combinations of these two approaches, a small percentage of patients remain refractory and are severely disabled by their symptoms. Such patients may well be helped by neurosurgical interventions. This article reviews the selection guidelines, indications and contraindications, available procedures, probable outcome, hazards involved, preoperative work-up, and the rationale behind neurosurgery in OCD.

Brain Mapping↗
PubMed1990

Obsessive compulsive patients: familial frustration and criticism.

Familial factors such as attitudes toward illness, knowledge of disease process, and criticism of patients often play an important role in patient compliance and outcome in general medical practice as well as in psychiatric settings. As part of the initial assessment in a psychoeducational group for obsessive compulsive disorder patients and their significant others, nonpatients completed the Relative's Reactions Questionnaire and the Control of Symptoms Schedule. The patients completed the Perceived Criticism Measure. Results suggest that significant others experience frustration with the symptomatic behavior of their friend or family member with obsessive compulsive disorder and may respond too frequently with verbal criticism. The patients themselves reported a moderately high level of criticism from significant others at home. Further research is needed on a larger sample size and with nonpsychiatric and nonobsessive compulsive disorder psychiatric controls.

Adult↗
PubMedDate not supplied

Tourette's disorder and related problems: a review and update.

Tourette's disorder is a complex, multifaceted condition of neurological origin with psychiatric symptomatology characterized by multiple motor and vocal tics. It begins during childhood and has a waxing and waning course. Coexisting obsessive-compulsive symptoms, attentional problems, and other behavioral features are common. Pathophysiology involves dysfunction in basal ganglia and related corticothalamic circuits. Many patients who present in clinical settings have mild to moderate symptoms and require only education, monitoring, and long-term follow-up. Those with more-severe symptoms require treatment, typically including both pharmacotherapy and nonmedication approaches. In addition to traditional neuroleptic treatment, a variety of agents such as clonidine, serotonin-reuptake inhibitors, and tricyclic antidepressants can be used. Further investigation is needed in a variety of areas, including longitudinal follow-up studies of children, adolescents, and adults with Tourette's disorder; systematic investigation of psychiatric comorbidity and the heterogeneity of the disorder; clarification of the phenomenological similarities and differences between Tourette's disorder and obsessive-compulsive disorder; and neuroimaging and neuropsychological studies of Tourette's disorder and related problems.

Antidepressive Agents, Tricyclic↗
PubMed1998

Open-label olanzapine treatment in five preadolescent children.

Olanzapine is a recently introduced atypical neuroleptic agent for which little information is available on its use in children. Open clinical trials of olanzapine treatment were conducted on five hospitalized children (ages 6 to 11 years) with varying diagnoses including bipolar disorder, psychosis not otherwise specified, schizophrenia, and attention-deficit/ hyperactivity disorder. Each patient had failed previous psychotropic medication trials, with a mean of four prior trials. The mean length of olanzapine treatment was 32 days (range, 2 to 7 weeks), and mean daily dose was 7.5 mg/day (range, 2.5 to 1.0 mg/day) or 0.22 mg/kg/day (range, 0.12 to 0.29 mg/kg/day). All children experienced adverse effects, including sedation (N = 3), weight gain of up to 16 pounds (N = 3), and akathisia (N = 2). Three patients showed some clinical improvement, but olanzapine treatment was discontinued in all five children within the first 6 weeks of treatment because of adverse effects or lack of clinically significant therapeutic response, although higher (or lower) doses, slower titration of dosage, or a longer duration of treatment might have produced more favorable results. Psychotic symptoms did not respond in the two patients with evidence of overt hallucinations and paranoid ideation. Improvement was observed in sleep in all five patients and in control of aggression in three. Before controlled trials of olanzapine in children are undertaken, further exploration of dose range and increased duration of treatment on an open basis are warranted. Until more encouraging data are available, clinicians should be cautious and conservative in their predictions about the potential value of olanzapine in treating preadolescent psychiatric disorders.

Akathisia, Drug-Induced↗
PubMed1991

Seasonal variation in obsessive-compulsive disorder: preliminary experience with light treatment.

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.

Adult↗
PubMed1999

Factor structure and predictive validity of the Obsessive Compulsive Drinking Scale.

BACKGROUND: The Obsessive Compulsive Drinking Scale (OCDS) is a 14-item, self-report instrument developed to measure obsessive thoughts about alcohol use and compulsive behaviors toward drinking. The objective of this study was to ascertain the factor structure underlying responses to the OCDS, and to further assess whether subscale scores derived from this structure were distinctive, internally consistent, predictive of future drinking, and able to differentiate between patients receiving naltrexone versus placebo in a controlled alcoholism treatment trial. METHODS: OCDS data were collected from a total of 132 alcohol-dependent subjects at up to 15 assessment points during the study. Interitem correlations were pooled across assessment periods, and an iterated principal axis factor analysis with oblique promax rotation was performed. The factor analysis suggested that three primary factors could parsimoniously account for the common variance in item responses. Subscale scores were formed by summing responses to the most salient items on each factor. RESULTS: The three common factors were interpreted as "resistance/control impairment," "obsession," and "interference." The subscale scores corresponding to these three factors were internally consistent, and their correlation with other baseline measures of alcohol use and severity suggested that they were distinct. Scores on each subscale reliably distinguished between subjects who remained abstinent, exhibited "slip" drinking, or relapsed to heavy drinking during the 12 weeks of active treatment. Additionally, scores on the resistance/control impairment subscale distinguished between those patients receiving treatment with naltrexone or placebo. Scores from each subscale also were able to predict the hazard for heavy drinking in the following week of treatment. CONCLUSIONS: The three OCDS factors are easily estimated with the summated scoring approach, and the resulting subscales appear to be internally consistent and distinctive. Moreover, the group differentiation capability and predictive utility of the subscale scores suggest that they might be useful as either predictor or outcome variables in alcoholism treatment trials. The duration of time for which a given OCDS assessment maintains its predictive utility awaits further confirmation.

Adult↗
PubMed2005

Focus on "cognition" in cognitive behavior therapy for ocd: is it really necessary?

The past decade has witnessed a significant shift toward a more cognitive emphasis in our understanding and treatment of obsessive-compulsive disorders (OCD). This article discusses the shortcomings in more standard behavioral treatment of OCD, which despite its demonstrated efficacy, led to the recent cognitive-behavioral approaches to the disorder. Current cognitive behavior therapy for OCD is described and a short critical review of the comparative treatment outcome literature on cognitive behavior therapy vs exposure and response prevention is provided. The article concludes that although the clinical utility of a more cognitive approach to OCD has not been consistently demonstrated, it would be premature to abandon cognitive formulations until some key research questions have been addressed.

Cognition↗